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Pharmacology review – OBGYN rotation

Pharmacology review – OBGYN rotation. focus on MOA and clinical application of the common drugs. Induction of labor & PPH 2/2 uterine atony. IOL: Generally one , two scheme (with ‘unfavorable cervix’): Cervical ripening with prostaglandin Followed by oxytocin. Prostaglandin (PGE)

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Pharmacology review – OBGYN rotation

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  1. Pharmacology review – OBGYN rotation focus on MOA and clinical application of the common drugs

  2. Induction of labor & PPH 2/2 uterine atony • IOL: Generally one , two scheme (with ‘unfavorable cervix’): • Cervical ripening with prostaglandin • Followed by oxytocin Prostaglandin (PGE) (ex: misoprostol) Oxytocin (ex: pitocin) EFA, phospholipid • PPH (post partum hemorrhage): • Prophylactic oxytocin • Can add prostaglandins post. pitu phospholipase A2 oxytocin arachidonic acid uterus cox 1,2 • inc – collagenase, elastase • Relax cervical smooth muscle • Stim contraction of myometrial cells PG (E)

  3. Maternal circulation Rhogam: Rh(-) physiology diagram Rhogam Rh+ Maternal RBC Rh+ Fetal RBC Rh+ Maternal RBC Rh+ Fetal RBC • Rh is a RBC surface antigen • Rhogam = IgG anti-D (anti-Rh) • This is important only in Rh(-) mothers • Goal is to PREVENT immunization • Screen for antibodies to Rh at initial visit • Given rhogam early 3rd trimester Rh+ Rh+ Maternal RBC IgG anti - RH Maternal circulation

  4. Mifepristone (ru 486), methotrexate Methotrexate (MTX) • Mifepristone used as an abortifactant with misoprostol Mifepristone MOA Dihydrofolic acid progesterone methotrexate Dihydrofolatereducatse - mifepristone p p THF (tetrahydrofolic acid) endometrium DNA, RNA purines protein

  5. Hypertension (chronic, not Pre-E) Antihypertensive – pregnancy Antihypertensive – pregnancy nifedipine SMC SR labetalol methyldopa a a2 Ca2+ b Ca2+ Sympathetic Nervous System NE L-type

  6. HPO axis pharmacology hypothalamus GnRH (+)clomiphene pituitary gland (+/-)GnRH ant. post. (-) OCPs LH FSH ovary (-) anastrozole estrogen (-) tamoxifen breast bone (+) raloxifene

  7. Antimicrobials (UTI, ASB) • Need to treat ASB, 7 days trimethoprim/sulfamethoxazole (Bactrim) TMP/SMX (Bactrim) Dihydropteroatesynthetase sulfonamides Dihydrofolic acid Dihydrofolatereducatse trimethoprim THF (tetrahydrofolic acid) purines protein DNA, RNA

  8. GBs Penicillin MOA nam nag nam • Screen, with culture @35 weeks • Treat when in labor or ROM (rupture of membranes • Penicillin (PCN) G vs V? • PCN binding protein – had transpeptidase (ENZYME) activity that does the cross-linking nag nam PCN binding protein nam nag nam nag nam nag nam PCN binding protein PCN nam nag nam nag

  9. vaginitis drugs • Protozoan - trichomonasvaginalis (motile trichomonads, pH high, green + cervical petechiae): metronidazole • Bacterial – g. vaginalis (clue cells, pH high, thin white discharge): metronidazole • Fungal – c. albicans (pseudohyphae, normal pH, cottage cheese): –azole (topical miconazole, oral fluconazole) Metronidazole (brand – Flagyl) - Azoles, ex - fluconazole (brand – diflucan) Fluconazole (diflucan) ergosterol 02• - Miconazole (monistat) -azole DNA Ketoconazole EtOH, metal, HA metro lanosterol p450 histoplasmosis h pylori blastomycosis cyrptococcus trichomonas entamoeba coccidioidomycosis cutaneous candidia anaerobes giardia gram +/- bacteria

  10. thank you for watching! • visit procedureready.com to download the powerpoint, or any of the images used in this presentation (for free of course!) • visit procedureready.com for more great educational content • consider checking out 52kids.org and making a donation

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