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Flashcards in OB Pharmacology Deck (114)
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1

3 Ways Products of Conception are Evacuated

Surgical
medical
Expectant

2

Reasons for Surgical Removal of Product of Conception

Unstable
Significant bleeding
Infection
Want immediate treatment

3

Reason for Medical Removal of Products of Conception

Do not want to wait for spontaneous passage

4

Define Expectant Evacuation of Products of Conception

Will eventually pass naturally
Days to weeks

5

Main Drug for Medical Management of Spontaneous Abortion

Misoprostol

6

Uses of Misoprostol

Missed abortion
Incomplete abortion
Cervical ripening (unlabeled use)
Postpartum hemorrhage (unlabeled use)

7

What is misoprostol?

Prostaglandin E1 analog
Induces uterine contractions

8

Route of Misoprostol Administration

Vaginally
Every 4 hours x 4

9

Medication Classes for Preterm Labor

Tocolytics
Corticosteroids

10

Goals of Tocolytics

Delay delivery by at least 48 hours
Provide transport time for mother
Stop labor to clear underlying medical condition

11

Benefits need to Outweigh Risks for Administration of Tocolytics

NOT for >34 weeks
Controversial

12

Contraindications for Tocolytics

Baby or mother unstable
Fetal demise
Lethal fetal anomaly
Non-reassuring fetal status
Severe pre-eclampsia or eclampsia
Maternal hemorrhage
Intra-amniotic infection
Maternal contraindication to drug

13

Drug of Choice for 24-32 Weeks of Gestation (Preterm Labor)

Indomethacin

14

MOA of Indomethacin

Decreases prostaglandin production through inhibition of cyclooxygenase

15

Administration of Indomethacin

PO
PR

16

Maternal SE of Indomethacin

Nausea
GE reflux
Gastritis
Emesis
Platelet dysfunction

17

Fetal SE of Indomethacin

Constriction of ductus arterioles
Oligohydramnios
Neonatal complications

18

When does indomethacin constrict the ductus arteriosus?

If given for >48 hours
Give past 32 weeks

19

Why oligohydramnios with use of indomethacin?

Decreases fetal urine output
Decreasing amniotic fluid volume

20

Neonatal Complications with Indomethacin Use

Bronchopulmonary dysplasia
Necrotizing enterocolitis
PDA
Periventricular leukomalacia
Intraventricular hemorrhage

21

Maternal Contraindications of Indomethacin

Platelet dysfunction
Bleeding disorders
Hepatic dysfunction
GI ulcers
Renal dysfunction
Asthma if sensitive to ASA

22

Second Line Therapy of Tocolytics

Nifedipine

23

MOA of Nifedipine

Myometrial relaxation
Peripheral vasodilation

24

Maternal SE of Nifedipine

Nausea
Flushing
Headache
Dizziness
Palpitations
Can cause severe hypotension

25

Contraindications of Nifedipine

Hypotension
Preload dependent cardiac lesion
Cautious with LV dysfunction or CHF

26

Precaution with Nifedipine

Do not use with magnesium sulfate
Act synergistically & result in respiratory depression

27

Pharmacokinetics of Nifedipine

Half life: 2-3 hours
Peak plasma concentrations: 30-60 minutes
Metabolized: liver
Excreted: kidney

28

Drug of Choice for 32-34 Weeks Gestation (Preterm Labor)

Nifedipine

29

2nd Line Therapy for 32-34 Weeks Gestation (Preterm Labor)

Beta-adrenergic receptor agonists
Terbutaline

30

Maternal SE of Terbutaline

Tachycardia
Palpitations
Hypotension
Tremor
SOB
Chest discomfort
Hypokalemia
Hyperglycemia