Labor Augmentation And Tocolysis

Front 1

What are the two drugs used to augment labor?

Back 1

Oxytocin

Prostaglandins

Front 2

Hydroxyprogesterone caproate is a ______________.

Back 2

Tocolytic

Front 3

COX inhibitors are _______________ with regards to labor.

Back 3

Tocolytics

Front 4

Ca2+ channel blockers are ______________ with regards to labor.

Back 4

Tocolytics

Front 5

B2 agonists are ___________ with regards to labor.

Back 5

Tocolytics

Front 6

Magnesium sulfate is a _______________ with regards to labor

Back 6

Tocolytic

Front 7

What is the synthetic analog of oxytocin?

Back 7

Pitocin

Front 8

What effect does oxytocin have on the breast?

Back 8

Milk ejection

Front 9

Pharmacologic concentrations of pitocin produce ________________ and can be used to induce or augment labor.

Back 9

Powerful uterine contractions

Front 10

Pitocin can be administered IM to control _______________________.

Back 10

Post partum bleeding

Front 11

If pitocin fails to control post-partum bleeding, what drug can be used instead?

Back 11

Ergonavine maleate

Front 12

______________ receptors on the uterus increase during the last half of pregnancy.

Back 12

Oxytocin

Front 13

What type of receptors are used to bind oxytocin?

Back 13

GPCR

Front 14

Oxytocin is not bound by plasma proteins, so it has a half life of ________.

Back 14

5 minutes

Front 15

Steady state for oxytocin/pitocin is achieved after __ minutes of initiation or dose change.

Back 15

40

Front 16

Pitocin and oxytocin stimulate the release of __________ and ____________, further augmenting labor contractions.

Back 16

Prostaglandins, leukotrienes

Front 17

Excessive stimulation of uterine contractions in which more than five contractions occur in 10 minutes for a 30 minute period is called ___________.

Back 17

Tachysystole

Front 18

What are the three adverse drug reactions of pitocin?

Back 18

Tachysystole

Hyperstimulation/hypertonus

Inadvertent activation of vasopressin receptor

Front 19

This adverse effect of pitocin can lead to fetal distress, placental abruption or uterine rupture.

Back 19

Tachysystole

Front 20

Treatment with pitocin should be stopped immediately if _____________ are observed, and should only be resumed when tachysystole stops and ___________ return to normal.

Back 20

Fetal heart changes, fetal heart patterns

Front 21

Inadvertent activation of the _______________ can lead to excessive fluid retention as an adverse effect of pitocin use

Back 21

Vasopressin receptor

Front 22

This adverse effect of pitocin use can lead to hyponatremia, heart failure, seizures and death. Treatment should be stopped immediately if this occurs.

Back 22

Water intoxication

Front 23

True or false: the best route of administration for pitocin is in bolus form.

Back 23

False. You should administer it as a dilute solution at a controlled rate.

Front 24

What kind of receptor binds to prostagandins?

Back 24

GCPR

Front 25

What is the synthetic version of prostaglandin E2?

Back 25

Dinoprostone

Front 26

What is the synthetic version of prostaglandin F2a?

Back 26

Carboprost tromethamine

Front 27

Which prostaglandins/products of COX are involved in uterine muscle contraction?

Back 27

PGF2a, TXA2

Low concentrations of PGE2

Front 28

Which prostaglandins are involved in uterine muscle relaxation?

Back 28

PGI2/prostacyclin

High concentrations of PGE2

Front 29

What are the two prostaglandins that have potent oxytocic actions?

Back 29

PGF2a, PGE2

Front 30

Which is a more portent oxytocic PG, PGE2 or PGF2a?

Back 30

PGE2

Front 31

This is the first step in the induction of labor and may initiate labor on its own.

Back 31

PGE2 vaginal preparation

Front 32

What effect does PGE2 have on the cervix?

Back 32

Softens/ripens

Front 33

This synthetic PGE1 can be used to ripen the cervix and induce labor.

Back 33

Alprostadil

Front 34

This PG is administered vaginally, where small amounts are absorbed into the maternal system to stimulate contraction of the uterus

Back 34

PGF2a

Front 35

Which PG, PGE2 or PGF2a, has more toxicity in the GI tract (N/V/D) from increased activation of smooth muscle?

Back 35

PGF2a

Front 36

PG administration increases uterine sensitivity to _____________, increasing the risk for tachysystole.

Back 36

Oxytocin

Front 37

This synthetic progestin is administered IM or vaginally to reduce the risk of premature labor in women with a history of preterm labor.

Back 37

Hydroxyprogesterone caproate

Front 38

Hydroxyprogesterone caproate can be used between __ and __ weeks gestation to prevent preterm labor.

Back 38

16, 37

Front 39

Urticaria, pain and swelling at the injection site and preterm labor are adverse effects of this tocolytic drug.

Back 39

Hydroxyprogesterone caproate

Front 40

This non-specific COX inhibitor prevents the conversion of arachidonic acid into prostaglandins, staving off preterm labor between 24-32 weeks.

Back 40

Indomethacin

Front 41

What is a maternal adverse effect seen with COX inhibitors?

Back 41

GI distress

Front 42

What are two fetal adverse effects seen with COX inhibitors?

Back 42

Premature closure of ductus arteriosus

Decreased fetal urine output --> decreasing amniotic fluid volumes --> oligohydramnios

Front 43

What are five contraindications to COX inhibitor use as a tocolytic?

Back 43

Platelet dysfunction/bleeding disorders

Hepatic dysfunction

GI ulcerative disease

Renal dsyfunction

Asthma

Front 44

Nifedipine is this type of drug.

Back 44

Ca2+ channel blocker

Front 45

Nifedipine inhibits the release of intracellular _________ from the SR, resulting in inhibition of the myosin light chain phosphorylation and myometrial ____________.

Back 45

Ca2+, relaxatoin

Front 46

A mother given a Ca2+ channel blocker as a tocolytic agent can experience __________________, resulting in nausea, flushing, headache, dizziness and palpitations.

Back 46

Peripheral vasodilation

Front 47

This tocolytic agent can lead to decreased uterine blood flow and decreased fetal O2 saturation.

Back 47

Ca2+ blocker

Front 48

This tocolytic agent works by interfering with myosin light chain kinase, which inhibits the interaction between actin and myosin and results in decreased myometrial contraction.

Back 48

B2 Agonist

Front 49

Terbutaline is this type of tocolytic agent.

Back 49

B2 agonist

Front 50

The target cells of B2 agonists can become desensitized, leading to a decreased drug effect known as __________.

Back 50

Tachyphylaxis

Front 51

Terbutaline should be used no longer than __ to __ hours.

Back 51

48-72

Front 52

B2 agonists can also activate maternal B1 receptors, increasing/decreasing maternal HR and SV.

Back 52

Increasing

Front 53

Stimulation of B2 receptors in other places aside from the uterus can lead to vasodilation/constriction, diastolic hyper/hypotension, and bronchial constriction/relaxation.

Back 53

Vasodilation, diastolic hypotension, bronchial relaxation

Front 54

The combination of a B2 agonist's action on both B1 and B2 receptors can lead to maternal ___________, palpitations and lower _______.

Back 54

Tachycardia, BP

Front 55

What adverse effect does a B2 agonist have on the fetus?

Back 55

tachycardia

Front 56

This drug's MOA in tocolysis is unknown, but it is thought to inhibit myosin light chain kinase activity in order to reduce myometrial contraction.

Back 56

Magnesium Sulfate

Front 57

Maternal side effects from magnesium sulfate include (list two)

Back 57

Diaphoresis, flushing

Front 58

Fetal side effects from magnesium sulfate include _____________. It is considered pregnancy category _.

Back 58

Bone abnormalities, D

Front 59

This is a marker for bone formation that is decreased with maternal use of magnesium sulfate.

Back 59

Osteocalcin

Front 60

These three drugs are used in combination to abort an early pregnancy.

Back 60

Mifeprostone (RU-486)

Misoprostol

PGE1

Front 61

The oral route for mifeprostone, PGE1 and misoprostol is preferred to vaginal because of a decreased risk for _________.

Back 61

Sepsis

Front 62

This combination of PGs can be used to abort a pregnancy in the 1st or 2nd trimester by promoting uterine contractions.

Back 62

PGF2a, PGE2

Front 63

A vaginal suppository of this drug at a dose much higher than that used for induction of labor is used for 2nd trimester abortion.

Back 63

PGE2

Front 64

IM administration of _________ is used for 2nd trimester abortion and postpartum hemorrhage unresponsive to conventional treatment.

Back 64

PGF2a

Front 65

This drug rapidly crosses the placenta and causes apnea and sedation in a newborn.

Back 65

Thiopental

Front 66

Lipid soluble/polar drugs cross the placenta more readily.

Back 66

Lipid soluble

Front 67

Polar compounds can cross the placenta if ____________ are high enough.

Back 67

Maternal fetal concentrations

Front 68

Smaller/larger MW drugs cross the placenta more readily.

Back 68

Smaller

Front 69

What is the anticoagulant of choice used in pregnancy and why?

Back 69

Heparin; larger MW than warfarin

Doesn't cross placenta as readily

Front 70

True or false: large molecules can cross the placenta through drug transport molecules.

Back 70

True

Front 71

Sulfonamides, barbiturates, phenytoin and local anesthetics have a much lower __________ of fetal fetal proteins, resulting in more free drug in the fetal blood.

Back 71

Binding affinity

Front 72

Ionized/unionized drugs can become trapped in a compartment (such as the fetus or placenta) because they cannot cross the membranes.

Back 72

Ionized

Front 73

The stage of fetal and placental ___________ at the time of drug exposure is crucial to whether or not the drug will affect the fetus.

Back 73

Development

Front 74

The placenta and the fetal liver are capable of __________ and activating certain drugs, which may lead to the buildup of the toxic products of this process.

Back 74

Metabolizing

Front 75

What is an example of a substance that can be metabolized into a toxic metabolite in the placenta or fetal liver?

Back 75

Alcohol

Front 76

Drugs that enter the umbilical artery return to the placenta and may be shunted back to the _____________ and metabolized.

Back 76

Umbilical vein

Front 77

This drug, when taken by the mother, can stimulate fetal lung maturation when a premature delivery is expected.

Back 77

Corticosteroids

Front 78

This drug, when taken by the mother, induces fetal hepatic enzymes responsible for the glucuronidation of bilirubin. It is administered to reduce the incidence of jaundice.

Back 78

Phenobarbital

Front 79

This drug is administered to an HIV positive mother to reduce transmission of the virus to the fetus.

Back 79

Zidovudine

Front 80

GI/respiratory distress, fever and high pitched cries are neonatal withdrawal symptoms witnessed when the mother has chronically used _________ during pregnancy.

Back 80

Opioids

Front 81

ACE inhibitor use in pregnancy may result in significant and irreversible ________ damage in neonates.

Back 81

Renal

Front 82

This drug is a synthetic estrogen that used to be prescribed to reduce pregnancy complications. However, it has been found to interfere with the reproductive system of a developing fetus when used in the first 5 months of pregnancy, leading to clear cell carcinoma of the vagina and cervix of female babies and future problems with fertility.

Back 82

Diethylstilbestrol (DEB)

Front 83

Which drug, when taken during pregnancy, can lead to clear cell carcinomas in the vagina/cervix of female infants?

Back 83

Diethylstilbestrol

Front 84

Vitamin A __________ are considered teratogenic in pregnancy.

Back 84

Analogs

Front 85

Isotretinoin and etretinate are examples of ___________ that are teratogenic in pregnancy.

Back 85

Vitamin A analogs

Front 86

Folic acid supplementation reduces ___________ defects.

Back 86

Neural tube

Front 87

True or false: even a single exposure to a teratogenic drug can affect fetal structures undergoing rapid development at the time of exposure.

Back 87

True

Front 88

Exposure to a teratogenic drug must occur during the ________________ for particular high risk site of teratogenic effect.

Back 88

Critical time in development

Front 89

This drug used to be administered to treat morning sickness until it was found to produce numerous birth defects, such as flipper-like appendages.

Back 89

Thalidomide

Front 90

This syndrome can result in fetal death, abnormal facial features, growth problems and CNS problems. It can also result in learning, memory, attention span, communication, vision and hearing problems.

Back 90

Fetal Alcohol Syndrome

Front 91

This disorder results in intellectual disabilities, behavior problems, learning impairment and poor school performance associated with math, memory, attention, judgment and impulse control.

Back 91

Alcohol related neurodevelopmental disorder

Front 92

Problems with these four organs/processes occur as alcohol-related birth defects.

Back 92

Heart

Kidneys

Bones

Hearing

Front 93

This pregnancy category indicates a drug is safe because controlled studies have failed to demonstrate a risk to the fetus.

Back 93

A

Front 94

This pregnancy category indicates a drug has not shown fetal risk in animal studies, but no human studies have been conducted.

OR

Some studies show animal risk, but studies in 1st trimester women have not shown problems.

Back 94

B

Front 95

This pregnancy category indicates that animal studies have revealed adverse effects, but there have been no controlled studies on humans. Drugs in this category should only be given if potential benefits justify potential risk.

Back 95

C

Front 96

This pregnancy category indicates that there is positive evidence of human risk, but benefits may be acceptable despite the risk in life threatening situations or with serious diseases for which safer drugs are ineffective.

Back 96

D

Front 97

This pregnancy category indicates that fetal abnormalities have been observed in both human and animal studies. The risk of these drugs far outweighs possible benefits, and they are contraindicated in women who are or may become pregnant.

Back 97

X

Front 98

Sick, preterm infants exhibit irregular drug absorption following IM administration due to decreased ___________.

Back 98

Bloodflow/perfusion

Front 99

Improved _____________ may result in a sudden unpredictable and toxic increase in the amount of IM drug entering circulation.

Back 99

Perfusion

Front 100

Full term infants' gastric acid secretion begins shortly after birth and increases over time, but preterm infants secrete it more slowly, with gastric acid levels peaking at 4 days after birth. This affects the ability to give ______ medications.

Back 100

Oral

Front 101

_____________ in infants may be prolonged, so drugs absorbed in the stomach may be absorbed more completely than in adults.

Back 101

Gastric emptying

Front 102

Since gastric emptying is prolonged in infants, especially those who are preterm, drugs absorbed in the _____________ may take longer to show benefit.

Back 102

Small intestine

Front 103

Neonates have a higher/lower percentage of body weight in the form of water.

Back 103

Higher

Front 104

______________ water is 40% of the body weigh t in neonates, which is important when determining concentration of drugs at receptor sites. It is especially important when considering water soluble drugs.

Back 104

Extracellular

Front 105

Most neonates exhibit ____________ during the first 24-48 hours of life, causing the initial weight loss.

Back 105

Diuresis

Front 106

Protein binding of drugs is increased/decreased in neonates, increasing/decreasing amount of free drug in the blood.

Back 106

Decreased, increasing

Front 107

If free drug concentration in neonates is increased, it also leads to increased drug _________ and __________.

Back 107

Effect and toxicity

Front 108

Some drugs compete with ____________ on albumin, leading to jaundice.

Back 108

Bilirubin

Front 109

Excess bilirubin can cross the BBB and cause ______________, which is extreme jaundice, slow startle reflex and poor sucking.

Back 109

Kernicterus

Front 110

GFR is higher/lower in newborns than adults.

Back 110

Lower

Front 111

GFR reaches adult values by _ to _ months.

Back 111

6-12

Front 112

True or false: toddlers have lower GFR than adults.

Back 112

False. It is much higher, causing a shorter drug half life

Front 113

Does indomethacin promote closure or maintain the ductus arteriosus?

Back 113

Promotes closure

Front 114

Does prostaglandin E1 promote closure or maintain the ductus arteriosus?

Back 114

Maintains

Front 115

Nursing mothers should take medication __ to __ minutes after nursing or _ to _ hours prior to nursing.

Back 115

30-60, 3-4

Front 116

Are caffeine and aspirin safe to take while breastfeeding?

Back 116

yes

Front 117

Codeine use while breastfeeding has a variable effect on the infant; mothers with ultrarapid metabolisms produce high levels of _________ through CYP2D6

Back 117

Morphine

Front 118

These two drugs have a significant effect on a nursing infant and can result in neonatal narcotic dependence.

Back 118

Heroin, methadone

Front 119

What effect can tetracycline have on a nursing infant?

Back 119

Staining of developing teeth