Certified Midwife Exam Prep Pharmacology & Medications in Midwifery 2 — Questions and Answers
Question 1: What is the specific antidote administered when a patient displays signs of magnesium sulfate toxicity?
- Naloxone 0.4 mg IV
- Flumazenil 0.2 mg IV
- Calcium gluconate 1 g IV (Correct answer)
- Protamine sulfate 1 mg/100 units
Correct answer: Calcium gluconate 1 g IV
Calcium gluconate 1 g IV given over 3 minutes directly antagonizes magnesium's effects and is the established antidote for magnesium toxicity.
Question 2: Which cervical ripening agent is classified as a prostaglandin E2 (PGE2) analog and is available as a controlled-release vaginal insert?
- Oxytocin
- Dinoprostone (Correct answer)
- Misoprostol
- Mifepristone
Correct answer: Dinoprostone
Dinoprostone (Cervidil) is a prostaglandin E2 analog approved for cervical ripening and is available as a controlled-release vaginal insert that can be removed if needed.
Question 3: A patient with an epidural in place develops circumoral tingling and a metallic taste. What is the most likely cause?
- Epidural migration into the intrathecal space
- Systemic local anesthetic toxicity (LAST) (Correct answer)
- Hypoglycemic episode
- Hyperventilation syndrome
Correct answer: Systemic local anesthetic toxicity (LAST)
Circumoral numbness and metallic taste are classic early CNS signs of local anesthetic systemic toxicity (LAST), indicating intravascular absorption of the epidural medication.
Question 4: Which oral iron formulation contains the highest percentage of elemental iron and is often preferred for treating iron-deficiency anemia in pregnancy?
- Ferrous sulfate
- Ferrous gluconate
- Ferrous fumarate (Correct answer)
- Iron polysaccharide complex
Correct answer: Ferrous fumarate
Ferrous fumarate contains approximately 33% elemental iron, the highest among common oral ferrous salts, making it an efficient option for correcting iron deficiency in pregnancy.
Question 5: A postpartum patient with uterine atony is prescribed methylergonovine (Methergine). Which pre-existing condition is an absolute contraindication?
- Type 2 diabetes mellitus
- Hypertension (Correct answer)
- Hypothyroidism
- Mild persistent asthma
Correct answer: Hypertension
Methylergonovine causes significant vasoconstriction and is absolutely contraindicated in patients with hypertension because it can precipitate a life-threatening hypertensive crisis.
Question 6: Which antibiotic is the ACOG-recommended prophylaxis for cesarean birth and should be administered 60 minutes before skin incision?
- Ampicillin-sulbactam
- Cefazolin (Correct answer)
- Gentamicin
- Metronidazole
Correct answer: Cefazolin
Cefazolin (first-generation cephalosporin) is the ACOG-preferred antibiotic prophylaxis for cesarean birth, with additional azithromycin recommended for non-elective cases.
Question 7: Terbutaline is used as a tocolytic agent. What is its primary mechanism of action in the uterus?
- Oxytocin receptor antagonist
- Beta-2 adrenergic receptor agonist (Correct answer)
- Calcium channel blocker
- Prostaglandin synthesis inhibitor
Correct answer: Beta-2 adrenergic receptor agonist
Terbutaline is a beta-2 adrenergic agonist that binds uterine smooth muscle receptors, increasing cAMP and causing uterine relaxation to inhibit preterm contractions.
Certified Midwife Exam Prep Pharmacology & Medications in Midwifery 2
What is the specific antidote administered when a patient displays signs of magnesium sulfate toxicity?