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Tocolytic drugs have what general effect?
Relax the uterus
Uterotonic or oxytocic drugs have what general effect?
Contract the uterus
What things are Uterotonic/Oxytocic drugs used for?
- Contraction of the uterus
- Start or normalize contractions
- Promote cervical ripening
- Control post-partum bleeding
What are the classes of Uterotonic drugs?
- Ergot Alkaloids
What prostaglandins are available as uterotonic drugs?
Dinoprostone, Carboprost and Misoprostal
What is the most commonly used uterotonic drug to induce or normalize contractions during labor?
What are Ergot Alkaloids mainly used for?
Limit postpartum bleeding
What is Carboprost used for?
Postpartum bleeding only
Does Oxytocin ripen the cervix?
Dinoprostone (Cervidil) is what type of molecule?
Synthetic prostaglandin E2 (PGE2)
What is Dinoprostone (Cervidil)used for?
- Cervical ripening
- Can also increase contractions
What is the MOA for Dinoprostone (Cervidil)?
- Directly stimulates PGE2 receptors on cervical smooth muscle
- Activates gelatinases and collagenase to cause cervical thinning
- Stimulates uterine contractions
What are the contraindications to Dinoprostone (Cervidil)?
Previous caesarean delivery (can tear previous uterine scar leading to uterine rupture)
What are the Maternal side effects of Dinoprostone (Cervidil)?
Back pain, nausea, vomiting, diarrhea, fever, chills
What are the Fetal side effects of Dinoprostone (Cervidil)?
- Uterine tachysystole = > 5 contractions/ 10min
- Can change Fetal heart rate changes and cause Fetal hypoxia
What are the Usesof Dinoprostone (Cervidil)?
- Cervical ripening =promotes induction of labor
- Terminate pregnancy
How is Dinoprostone (Cervidil) administered?
Intravaginal or intracervical as a gel or insert
What is the relative cost ofr Dinoprostone (Cervidil)?
Eexpensive b/c short shelf life and must be refrigerated
Misoprostol (Cytotec) is what type of molecule?
Prostaglandin E1 (PGE1) analogue
What is Misoprostol (Cytotec) used for?
- Locally and Off label: cervical ripening
- Orally: Treat ulcers caused by NSAIDs
What are the contraindications for Misoprostol (Cytotec)?
Previous cesarean delivery - disrupts uterine scar leading to rupture
What is the Mechanism of action for Misoprostol (Cytotec)?
- Directly stimulates PGE1 receptors on cervical smooth muscle
- Activates collagenase to cause cervical thinning
- Stimulates uterine contractions and can induce labor
What are the Maternal side effects of Misoprostol (Cytotec)?
- Intravaginal dosing: rarely uterine rupture
- Oral dosing: nausea, vomiting, diarrhea, abdominal pain, chills, shivering
What are the fetal side effects of Fetal side effects of Misoprostol (Cytotec)?
Uterine tachysystole, hypoxia and fetal distress.
How is Misoprostol (Cytotec) administered?
- Intravaginally for cervical ripening and induction of contractions
- Used with mifepristone (RU-486) to terminate pregnancy
- Orally for NSAID induced ulcers
Is Misoprostol (Cytotec) very effective?
Yes, Highly effective
What is the relative cost of Misoprostol (Cytotec) and why?
- b/c stable at room temperature
Does Misoprostol (Cytotec) have stability issues?
No, stable at room temperature
Misoprostal is used with Used with mifepristone (RU-486) for what purpose?
- Terminate pregnancy:
- Mifepristone blocks progesterone receptors
- Misoprostal causes contractions
Oxytocin (Pitocin )is what type of molecule?
Peptide hormone produced in the posterior pituitary
What is Oxytocin (Pitocin) most often used for?
- Induction of labor/contractions
- Reduce postpartum bleeding
- Ejection of milk
What is the MOA of Oxytocin (Pitocin)?
- Stimulates oxytocin receptors on the uterus
- Increases force, frequency, and duration of uterine contractions (similar to normal labor)
- Causes contraction that forces milk produced by glandular tissue of breast into the sinuses
What are the Contraindications for Oxytocin (Pitocin)?
- Previous cesarean delivery = rupture
- Fetal lungs are not mature (Causes fetal distress syndrome)
- Cervix is not ripe - can lead to uterine rupture
How is Oxytocin (Pitocin) administered?
- IV until contractions resembling normal labor are produced
- (Discontinue if uterine tachysystole or fetal distress)
What are the Adverse effects of Oxytocin (Pitocin)?
- Water retention/intoxication due to antidiuretic effect
- Uterine rupture
Carboprost (Hemabate) is what type of molecule?
Prostaglandin (PGF2α) analogue
What is Carboprost (Hemabate) used for?
- Postpartum bleeding
- Pregnancy termination
What is the MOA of Carboprost (Hemabate)?
- Stimulates PGF2α receptors on uterine smooth muscle to cause intense uterine contractions
- Directly constricts uterine blood vessels
Why is Carboprost (Hemabate) not used for induction of uterine contraction?
The uterine contractions it produces are too severee
What are the Contraindications/Precautions for Carboprost (Hemabate)?
- Pelvic inflammatory disease = due to vessel constriction
- Heart or kidney disease, hypertension = elevates BP
- Asthma = Contracts bronchioles
- Uterine scarring
What are the Adverse effects of Carboprost (Hemabate)?
Hypertension and bronchoconstriction. Chills, fever, N/V, diarrhea.
What are the Ergot alkaloids?
Ergonovine and Methylergonovine
What are the Ergot alkaloids (Ergonovine and Methylergonovine) used for?
- Given postpartum to decrease bleeding
- Second line drugs because of risk of hypertension (carboprost and oxytocin are better choices)
Why are Ergonovine and Methylergonovine (ergot alkaloids) not used to induce contractions?
Contractions are too intense
What is the MOA for Ergonovine and Methylergonovine (ergot alkaloids)?
- Stimulates adrenergic, dopaminergic, and serotonergic receptors
- On the uterus: intense and prolonged uterine contraction
- Vascular effects: constricts arteries/ veins
What are the Contraindications for Ergonovine and Methylergonovine (ergot alkaloids)?
What are the Adverse effects of Ergonovine and Methylergonovine (ergot alkaloids)?
HTN, N/V, HA and convulsions