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Pharmacology > Summer Exam 4 > Flashcards

Summer Exam 4 Flashcards

1
Q

Pharmacokinetic changes in pregnancy

A

increase volume distribution, increase clearance, decrease protein binding, and shorten or lengthen elimination half-life; increased clearance wins out lowering drug levels

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2
Q

Drugs that cross placenta easily

A

High lipophilic, non-highly protein bound (digoxin, ampicillin), small molecules (<500Da) readily cross, >1000 cannot cross placenta (insulin, heparin)
Inhaled or IV anesthetics (need baby out asap after anesthesia, epidural is safe)

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3
Q

What drug does fetal placenta metabolize?

A

Prednisolone** converted to inactive prednisone (this is good, we can use it without giving baby steroids!)

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4
Q

When does fetal CYP450 appear?

A

14 weeks

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5
Q

Drugs that are safe in pregnancy?

A

Beta blockers (labetolol), methyldopa, hydralazine, nifedipine (CCB), magnesium sulfate

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6
Q

Drugs contraindicated in pregnancy

A

ACE/ARB

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7
Q

Antibiotics safe in pregnancy

A

Nitro, penicillins and cephalosporins

Commonly given cephalexin/keflex

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8
Q

First line antiemetics in pregnancy

A

Pyridoxine/B6

-can also use doxylamine w/B6, promethazine, ondansetron/metoclopramide

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9
Q

When can you not give nitro in pregnancy?

A

after week 37 in patients with G6PD deficiency-causes hemolytic anemia in baby

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10
Q

Suppression of lactation

A

Used to use bromocriptine but not anymore bc risk of stroke, MI, seizures and HTN

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11
Q

How do drugs move into breast milk?

A

Passive diffusion or carrier-mediated (organic cation transporters), baby usually actually gets super small amount

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12
Q

Safe exposure Index

A

No more than 10% of therapeutic dose for infant; more than this causes concern
Exceptions: chemo drugs, drugs that cause hemolysis in G6PD babies

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13
Q

Drugs to avoid in breast feeding

A

Oxycodone and meperidine in lg dose; methotrexate, lithium, chemo drugs, phenobarbital, primidone and ethosuximide, amiodorone, atenolol, nadolol, theophylline, iodine

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14
Q

Treatment of Syphilis vs neurosyphilis in pregnancy

A

Benzathine penicillin G in all regular syphilis, Procaine penicillin in neurosyphilis

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15
Q

Why do we promote uterine contractions?

A

Promote cervical ripening/contractions, control postpartum hemorrhage, terminate pregnancy

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16
Q

Drugs that promote uterine contractions

A

Oxytocin (intense contractions, good for hemorrhage too), prostaglandin E2 (ripening and contractions), carboprost/methylergonovine (postpartum hemorrhage), mifepristone (abortion)

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17
Q

Oxytocin AEs

A

Uterine rupture, fetal distress

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18
Q

Oxytocin MOA/Use

A

opens cation channels causing membrane depolarization allowing calcium entry
Used to enhance contractions to deliver placenta

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19
Q

Prostaglandin applications

A

gel or vaginal insert, used when induction planned in next couple days to promote contractions
suppository (larger dose) used for termination from 12-20 weeks

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20
Q

Prostaglandin AEs

A

N/V, fever, HTN and hypotension

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21
Q

Carboprost Indication

A

Mostly for postpartum hemorrhage (causes strong contractions)-NOT used for induction
can be used to empty uterus from 13-20 weeks

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22
Q

Carboprost AEs

A

Bronchospasm, HTN, diarrhea, vomiting (don’t use in asthmatics)

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23
Q

Mifepristone Use

A

Termination up to day 49 of pregnancy, sometimes given with misoprostol too

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24
Q

Why do we suppress uterine contractions

A

so we can mature baby (esp lungs) with drugs (betamethasone and dexamethasone)
Avoid respiratory distress syndrome, death

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25
Q

Drugs to suppress uterine contractions

A

Terbutaline, nifedipine (#1 choice), NSAIDs (indomethacin, ibuprofen), magnesium sulfate

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26
Q

Terbutaline MOA

A

Beta agonist-uterine smooth muscle relaxation

27
Q

Terbutaline AEs

A

Tachycardia, pelm edema, hypokalemia, metabolic acidosis, hypotension
Black box for use >72 hours bc maternal cardio toxicity and death

28
Q

Magnesium Sulfate Use

A

No more than 5-7 days, may cause hypocalcemia, osteopenia and fractures in newborn
Its neuroprotective- decreases risk cerebral palsy in premies

29
Q

Magnesium sulfate AEs

A

weakness, paralysis, resp failure, hypotension, renal toxicity; watch for knee-jerk reaction

30
Q

Nifedipine MOA in contractions

A

CCB relaxes smooth muscle and vascular muscle

31
Q

Nifedipine AEs

A

constipation, hypotension

32
Q

NSAID MOA in contractions

A

PGE2 inhibitors causing uterine relaxation

33
Q

NSAID AEs

A

decreased GFR in baby, narrowing/closure of fectal ductus arteriosus

34
Q

What do we give patients with history of recurrent miscarriage to maintain pregnancy?

A

Hydroxyprogesterone caproate

weekly injections starting at week 16

35
Q

Whats the most common cause of amenorrhea?

A

unrecognized pregnancy

36
Q

How do we treat hypoestrogenic amenorrhea?

A

estrogen (progestin)

37
Q

Causes of menorrhagia

A

Intrauterine, ectopic pregnancies, miscarriage

-ovulatory dysfunction

38
Q

PCOS

A
  • Can be amenorrhea, menorrhagia or anovulatory bleeding
  • Usually due to excessive androgen leading to insulin insensitivity
  • treated with metformin extended release (first line) or oral contraception
39
Q

Goals of amenorrhea treatment

A

Bone density/loss preservation, ovulation restoration to improve fertility

40
Q

Amenorrhea Treatment options

A
  • estrogen
  • dopamine agonist (bromocriptine/cabergoline)
  • clomiphene citrate
  • metformin
  • progestin
41
Q

Menorrhagia treatment options

A

NSAIDs

  • transexamic acid or luteal progesterone
  • levonorgestrel releasing intrauterine system
  • endometrial ablation
  • oral contraception
42
Q

Transexamic acid AEs

A

N/V, diarrhea, dyspepsia

Can have large clots

43
Q

Transexamic acid MOA

A

Antifibrinolytic-reversibly blocks lysin binding on plasminogen preventing blood clot breakdown reducing menstrual blood loss

44
Q

Most common cause of abnormal uterine bleeding?

A

PCOS (also MC endocrine abnormality in US women)

45
Q

Dysmenorrhea treatment

A
  • Heat therapy, exercise and low fat vegan diet
  • powdered ginger 250mg
  • NSAIDs treatment of choice (inhibits prostaglandins)
  • oral contraception (reduces endometrial derived prostaglandins)
  • MPA (depo) or LNG IUS (intrauterine) (amenorrhea w/in 6-12 months)
46
Q

PMS and PMDD treatment

A
  • Non-pharma: minimize intake of caffeine, refined sugar and sodium; increase exercise
  • Meds: SSRIs, SNRIs, hormonal contraception, GnRH agonists (leuprolide)
47
Q

Treatment goal in menopause

A

Relieve symptoms and improve quality of life with hormone therapy

48
Q

Menopause treatment in general

A
  • Intact uterus: estrogen PLUS progesterone to avoid endometrial cancer
  • Post-hysterectomy: estrogen alone
49
Q

Risks of menopause hormonal treatment

A 
Breast cancer (not increased if estrogen alone-progestogen is what increases BC risk)
-CV disease, venous thromboembolic events with any hormonal treatment
50
Q

Menopause treatment specific for depression and osteoporotic fractures

A

Systemic estrogen

51
Q

Absolute contraindications of hormone replacement therapy

A

Undiagnosed genital bleeding, breast cancer, DVT, pulmonary embolism, thromboembolic disease, liver dysfunction

52
Q

FDA approved indications for hormone therapy (4)

A
  • bothersome vasomotor symptoms
  • prevention of bone loss
  • Genitourinary syndrome of menopause (GSM)
  • hypoestrogenism from hypogonadism, primary ovarian insufficiency
53
Q

Nonpharmacologic menopause treatment

A

Lifestyle modifications (layered clothing, colder room temp, decrease intake of spicy food, caffeine and hot drinks; exercise)

54
Q

Alternative menopause treatment to hormones

A

Venlafaxine, desvenlafaxine, paroxetine (SNRIs)

Megastrol acetate, clonidine, gabapentin

55
Q

What complaints do androgens help with?

A

Decrease libido, sexual receptivity, decreased pleasure

  • unexplained fatigue
  • diminished sense of well being
56
Q

Androgen treatments

A

Best is testosterone pellet implanted subQ

57
Q

Ospemifene MOA

A

Selective estrogen receptor modulator to help with dyspareunia and vaginal dryness
12 weeks for response
-given orally

58
Q

Ospemifene AEs/monitoring

A
  • endometrial hyperplasia (bleeding >6months), vaginal discharge, hot flashes, headache, muscle spasms
  • Monitor breast cancer and CVD ( no adjustment for renal/hepatic insufficiency)
59
Q

Prasterone MOA

A

inactive steroid converted to estrogen and testosterone for dyspareunia and vaginal dryness

  • synthetic DHEA
  • given intravaginally
60
Q

Prasterone AEs/Monitoring

A

Vaginal discharge, abnormal pap

-monitor for excessive bleeding/discharge

61
Q

Phytoestrogens

A

Plant compounds with estrogen like biologic activity

  • isoflavones, lignin’s and coumestans
  • soybeans, cereal, oilseed/flaxseed, alfalfa
  • no clinical support
62
Q

Black Cohosh

A

Herbal supplement

  • no real benefit for vasomotor symptoms
  • hepatotoxicity
  • mostly acts through serotonin
63
Q

Bioidentical hormones

A

Carries same risk as traditional hormone therapy

Pharmacology (7 decks)

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