GI and UG spasm muscle relaxants and drugs affecting the uterus

Question 1

What are the muscarinic drugs for GI and UG spams releif?

Answer 1

Oxybutinin and Tolterodine

Darifenacin and Solifenacin and Tospium

Butylscopolamine, Homatropine and Methylatropine

Question 2

What are the PDE inhibitors for GI spasm?

What PDE subtgype do they inhibit and what other target?

Answer 2

Papaverine
Drotaverine

Inhibit cPDE and L type Ca channels

Question 3

What are the other -verine drugs

Answer 3

Pinaverin - inhibits Ca channels only. Used in IBS and biliary disorders

Mebeverine - Unclear mechanism, direct SM relaxation effects possibly through Ca. Also used for IBS.

Question 4

Side effects of Papaverine and Drotaverine

Answer 4

Hypotension

Coronary steal syn

Sedation

Question 5

Drugs that contract the uterus

Answer 5

Oxytocin

Ergotamine, dihydroergotamine

Misoprostol

Dinoprostone

Dinoprost tromethamine

Sulprostone

Question 6

Drugs that relax the uterus

Answer 6

Atosiban

Terbutaline
Salbutamol
Fenoterol

Indomethacin

Nifedipine

MgSO4, Magnesium Sulfate injection.

Ethanol

Progesterone but only during 1st trim

Question 7

Oxytocin

Answer 7

Given i.v. for labor or postpartum bleeding.
Stimulates rhythmic contractions of the uterus and can induce or reinforce labor.

Reduces postpartum bleeding

Can also stimulate lactation, given as intranasal spray.

Question 8

What is the oxytocin antagonist

Answer 8

Atosiban

given i.v. to suppress preterm labor.

Question 9

What is the effect of Ergotamine and when is it used in obstetrics

What are its SEs

Answer 9

Used ONLY after delivery to reduce post partum bleeding.

Causes a powerful tonic contraction of the uterus

SEs
Hypertension, potential intestinal ischemia.
neurologic SEs, seizures.

Question 10

What is misoprostol

Answer 10

Synthetic PGE1.

Induces labor and stimulates protective gastric secretions.

Used along with Mifepristone and MTX as an abortificent.

SE:
Diarrhea
Uterine cramps.

Question 11

What is Dinoprostone

Answer 11

another name for PGE2.

Also can induce labor or abortion.
Reduce post partum bleeding

Maintains patent ducuts arteriousus in newborns with cardiac or vessel malformations, until surgery

Question 12

What is Sulprostone

Answer 12

Synthetic PGE2.

Question 13

What is Dinoprost tromethamine

Answer 13

PGF-2-alpha

Used as an abortificent

Side effect of bronchoconstriction.

Question 14

How are the prostaglandin analogs eliminated?

Answer 14

Metabolized by liver and eliminated via urine.

Sulprostone is eliminated in bile.

Question 15

What is Mifepristone

Answer 15

A steroid antagonist of progesterone and glucocorticoid receptors.

Terminates 1st trim pregnancy along with misoprostol.

Question 16

What is the term for a drug that delays labor

Answer 16

Tocolytic

Question 17

What are the tocolytics

Answer 17

Atosiban
Terbutaline
Salbutamol, Fenoterol

Nifedipine
MG sulfate injection
Ethanol
Progesteron

(NOT indomethacin, its just used as a uterine relaxer to reduce menstrual cramps)

Question 18

How long can Terbutaline be used to delay pregnancy?

When is it used?

Answer 18

After week 16, can be used for up to 48 hours while a C section is prepared for.

Also to delay contractions when the baby is in a position that may cause uterine rupture.

Question 19

How long can nifedipine be used to delay?

Answer 19

Ideally, no tocolytic should be used more than 48 hours, but Nifedipine has been used off label for up to a week.

Question 20

MoA of terbutaline and side effects

Answer 20

Terbutaline is a Beta-2 AGONIST.
Stimulating uterine relaxation.

systemic side effects,
Tachycardia, hypotension, hyperglycemia