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Flashcards in L&D Deck (31):
1

What effect does calcium play in uterine contractions?

muscle contraction

2

What effect does stimulation of ATP-sensitive potassium channels?

inhibits muscle contraction

3

3 reasons for promotion of uterine contractions?

1. Cervical ripening (thinning and softening)
2. Control of postpartum hemorrhage
3. Pregnancy termination

4

Name 5 drugs that promote uterine contractions

1. Oxytocin
2. Prostaglandin E2
3. Carboprost
4. Mifepristone
5. Methylergonovine

5

Oxytocin: indications

-induce labor
-promote cervical ripening
-control post partum hemorrhage

6

Prostaglandin E2: indications

-promote cervical ripening and contractions

7

Carboprost: indications

-postpartum hemorrhage

8

Mifepristone: indication

terminate pregnancy

9

Methylergonovine: indication

-postpartum hemorrhage

10

Which drugs are indicated for controlling postpartum hemorrhage?

1. Oxytocin (IV)
2. Carboprost (IM)
3. Methylergonovine (IM)

11

What complications can come from giving too much Oxytocin too fast?

**excessive uterine contractions
-Uterine rupture
-fetal distress (robs O2 from baby)

12

What forms does prostaglandin E2 come in? What are each used for?

1. PGE2 gel
2. Vaginal insert

**cervical ripening + uterine contractions

3. Vaginal suppository
**termination of pregnancy (weeks 12-20) [higher dose]

13

Prostaglandin side effects

-Nausea, vomiting, (sometimes fever)
-Hypertension and hypotension

14

What is carboprost used for?

-postpartum hemorrhage (IM)
-induce uterine emptying at 13-20 weeks with non-viable infant (but not for elective abortion)

15

When is it contraindicated to give a women Carboprost?

asthma (gives bronchospasm)

16

Carboprost side effects

-Bronchospasm**
-HTN
-Diarrhea, vomiting
-"choking"

17

Mifepristone uses

-terminate pregnancy up through 49 days gestation

18

Why is methylergonovine given IM?

given IM after delivery to lessen postpartum bleeding

IV use not recommended due to increased risk of severe hypertension (if given too rapidly)

19

What do tocolytic agents do?

-suppress uterine contractions
-suppress labor so baby isn't born prematurely (can delay 48hrs to a week)

20

If you need to accelerate fetal lung maturity what drugs to you give?

1. Betamethasone IM
2. Dexamethasone IM

-give to women between 24 and 34 weeks gestation at risk for giving birth in the next 7 days

21

Name the 4 drugs that suppress uterine contractions (Tocolytics)

1. Terbutaline (beta-2 agonist)

2. Nifedipine (CCB)*

3. NSAIDs

4. Magnesium sulfate

22

Terbutaline

-beta 2 agonist
-causes uterine smooth muscle relaxation
-oral, SQ, or IV

23

Terbutaline: side effects

-syndrome of tachycardia
-pulmonary edema
-hypokalemia
-metabolic acidosis
-hypotension

24

Terbutaline: black box warning

Oral and prolonged IM, or IV use (more than 48-72hrs) due to maternal cardiotoxicity and death

25

Magnesium sulfate

-DO NOT use for more than 5-7 days --> may lead to in utero exposure may lead to hypocalemia, increased risk of osteopenia and bone fractures in newborns

-category D (according to FDA: evidence of human fetal risk)

26

In what way is magnesium sulfate protective in premature infants?

neuroprotective, decreases occurrence of moderate to severe cerebral palsy

27

Magnesium sulfate: side effects/toxicity

High serum levels:
-weakness
-paralysis
-respiratory failure
-hypotension

28

What type of patient do you need to use caution for Magnesium sulfate?

-Renal patients

if insufficiency body won't eliminate and may predispose to toxicity --> hemodialysis may be needed to correct

29

Nifedipine

-CCB
-relaxes uterine smooth muscle and vascular muscle

Side effects: constipation

30

NSAIDs

ex. indomethacin, Ibuprofen

-2nd or 3rd line agent

Side effects:
1. decrease GFR in baby
2. narrowing/closure of fetal ductus arteriosis

31

Hydroxyprogesterone caproate

-Maintains pregnancy (improves action of progesterone)
-Given IM weekly (starting at 16 weeks) if hx of recurrent miscarriage at greater than 20 weeks