L10 Reproductive Pharmacology​

Choose ALL correct statements about pregnancy physiology.

Placental transfer of medications​ 1. Factors promoting transfer​: - [blank_start]Lipophilic[blank_end] ​- [blank_start]Low[blank_end] molecular weight (250-500)​ 2. Factors reducing transfer​ - Highly [blank_start]ionized[blank_end]​ - [blank_start]Protein[blank_end] binding​ - [blank_start]High[blank_end] Molecular weight (>500-1000)​

Teratogenic medicines can have a direct effect (eg thalidomide, isotretinoin), or act through effects on oxygen transfer or nutrient supply to the developing fetus (eg methotrexate)​

Known specific teratogens​ - match to effect: [blank_start]Thalidomide[blank_end] - first trimester phocomelia​ [blank_start]Warfarin[blank_end] - late first trimester nasal hypoplasia, third trimester fetal anticoagulation and intracranial bleeding​ [blank_start]ACE inhibitors[blank_end] - first trimester spontaneous abortion, second and third trimester renal hypoplasia​ [blank_start]Valproic acid[blank_end] - first trimester-cardiac and NTD​ (neural tube defects) [blank_start]Carbamazepine[blank_end] - NTDs and facial hypoplasia​

Opiod dependence: Cessation during pregnancy can result in fetal [blank_start]withdrawal[blank_end] and fetal death​ Usual course of action is [blank_start]methadone[blank_end] maintenance​ Detoxification by tapering can be performed in carefully selected patients with fetal [blank_start]monitoring[blank_end]​

Select all antimicrobial classes that are generally safe in pregnancy​.

Lamivudine and zidovudine for HIV in pregnancy reduces vertical transmission to the neonate from 15-30% to < 2%.

Corticosteroids (betamethasone preferred, or dexamethasone) can be administered to reduce the incidence of intraventricular hemorrhage and reduce the risk of respiratory distress syndrome in preterm (<34 weeks) deliveries​

Group B streptococcus can cause neonatal sepsis, pneumonia, meningitis​. With penicillin prophylaxis, risk is reduced to 1:600 in known carriers​.

_______ administered to patients delivering at <30 weeks gestation reduces the risk of cerebral palsy from 3.5% to 1.9% (RR 0.55)​.

Congenital Adrenal Hyperplasia​ is an [blank_start]autosomal recessive​[blank_end] genetic condition causing increased androgen production in a female fetus. Maternal administration of [blank_start]dexamethasone[blank_end] suppresses the [blank_start]fetal[blank_end] adrenal glands​. Must be initiated [blank_start]early[blank_end] in pregnancy​.

Uterine stimulants for labour induction, PPH: [blank_start]Oxytocin[blank_end]​ Ergot alkaloids​ (May cause hypertensive crisis in hypertensives or when administered by the [blank_start]IV[blank_end] route​) Prostaglandins (Categories [blank_start]E and F[blank_end] are potent uterine stimulants​)

Uterine relaxants/Tocolytics​: Beta 2 agonists​ (ritodrine, terbutaline and salbutamol, no effect on delaying [blank_start]preterm labour[blank_end]) Calcium channel blockers​ (Nifedipine​, [blank_start]effective[blank_end] for preterm) Oxytocin receptor antagonists​ (Atosiban​. Doesn't work though - [blank_start]placebo[blank_end] just as good) Nitrates​ (Nitroglycerin and isosorbide dinitrate, [blank_start]cGMP[blank_end] mediated relaxation of smooth muscle​. Good for twins or C section) Prostaglandin synthetase inhibitors​ (blocks synthesis of prostaglandins via COX, limited use <[blank_start]48[blank_end]h)

Contraceptives: - Estrogen component inhibits [blank_start]ovulation[blank_end] through suppression of [blank_start]FSH and LH[blank_end] - Progesterone: Inhibits ovulation by suppressing the LH surge, thick cervical [blank_start]mucous[blank_end] barrier​, ovum transport is altered​, implantation is hampered by [blank_start]endometrial[blank_end] changes​

Metformin can be used as a fertility treatment to induce ovulation.

Physiologic bladder contraction is mediated by acetlycholine at post-ganglionic [blank_start]muscarinic[blank_end] receptors (M3)​. Treatment of abnormal contraction ([blank_start]overactive[blank_end] bladder or detrusor overactivity) is therefor mainly [blank_start]anticholinergic[blank_end] agents​ like atropine, propanetheline, solifenacin. Common side effects: dry mouth and eyes, blurred vision, tachycardia, pruritis, sedation, headache, constipation​. Contraindication in narrow angle [blank_start]glaucoma[blank_end] and urinary retention. Incontinence due to reduced outlet resistance​ is usually treated surgically​. [blank_start]Alpha-adrenergic[blank_end] receptors contract the urinary sphincter​. Ephedrine and pseudoephedrine minimally effective (only [blank_start]mild[blank_end] cases)​. [blank_start]Duloxetine[blank_end] (SNRI) contracts the sphincter during filling with no effect on relaxation with voiding​.