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What is Clomiphene citrate?
- what to do before treatment
- Ovarian stimulator
- - It increases FSH, LH secreted by the pituitary gland) ( po)
- - Ovulation begins 5-10 days after treatment
- - If it doesnt work after 3 treatments --> stop
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What is menotropin?
gonadtropin stim FSKH, LH to mature follicles
- - followed by hCG
- - monitor hCG and estradiol
-
What is follitropin alfa?
- It induces ovulation
- -hCG is given 1 day after the last dose
- -monitor serum estradiol
DONT SHAKE
-
How does hCG work?
LH replacement to stimulate ovulation
Overstimulated ovaries: edema, depression, arterial thrombosis
-
What is Leuprolide?
gonadtropic release to prevent preamature ovulation
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Describe pharmokinetics during pregnancy
less predictable
plasma volume, kidney, liver metabolism increase
-
Immunizations pregnant women should get
- pneumonia
- meningitis
- flu shot
- hep b
- tdap
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How much folic acid should a pregnant lady take
800mcg
-
Safest drug to give during pregnancy if constipation occurs
psylium
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Why does GERD happen during pregnancy
- hormonal changes
- lower esaphageal sphincter relaxes
-
Describe gestational DM
- GTT test at 24-28 weeks
- fasting blood sugar at 95+
Regular insulin= best
-
best antiemetic drug for pregnant
ondansetron
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What is preeclampsia?
- Hypertension 140+/90+
- proteinura" 300+mg
at 20 weeks
-
What is teratogenic? When are the effects most seen
cause abnormal fetal development
most likely 1st trimester = material effects
2,3rd = adverse on baby
-
What are tocolytics
drugs to inhibit labor and maintain pregnancy
-
Nifedipine
- Ca+ channel blocker
- causes uterine contraction and bp to decrease
PRO: it can lower bp in the placenta
DONT NOT USE with IV Magnesium sulfate
-
Whats hydralazine
vasodilator and tocolytic
-
whats Labetalol
beta blocker used as a tocolytic
-
What is magensium sulfate?
- Neuromuscular blocking ( prevents seizures)
- -- treats severe preeclampsia and eclampsia
-- safe in pregnancy and lactation
- DO NOT USE with Nifedipine
1st sign: lose patella reflex, confusion bp
-
Antidote for magnesium sulfate
- Calcium gluconate by slow IV push (30 minutes)
- watch for pulmonary edema
-
Terbutaline sulfate
- beta adrenergic inhibits uterine contractions
- ca+ decreases
adverse: hyperkalemia, jittery fetal tachy
DO NOT give longer than 48-72 hrs = heart probs
-
Indomethacin
NSAID that inhibits uterine prostaglandins
bad: GI bleed
-
What do prostaglandins do?
promote cervical ripening ( thinner cervix)
increase contractions
carboprost tromethamine
-
Dinoprostone
synthetic prostagland E2 stimulating uterine contractions
Dont do it on someone with a Csection
-
Misoprostol
synthetic prostagland that inhibits gastric acid secretion to induce labor
- -Wait 4 hours before oxytocin
- -measure fetal hr
- -dont do on those with a c section before
-
Oxytocin
- Helps to induce labor
- and help with postpartum hemorrhage
- - stop if hypertension
- -monitor uterine activity q 15 min
-
What are uterotonics
stop post partum hemorrhage
-
Carboprost tromethamine
stimulates the uterus to contract postpartum
STAY HYDRATED
-
Methylergonovine
to increase strength and frequency of uterine contractions post partum
- need to move or blood clot risk
-
3 types of ovarian estrogens
- estradiol ( most estrogen)
- estrone
- estriol
-
Adverse reactions of estrogen
- blood clots ( 35+ smokers)
- thromboembolism
- mestrual disorder
- gallbladder disease
- migraine
- water weight
- dementia
- endometrial cancer
DONT GIVE: pregnant, tobacco , past blood clot, liver disease
-
Estrogen can reduce the effectiveness of
- warfarin
- - monitor INR, PT
-
Anticonvulsants do what to estrogen?
induce the enzyme
-
What inactivates estrogen?
- barbiturates
- rifampin
- tetracycline
-
What does progesterone do?
helps maintain pregnancy/ prepare uterine lining for pregnancy
used as bc, hormone rep, maintain preg, emerg contracept
-
Medroxyprogesterone acetate
- progesterone that changes endometrium to secrete
- inhibits ovulations
- spontaneous uterine contractions
- Can cause HDL to go down
- LDL to go up
adverse: osteoporosis
-- do self breast exams
-
Androgen deficiency primary hypogonads
If FSH is high and LH is normal/ low
- testicular disorder
- mumps
- testicular inflammation
- trauma
-
Androgen deficiency secondary hypogonadism
-
Signs of an androgen deficiency
and what to check
- erectile dysfuntction
- infertility
- less hair and muscles
- loss of bone mass
-
Barbiturates effect testosterone how
increase the effects
barbiturates ( sedative)
-
What decreases testosterone effects
Ca retention lowers
-
Dont use sulonylureas with what?
andorgens ( they increase the effect)
-
Name 3 phosophdiesteraste type 5 inhibitors
Sildenafil
Tadalafil
Verdenafil
-
Sildenafil ( viagra)
inhibits cGMP enzybe, vasoodilator
adv: facial flush, dyspepsia, PO 1 hr before
Alcohol: orthostatic hypo
- DONT MIX WITH NITROGLYCERIN
- high fat diet decreases effects
-
Tadalafil (cialis)
reaches peak 2hr lasts 24 hr
- meals dont affect absoprtion
- back and muscle pain
-
Verdenafil ( levitra)
peak 1hr , duration 4hr for erectile dysfunction
prolonged OT interval shouldnt be used with class I, II antidysrhythmic
-
How to 5 Alpha reductase inhibitors work?
proliferate prostatic cells lessen causing prostates to shrink
-
Finasteride
inhibits testosterone
- take 6-12 months for full effects
DONT NOT TOUCH if brocken or curhsed and pregnant
-
Ditasteride
- 5 alpha reductase inhibt
- for enlarged prostate
- 3-6 months for max benefit
DONT HANDLE IF PREGNANT
-
Tamsulosin
- Improves urination in those with enlarge prostate
- cimetide= lower clearance
- dont use before eye surgery
-
Hyperkalemia treatment
Sodium bicarbonate: K+--> cells
Calcium gluconate: decreases cardiotoxic
Glucose+ insulin: insulin cause K+ to move into the cells
Sodium polystyrene sulfonate ( kayexelate)
-
Feedings ml
- Dont give more than 500ml per feeding
- including 60-90ml for flushing
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