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OB Pharm Part 2
Terms in this set (159)
common factors associated with infertility (male & female) can include? (4)
-decreased sperm production
what are the 5 things that can cause female infertility
1. anovulation (failure to ovulate)
2. failure of follicular maturation
3. unfavorable cervical mucus
5. polycystic ovary syndrome
________ is the complete absence of reproductive ability
________ blocks receptors for estrogen - increasing production of LH and FSH
clomid promotes __________ and _________ in women without issues with pituitary production of LH and FSH (gonadotropins)
Menotropins (Repronex, Menopur) is used in conjunction with _______
What action should be taken to resolve ovarian overstimulation occurring with Menotropins (Repronex, Menopur)
______ causes ovulation by stimulating LH midcycle
hCG is a polypeptide hormone produced by _________
when hCG is used to promote ovulation, follicular maturation must FIRST be stimulated by _____________ or ________
menotropins or clomid
what agent is used first to stimulate follicular maturation, when using hCG to promote ovulation?
Menotropins (Repronex, Menopur)
ovarian hyperstimulation occurs with use of ______
____________ drugs cross placenta easily
drugs that are ______, ______, or ______ cross placenta with difficulty
the production of birth defects
the adverse effect of greatest concern is _______
Regular use of dependence producing drugs such as ________, _________, and _________during pregnancy can result in birth of drug-dependent baby
certain pain relievers used during delivery can _________ in neonate
pregnancy causes physiological changes in ______, _____, and ______ which may result in need for compensatory change in dosage
kidney, liver, and GI tract
what alterations should be made to doses in the 3rd trimester? Why?
-increase in dosage
-excretion is accelerated (change in kidneys)
what 2 changes in the kidneys in 3rd trimester causes accelerated excretion and may cause dosages to be increased?
-renal blood flow is doubled
-GFR largely increases
hepatic metabolism increases during pregnancy - affecting metabolism of drugs such as ______, ______ and ______ (anti-seizure medications)
GI tract tone & motility decrease during pregnancy - causing intestinal transit time to increase - what alteration of dosage may be necessary? Why?
-may need to decrease dose
-drug has more time to be absorbed
what is the most common genetic congenital anomaly
at what time during pregnancy is teratogenesis "all or nothing" - if dose is high = death of embryo occurs
conception - week 2 [1st trimester]
what stage/time of fetal development are internal organs and structures developing
week 3- 8 (embryonic period) [1st trimester]
Gross malformations and conspicuous anatomic distortion occur during what stage of development
week 3 - 8 (embryonic stage) [1st trimester]
Teratogenesis during what stage of development - disrupts function rather than gross anatomy ?
week 9 - term
growth and development of brain is especially important in what stage of development
week 9 - term (fetal period)
For pregnant women with chronic illnesses such as ________, _______, and ______ - these disease states pose greater risk for fetus than the drugs used for treatment- but should try to discontinue or find alternative treatments if drugs pose high risk of teratogenesis
epilepsy, asthma, diabetes
Neural tube defects and mental retardation are highly sensitive during what weeks of fetal development?
list of drugs to avoid in pregnancy due to proven teratogenicity:
-Vit A derivatives
What 3 teratogenic effects do these drugs cause?
-Vit A derivatives
-fetal alcohol syndrome
-physiological medical conditions
What 2 teratogenic effects do sex hormones cause?
-masculinization of female fetus
Neural tube defects & growth retardation are teratogenic effects caused by what drugs?
carbamazepine, valproic acid, phenytoin
what teratogenic effect do anticancer drugs have
Which risk category is: Proven Risk of Fetal Harm-benefits outweigh harm (tx of life-threatening disease)
Which risk category: Proven Risk of Fetal Harm-benefits do not outweigh harm
chronic HTN is HTN present __________ or that develops PRIOR to ____________.
women with chronic HTN have a greater risk for developing _________
6 adverse effects of chronic HTN for mother & fetus include:
• Placental abruption
• Maternal cardiac decompression
• Premature birth
• Fetal growth retardation
• CNS hemorrhage
• Renal failure
Severe HTN requires tx - this is a systolic greater than ______ OR a diastolic greater than ________
mild HTN generally does not require tx - this is systolic ______ OR a diastolic ________
Antihypertensive meds taken prior to pregnancy can be continued EXCEPT:
• ACE inhibitors (lisonipril)
• ARBs (azilsartan, candesartan)
• DRIs (aliskiren)
ACEi, ARBs and DRIs are contraindicated due to potential for fetal harm such as: (4)
-fetal growth retardation
-neonatal renal failure
what 4 medications are generally OK to use during pregnancy
• Labatelol -beta blocker
• Nifedipine-calcium channel blocker
• Hydralazine -vasodilator
what is the drug of choice for HTN during pregnancy - bc it has limited effects on uteroplacental and fetal hemodynamics and does not negatively affect fetus/neonate
Multisystem disorder characterized by elevated BP (above 140/90 mm Hg) AND proteinuria (300 mg (3+) or more in 24 hours) that develops AFTER 20th week of gestation
goal of tx for ___________ is minimize risk of hypertension to mother and fetus while avoiding drug-induced harm to fetus
goal of tx for ___________preserve health of mother and deliver an infant who will not require intensive and prolonged neonatal care
risk factors for preeclampsia (6)
• African American
• Chronic hypertension
• Collagen vascular disorders
• Previous preeclampsia
adverse effects of preeclampsia to fetus (3)
• Intrauterine growth retardation (IUGR)
• Premature birth
adverse effects of preeclampsia to mother (5)
• Seizures (eclampsia)
• Renal failure
• Pulmonary edema
what action should be taken if pt has mild/severe preeclampsia and is close to term?
induce labor & deliver baby
what (4) actions should be taken if pt has mild preeclampsia and is early in gestation?
-tx with antihypertensive meds
-prophylaxis with anticonvulsant
mild preeclampsia may be treated with __________.
What baseline levels should be gather before starting?
if pt has severe preeclampsia early on in gestation - BP can be lowered with what drug of choice?
what is the dosage/route/frequency for hydralazine for severe preeclampsia ?
-can be repeated 3x at 20 min intervals
what is the drug of choice for anticonvulsant prophylaxis - for a pt with severe preeclampsia
what is the dose/route/frequency of magnesium sulfate when given for severe preeclampsia
10gm IM - loading dose
followed by 5gm IM q 4 hours
what is the dose/route/frequency of magnesium sulfate when given for eclampsia
10gm IV - loading dose
followed by 5gm IM q 4 hours
____________ - when preeclamptic women develop seizures
_______________ is drug of choice for seizure control
(monitor blood levels)
Target range for serum magnesium when giving magnesium sulfate for eclampsia is __________ mEq/L
4 to 7
(normal 1.5 - 2)
what drug is used for eclampsia, preeclampsia and preterm labor
decreased deep tendon reflexes may indicate toxicity of ?
Successful management of diabetes in pregnancy affected by what three factors:
1. placenta producing hormones that antagonize insulins actions (need for insulin increases)
-cortisol production (promotes hyperglycemia - increases bodys need for insulin)
-glucose can pass freely from mom to fetus (excessive secretion of insulin in fetus/hyperinsulinism)
____________ production increases during pregnancy - promoting hyperglycemia
CBGS should be monitored how often when pregnant w diabetes
diabetes in pregnancy can cause fetal death near term - once tests indicate ________, labor will be induced and fetus delivered early
fetus is mature
with gestational diabetes - ___________ begins after pregnancy begins
what is the drug of choice for gestational diabetes?
For mothers with type 2 diabetes on oral meds, the oral meds are discontinued during pregnancy and switched to insulin - with the EXCEPTION of ____________
All of conventional Antiepileptic drugs (AEDs) increase risk for?
minor/major malformations and growth retardation
what are the 2 most common malformations caused by Antiepileptic drugs (AEDs)
-midline heart defects
risk for malformations from AEDs are greatest during which trimester?
Some ________ can cause neonatal hemorrhage
which drug given to treat seizures causes high risk for spina bifida, neural tube defects, and can impair cognitive development
Uncontrolled seizures don't cause fetal malformation but can _________, _________ and ____________.
Maternal ___________ can result in development delays in infant, promote epilepsy in infant and can put mother at risk for falls and injuries.
Mothers with epilepsy should continue to take AEDs during pregnancy but at ____________ and should _____________
-lowest effective dose
-take only one AED
________ dosage may need to be increased during pregnancy to account for increased hepatic metabolism
What medication for seizures should be AVOIDED in pregnancy?
4 AEDs _______, __________, _________, and ___________ - reduce levels of Vitamin K-dependent clotting factors by inducing hepatic enzymes- this leads to an increase risk of bleeding
pregnant women taking AEDs should take ____________ to help avoid/prevent neural tube defects
Folic acid supplements (2mg/day) - dose increased from normal dose
To reduce risk of bleeding- women should be given _____ of Vitamin K daily during the last few weeks of pregnancy and the infant should be given a _____________ of Vitamin K at birth.
- 10 mg
- 1 mg IM injection
during pregnancy, requirements for __________ increase due to expansion of maternal blood volume and production of RBCs by fetus
how many mg/day of iron supplements are recommended during pregnancy? how long after delivery?
2-3 months after delivery
____________ and _________ interfere with the absorption of iron
deficiency of folic acid during pregnancy can impair development of the CNS, resulting in neural tube defects, manifesting as _____________ or __________
anencephaly or spinal bifida
when is the time of vulnerability for folic acid deficiency?
days 21-28 after conception
what is the recommended amount of folic acid to all women who may become pregnant or of child-bearing age?
a preterm birth is birth when?
prior to 37 weeks gestation
what are some factors for preterm birth
Previous preterm birth, multifetal pregnancy, cervical or uterine abnormalities, intrauterine infection, inflammation, social factors
what are the two categories of drugs for preterm labor
-suppression of PL
-prevention of PL
__________ are drugs used to suppress preterm labor
Tocolytics suppress preterm labor by promoting ____________ thereby delaying delivery
Tocolytics only suppress preterm labor for how long?
up to 48 hours
Tocolytics are used with ______________ to accelerate fetal lung maturity
When Tocolytics are used with glucocorticoids this improves outcomes for neonate with less _____________, ____________ and ___________
respiratory distress, intraventricular hemorrhage and mortality
All tocolytics work by decreasing availability of ____________ which interacts with actin to cause contractions.
use of tocolytics for suppression of PT labor is ______
Do not use Terbutaline (Brethine) (drug to suppress preterm labor) if ?
maternal HR exceeds 120
what risk does Terbutaline (Brethine) cause in both the mother & fetus?
which tocolytic is used to decrease intensity & frequency of contractions or stop them alltogether?
which tocolytic is for women who go into extremely early preterm labor?
which drug to prevent preterm labor is indicated for women with singleton pregnancy only with hx of at least one preterm birth
Hydroxyprogesterone caproate (Makena)
Hydroxyprogesterone caproate (Makena) is contraindicated in women with ?
____________ can be used to prevent preterm labor in women with bacterial vaginosis
___________ is an early sign of dangerously high magnesium levels
loss of DTRs
what 3 side effects does high doses of magnesium sulfate cause in the mother
when is the induction of labor appropriate?
when the benefits of induction outweigh the risks of continued pregnancy & risks of induction
Labor should be induced ONLY when: (3)
1. Benefits outweigh risks to mother & fetus
2. post-term pregnancy (42 weeks + most common reason)
3. early vag delivery likely to decrease mortality & morbidity for mother or infant
what are 7 indications for induction of labor
• Abruptio placentae
• Premature rupture of membranes
• Gestational hypertension
• Fetal compromise
• Fetal demise
• Maternal medical conditions (diabetes, renal disease, etc)
what are 6 contraindications for induction of labor
• Umbilical cord prolapse
• Transverse fetal position
• Active genital herpes
• Previous c-section
• Placenta previa
• History of removal of uterine fibroids
BEFORE labor is induced ____________ should occur
During pregnancy the cervix is elongated, rigid and constricted -- Ripening causes cervix to _______, __________ and ________ which allows fetus to pass through birth canal
uterine tachysystole (6 + contractions in 10 min) is a major adverse effect of what drug for cervical ripening?
Dinoprostone (Prepidil, Cervidil)
uterine tachysystole is high rate of uterine contractions defined as how many?
6 or more in 10 minutes
Misoprostol (Cytotec) is more _____ than other prostaglandins but has a higher incidence of _______________
____________ act on the cervix to promote ripening and on the uterus to promote contractions - in addition to induce abortions
Prostaglandins act on the _______ to promote contractions
_____________ can be used to induce abortions
What must be continuously monitored when pt is on Dinoprostone (Prepidil, Cervidil)
Oxytocin is used ONLY for _______
induction of labor
DO NOT induce labor with oxytocin if: (2)
-fetal lungs not mature
-no cervical ripening has occurred
If fetal lungs are not mature - oxytocin cannot be used to induce labor... what should be given to speed up fetal lung maturity?
precautions/contraindications that can occur with induction of labor using oxytocin
-uterine rupture (more common if mother has classic C section scar)
-Trauma if: cephalopelvic disproportion (CPD), fetal malpresentation, placental abnormalities, umbilical cord prolapse, previous uterine surgery, fetal distress
women with ___________ have a higher risk for uterine rupture
high parity (5 or more pregnancies)
Oxytocin is administered IV and titrated up or down until uterine contractions are every ________ and last __________
stop oxytocin infusion if __________ occurs or _________ occurs
-significant maternal or fetal distress
misoprostol with Oxytocin can be used for?
-cervical ripening & induction of labor
oxytocin is used to increase frequency, force and duration of contractions to induce labor as well as what other 4 uses
-stimulate milk production
-control postpartum bleeding
-manage incomplete abortion
measure serum estrogen levels when pt taking what drug for infertility?
menotropins (Repronex, Menopur)
Ovarian hyperstimulation can occur as an adverse effect of what drugs?
Drugs to treat fertility:
-Clomid (Clomiphene) -- rare
-Menotropins (Repronex, Menopur)
which drug used to prevent preterm labor can cause hives
Hydroxyprogesterone Caproate [Makena]
A good history is needed before admin Hydroxyprogesterone Caproate [Makena], bc it promotes ___________, _____________ and ____________
-glucose intolerance (high blood sugar)
which drug to prevent preterm labor has infant adverse effects of hypotonia (muscle weakness) and sleepiness?
what should be monitored for in a pt taking magnesium sulfate? (4)
-mg serum levels
what drug causes transient hypotension
what drug causes dry mouth in mothers
________________ is as effective as terbutaline to suppress preterm labor but has HIGHER FETAL RISKS
what are 5 fetal risk that can occur with Indomethacin [Indocin] - to suppress preterm labor
• Prolonged renal insuff.
• Bronchopulmonary dysplasia (BPD)
• Necrotizing enterocolotis (NEC)
• Periventricular leukomalacia (white matter injury to brain)
• In utero closure of ductus arteriosus.
what drug to suppress preterm labor can cause interstitial nephritis in the mother
what are the drugs used to treat infertility (3)
-Menotropins (Repronex, Menopur)
What are drugs used to PREVENT preterm labor
-Hydroxyprogesterone Caproate (Makena)
HIGH doses of mg sulfate does NOT delay/prevent preterm labor but increases risk for ___________
low doses of mg sulfate have no effect on delivery but protects against ____________
Tocolytics are drugs used to SUPPRESS preterm labor, these include: (4)
-Oxytocin receptor antagonist (not used in US)
Prostaglandins are used for cervical ripening, these include:
-Dinoprostone (Prepidil, Cervidil)
what is the route/site of administration for Hydroxyprogesterone Caproate (Makena)
IM - into upper quadrant of gluteus maximus
which drug to treat infertility can cause breast engorgement (hard, swollen, painful) and visual disturbances
which drug to treat infertility should be avoided in pregnancy
which drug to treat infertility causes rupture ovarian cysts and CNS disturbances (headache, irritability, fatigue, restless)
stop dosing of (which Tocolytic) ________ after 48 hours
When pt taking Dinoprostone [Prepidil, Cervidil], what should be continuously monitored in mother/infant
Infusion of Oxytocin should be stopped if any of what 4 things occur
• Elevation of resting uterine pressure above 15-20 mm Hg
• Contractions that last longer than 1 minute
• Contractions that occur more often than every 2-3 minutes
• Pronounced alteration in fetal heart rate or rhythm
oxytocin - used to induce labor - should be used with agents to ripen cervix: these include?
-Dinoprostone [Prepidil, Cervadil]
ovarian overstimulation is an adverse effect that occurs with drugs that are used to ____________
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