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Tocolytic drugs have what general effect?
Relax the uterus
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Uterotonic or oxytocic drugs have what general effect?
Contract the uterus
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What things are Uterotonic/Oxytocic drugs used for?
- Contraction of the uterus
- Start or normalize contractions
- Promote cervical ripening
- Control post-partum bleeding
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What are the classes of Uterotonic drugs?
- Prostaglandins
- Oxytocin
- Ergot Alkaloids
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What prostaglandins are available as uterotonic drugs?
Dinoprostone, Carboprost and Misoprostal
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What is the most commonly used uterotonic drug to induce or normalize contractions during labor?
Oxytocin
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What are Ergot Alkaloids mainly used for?
Limit postpartum bleeding
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What is Carboprost used for?
Postpartum bleeding only
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Does Oxytocin ripen the cervix?
No
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Dinoprostone (Cervidil) is what type of molecule?
Synthetic prostaglandin E2 (PGE2)
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What is Dinoprostone (Cervidil)used for?
- Cervical ripening
- Can also increase contractions
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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
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What are the contraindications to Dinoprostone (Cervidil)?
Previous caesarean delivery (can tear previous uterine scar leading to uterine rupture)
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What are the Maternal side effects of Dinoprostone (Cervidil)?
Back pain, nausea, vomiting, diarrhea, fever, chills
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What are the Fetal side effects of Dinoprostone (Cervidil)?
- Uterine tachysystole = > 5 contractions/ 10min
- Can change Fetal heart rate changes and cause Fetal hypoxia
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What are the Usesof Dinoprostone (Cervidil)?
- Cervical ripening =promotes induction of labor
- Terminate pregnancy
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How is Dinoprostone (Cervidil) administered?
Intravaginal or intracervical as a gel or insert
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What is the relative cost ofr Dinoprostone (Cervidil)?
Eexpensive b/c short shelf life and must be refrigerated
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Misoprostol (Cytotec) is what type of molecule?
Prostaglandin E1 (PGE1) analogue
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What is Misoprostol (Cytotec) used for?
- Locally and Off label: cervical ripening
- Orally: Treat ulcers caused by NSAIDs
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What are the contraindications for Misoprostol (Cytotec)?
Previous cesarean delivery - disrupts uterine scar leading to rupture
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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
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What are the Maternal side effects of Misoprostol (Cytotec)?
- Intravaginal dosing: rarely uterine rupture
- Oral dosing: nausea, vomiting, diarrhea, abdominal pain, chills, shivering
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What are the fetal side effects of Fetal side effects of Misoprostol (Cytotec)?
Uterine tachysystole, hypoxia and fetal distress.
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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
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Is Misoprostol (Cytotec) very effective?
Yes, Highly effective
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What is the relative cost of Misoprostol (Cytotec) and why?
- Inexpensive
- b/c stable at room temperature
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Does Misoprostol (Cytotec) have stability issues?
No, stable at room temperature
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Misoprostal is used with Used with mifepristone (RU-486) for what purpose?
- Terminate pregnancy:
- Mifepristone blocks progesterone receptors
- Misoprostal causes contractions
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Oxytocin (Pitocin )is what type of molecule?
Peptide hormone produced in the posterior pituitary
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What is Oxytocin (Pitocin) most often used for?
- Induction of labor/contractions
- Reduce postpartum bleeding
- Ejection of milk
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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
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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
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How is Oxytocin (Pitocin) administered?
- IV until contractions resembling normal labor are produced
- (Discontinue if uterine tachysystole or fetal distress)
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What are the Adverse effects of Oxytocin (Pitocin)?
- Water retention/intoxication due to antidiuretic effect
- Uterine rupture
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Carboprost (Hemabate) is what type of molecule?
Prostaglandin (PGF2α) analogue
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What is Carboprost (Hemabate) used for?
- Postpartum bleeding
- Pregnancy termination
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What is the MOA of Carboprost (Hemabate)?
- Stimulates PGF2α receptors on uterine smooth muscle to cause intense uterine contractions
- Directly constricts uterine blood vessels
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Why is Carboprost (Hemabate) not used for induction of uterine contraction?
The uterine contractions it produces are too severee
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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
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What are the Adverse effects of Carboprost (Hemabate)?
Hypertension and bronchoconstriction. Chills, fever, N/V, diarrhea.
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What are the Ergot alkaloids?
Ergonovine and Methylergonovine
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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)
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Why are Ergonovine and Methylergonovine (ergot alkaloids) not used to induce contractions?
Contractions are too intense
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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
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What are the Contraindications for Ergonovine and Methylergonovine (ergot alkaloids)?
Hypertension
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What are the Adverse effects of Ergonovine and Methylergonovine (ergot alkaloids)?
HTN, N/V, HA and convulsions
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