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Flashcards in Repro pharm Deck (27)
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1

After delivery of a healthy infant, a young woman begins to bleed extensively because her uterus has failed to contract. What can you give her?

Oxytocin
contracts uterine smooth muscle
- also used to control post partum hemorrhage

2

Gq

Increased by oxytocin

-increase PLC

Myometrial contraction

3

Gs

increased by beta 2 - relaxes

B2 agonist --> increases Gs --> increases cAMP --> decreases MLCK

*myosin light chain kinase

4

PGE2, PGF2a, and oxytocin all activate Gq, which increase Ca2+ and causes myometrial contraction, What is their receptors?

PGE2: EP1

PGF2a: FP

Oxytocin: OXT

5

PGE2: EP1

PGF2a: FP

Oxytocin: OXT

these receptors do what?

activate Gq and cause increase in Ca2+ (thru L type Ca2+ channels) and cause myometrial contraction

6

PGE and EPI increase Gs and have what effects?

PGE --> Ep2-4 --> Gs --> increase cAMP --> cervic ripening-dilation

EPI --> B2 --> Gs --> increase cAMP --> myometrial relaxation

7

Cervical dilatation is dependent upon ______

prostaglandins

8

Oxytocic -->
Tocolytic -->

Oxytocic --> contract

Tocolytic --> relax

9

Uterin sm also expresses B2-adrenergic receptors that mediate _____

relaxation

Epi --> B2 --> Gs --> Increase cAMP --> myometrial relaxation

10

HELLP

Hemolysis
Elevated Liver enzymes
Low Platelet count

11

Leading cause of infant mortality

Preventing preterm labor

12

Adverse drug rxns of oxytocin

Higher doses --> water intoxication --> coma, convulsions, death

Uterine rupture

Impaired fetal oxygenation

13

Misoprostol

PGE1 analog
- given orally to induce uterine contractions

14

CCB
- Nifedipine
- DIltiazem
- Verapamil

all vasodilators
Nifedipine increases HR

15

Ergot alkaloids

act via a1 and 5HT2 receptors --> direct contraction of vascular and uterine sm
- ONLY used for control of LATE uterine bleeding (if oxytocin doesnt work)
- reduce bleeding by causing sustained contraction of the uterus

16

A pregnant women presents at term for induction of labor, what to give her?

Admin of PGE2 vaginal gel until cervix has ripened followed in 6 hrs by admin of IC oxytocin thru an infusion pump if active labor has not occured

17

Wen are tocolytic agents indicated?

when delay in delivery for 48 hours will provide benefit to newborn
- reduce prematurity problems

ie: indomethacin

18

Indomethacin

tocolytic agent
Prostaglandin synthesis inhibitors (NSAIDS)

Most potent and widely used in suppressing labor in first 24-32 weeks gestation

19

Choice of inhibition of labor (tocolytic agent) if NSAIDS are contraindicated
(platelet disorders, renal dysfxn, GI ulcer disease, asthma)

Nifedipine CCB

- a vascular sm dilation
- potential concern is that fall in maternal BP may have negative fx on blood flow betwen uterus and placenta

20

Terbutaline

b2 adrenergic agonist
- tocolytic agent
- inhibition of labor

- less effective if cervix has dilated and membranes have ruptured
- higher relative incidence of maternal side effects
(risk of maternal hyperglycemia, and fetal hypoglycemia)

21

MgSO4

decreases Ca2+ --> decreases MLCK

- indicated for pre-eclampsia and eclampsia

(tocolytic agent)

22

drug class that will cause uterine contractions and deliver the products of conception following interruption of an established pregnancy with mifepristone is:

prostaglandin analogs (misoprostol)

*note: prostaglandin analogs have Prost in the name

23

What drug interacts with nitroglycerin by inhibiting metabolism of cGMP?

sildenafil

24

Phosphodiesterase inhibitors

-afils

Sildenafil (viagra)

1st line for ED

*blocks cGMP breakdown --> increases cGMP --> enhance vasodilation --> increase blood flow

*enhance fx of nitric oxide

25

Adverse rxns of sildenafil

H's

1. "hot and sweaty"
2. H/A
3. Heartburn
4. HYPOtension
5. Cyanopsia (blue-tinted vision)

26

PDE-5 inhibitors

"fils" that fill the penis
1. Sildenafil
2. Vardenafil
3. Tadalafill

Inhibit PDE-5 --> increase cGMP -->
sm relaxation in corpus cavernosum --> increase BF --> erection
*enhance NO effect

27

Risk of taking PDE-5 inhibitors with:
- Nitrates:
- alpha-blockers:

- Nitrates: hypotension
- alpha-blockers: hypotension