Prostaglandins & Oxytocics

Question 1

What do Prostaglandins and oxytocics do?

Answer 1

● Induce abortion
● Induce or augment labour
● Minimise blood loss from the placenta
● Induce uterine contractions with different levels of pain

Question 2

Examples of Prostaglandins and oxytocics?

Answer 2

Prostaglandins
- Gemeprost
- Misoprostol

Oxytocics
- Oxytocin
- Carboprost
- ergometrine

Question 3

Give examples of drugs used to induce abortion?

Answer 3

● Gemeprost: a prostaglandin given vaginally as pessaries.
Induces abortion and ripens cervix before surgical abortion

● Misoprostol: a prostaglandin given by mouth or vagina but unlicensed

● Mifepristone: can be used to facilitate abortion. Sensitises the uterus to prostaglandin, so shorter time and lower dose of prostaglandin needed

Question 4

Which drugs are used to induce labour?

Answer 4

• Dinoprostone
• Oxytocin
• Misoprostol (unlicensed)

Question 5

What can be used in the prevention and treatment of a haemorrhage during a miscarriage or abortion?

Answer 5

Ergometrine and oxytocin.

Carboprost can be used in severe postpartum haemorrhage.

Question 6

What is Mifepristone used for?

Answer 6

For termination of pregnancy.

● A single dose of mifepristone is followed by administration of prostaglandin
(gemeprost or misoprostol)

Question 7

What is used for the management of Ectopic pregnancy?

Answer 7

Systemic methotrexate

Question 8

What is Vaginal Atrophy?

Answer 8

The thinning, drying and inflammation of the vaginal walls due to less oestrogen production (occurs mostly after menopause)

Question 9

What medications are used for Vaginal Atrophy?

Answer 9

Short term use of a cream containing oestrogen to improve symptoms

● To prevent side effects, use small amounts of topical oestrogens

Examples: Ovestin, Gynest, Vagifem

Question 10

What can the systemic use of oestrogens cause?

Answer 10

The risk of hyperplasia and carcinoma to be increased

Question 11

What are the risk factors for erectile dyfunction?

Answer 11

● Sedentary lifestyle
● Obesity
● Smoking
● Hypercholesterolaemia
● Metabolic syndrome

Question 12

What risk can Erectile dysfunction increase/

Answer 12

Increases the risk of CVD

[SO assess all men with unexplained
erectile dysfunction for CVD risk factors]

Question 13

What is the 1st line treatment for Erectile dysfunction?

Answer 13

Oral phosphodiesterase type 5 inhibitor - increases blood flow to penis.

Drug choice depends on frequency of intercourse & response to treatment

Question 14

Examples of phosphodiesterase type 5 inhibitor?

Answer 14

Avanafil, sildenafil and vardenafil (short-acting & suitable for occasional use as required)

Tadalafil (long acting, used for spontaneous/not scheduled or those that have frequent sexual activity)

Question 15

What are the side effects of phosphodiesterase type 5 inhibitor?

Answer 15

• Vasodilation
• Headaches
• G.I
• Dizziness
• Vision disorders
• Arrhythmias

Question 16

What are the contraindications of phosphodiesterase type 5 inhibitor?

Answer 16

• Recent history of M.I. or stroke
• Avoid if systolic BP is below 90mmHg]

Question 17

Which medications interact with phosphodiesterase type 5 inhibitor?

Answer 17

• Nitrates
• CCB
• Alpha blockers

Question 18

What is the second line treatment for Erectile dysfunction?

Answer 18

Alprostadil - a Prostaglandin analogue

Question 19

How is Alprostadil administered?

Answer 19

Not orally!

• Intracavernosal (base of penis)
• Intraurethral
• Topical application

Question 20

What can Alprostadil cause and what should be done?

Answer 20

Priapism [prolonged erection lasting 4 hours or more] - seek
medical help, apply ice pack

Question 21

Patient & carer advice for Alprostadil?

Answer 21

Report any erection lasting > 4hours.

Use condoms to avoid local reactions to women of childbearing age, pregnant or
lactating women