Therapeutics - Drugs in Pregnancy 3
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What defines pre-eclampsia?
- Either elevation of blood pressure and/or:
- - Proteinuria
- - Blurred vision
- - Abdominal pain
- - Elevated liver enzymes
- - Headache
- - Thrombocytopenia (< 100,000)
- (Peanut Butter and extra hypertension)
What defines Eclampsia?
Pre-eclampsia with seizures
How is Pre-eclampsia prophylaxed and treated?
- ASA 50 – 150 mg daily
- Calcium supplementation
- DOC - methyldopa (Aldomet®)
- Alternatives: hydralazine (Apresoline®), labetalol, nifedipine
What drugs are Contraindicated with pre-eclampsia?
ACE inhibitors, diuretics
What is the brand name for Methyldopa?
What is the generic name for Aldomet?
What is the Brand name for Hydralazine?
What is the generic name for Apreoline?
What is the treatment for moderate to severe pre-eclampsia?
Magnesium sulfate 2 - 4 gm IV bolus, followed by 1-3 gm IV/hr to maintain serum concentration @ 4-7 mEq/L
When does Respiratory depression occur, when too much Magnesium sulfate is given for pre-eclampsia?
When does cardiac arrest occur, when too much Magnesium sulfate is given for pre-eclampsia?
Cardiac arrest > 15 mEq/L
How is overdosing on magnesium sulfate treated?
With Calcium gluconate
How should you treat seizures due to Eclampsia?
magnesium sulfate 5 – 6 gm IV bolus
What is HELLP syndrome?
- A complication of eclampsia:
- Elevation of Liver enzymes
- Low Platelets
What are the complications of pre-eclampsia and eclampsia?
- HELLP syndrome
What drugs should be given to a mother for premature labor to ensure good infant outcomes?
- Bed rest and Fluids
- Antibiotics for Group B Strep Prophylaxis: Pen G – DOC, Ampicillin
- Corticosteroids: Betamethasone (Celestone®), Dexamethasone
- Neuroprotection: Magnesium sulfate
What is the brand name for Betamethasone?
What is the generic name for Celestone?
What is the DOC for Group B strep prophylaxis?
How is pre-mature labor stopped?
- - Terbutaline (beta-2 agonist)
- - Magnesium sulfate
- - NSAIDs
- - Calcium channel blockers
What Beta 2 agonist is used to stop premature labor?
What are the SE for Terbutaline when use to stop premature labor?
- Pulmonary edema
- Limit use to inpatient and ≤72 hours due to last 2 bullet points - New FDA warning
- (Terbutaline acts to halt premature labor)
Miscarriage and preterm labor are associated with low levels of what and how can it be remedied?
- 17-alphahydroxyprogesterone caproate (progesterone)
- Give progesterone as early as 20 weeks of gestation
What drugs are used for cervical ripening?
- Prostaglandin E2 (Prepidil® and Cervidil®)
- Misoprostol- Most commonly used
What is the brand name for Prostaglandin E2?
What is the generic name for Prepidil and Cervidil?
What is the dose of Misoprostol for cervical ripening?
25 – 50 mcg PO q4-6h times 6 – 8 doses
By what route and how often is Prostaglandin E2 (Prepidil® and Cervidil®) given?
Administered intra-cervical Q 6hrs
How are contractions stimulated in labor induction?
- Oxytocin (Pitocin®)
- IV titrated to frequency and strength of contraction
What is the generic name for Pitocin?
What is the brand name for Oxytocin?
In what ways is labor induced without traditional pharmacologics?
- Laminaria – OB physicians use
- Evening primrose oil
- Black haw
- Black and blue cohosh
- Red raspberry leaves
- Stripping of membranes
What is the main analgesic used to treat labor pain?
Fentanyl/Sufentanyl with bupivacaine via epidural
What is the antidote to Heparin?
Protamine and Fresh frozen plasma
New labeling of prescription drugs approved after June 2001 require what sections?
- 8.1 Pregnancy (includes labor and delivery)
- 8.2 Lactation (includes nursing mothers)
- 8.3 (Females and Males of Reproductive potential)
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