OB & Prostaglandins

Question 1

Eicosanoids

Answer 1

• synthesized from arachidonic acid
• Ex: prostaglandins, prostacyclins, thromboxanes, leukotriens
• Role: inflammation, fever, regulate BP, blood clotting, immune sys modulation, control reporductive process & tissue growth, regluate sleep/wake cycle

Question 2

Pitocin
MOA, SE, Contraindicaitons

Answer 2

-synthetic oxytocin (20-40 units IV/IM)
MOA: stimulates uterine smooth muscle d/t ↑intracellular Ca
SE: uterine tetany, fetal distress d/t hyperstimulation, water intox, transient HoTN, N/V
Contraindicaiton: HoTN, hemodynamically unstable

Question 3

Methergine
MOA, SE, Contraindicaitons

Answer 3

-ergot alkaloid (200 mcg IM)
MOA: tetanic contraction
SE: severe HTN, CVA, MI, HA, sz, reflex brady, N/V
Contraindications: HTN, MI

Question 4

Hemabate
MOA, SE, Contraindicaitons

Answer 4

• synthetic PGF2 alpha (250 mcg IM)
  MOA: tetanic contraction
  SE: N/V/D, bronchospasm, fever
  Contraindications: avoid asthma, reactive airway, PHTN

Question 5

Misoprostol (cytotec)
MOA, SE

Answer 5

-synthetic PGE1 analog (600-2000 mcg rectal or SL)
MOA: ripens cervix & stimulates uterine contractions
SE: chills, diarrhea, fever, N/V

Question 6

Tocolytics Criteria

Answer 6

Criteria: GA 20-34 wks, reassuring fetal status, no clinical signs of infection
-Don’t prolong pregnancy beyond 48h (used for transfer or delay for steroids)
-No clear “first-line” tocolytic, combining tocolytics ↑ risk of SE

Question 7

Beta Agonists Tocolytics (terbutaline, salbutamol, ritodrine) SE

Answer 7

Maternal SE: HoTN, ↑HR (+/- arrhythmia & ischemia), pulmonary edema, hyperglycemia, ↓K, hyperinsulinemia, antidiuresis, altered thyroid function
Fetal SE: ↑HR, hyperglycemia, hyperinsulinemia, myocardial/septal hypertrophy
Neonatal SE: ↑HR, hypoglycemia, hypocalcemia, IVH, hyperbilirubinemia, HoTN

Question 8

Beta Agonists Tocolytics (terbutaline, salbutamol, ritodrine) Contraindications

Answer 8

-dysrhythmias
-poorly-controlled thyroid disease/DM

Question 9

CCB Tocolytics (Nifedipine) SE

Answer 9

-HoTN
-HA
-Flushing
- dizziness

Question 10

CCB Tocolytics (Nifedipine) Contraindications

Answer 10

-maternal HoTN
-CV or renal dz

Question 11

NSAIDs Tocolytics SE

Answer 11

Maternal SE: N, heartburn, transient effect of plt (RA still ok)

Fetal SE: constriction of ductus arteriosus, PHTN, reversible renal dysfunc, IVH, hyperbilirubinemia, NEC

Question 12

NSAIDs Tocolytics Contraindications

Answer 12

-renal/hepatic impairment
-PUD
-coag disorders
-↓plt
-NSAID sensitive

Question 13

Mag Tocolytic Contraindication

Answer 13

-MG
-myotonic dystrophy
-↓dose w/ renal dz

Question 14

Mag Tocolytic Therapeutic Range

Answer 14

5-9 mg/dL
or
4-7 mEq/L