Uterine Drugs Flashcards Preview

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Flashcards in Uterine Drugs Deck (39):
1

Oxytocin description

Peptide hormone secreted by the posterior pituitary -> milk ejection
Uterus becomes more sensitive to oxytocin during second half of pregnancy

2

Oxytocin mechanism

Activates Gq->Increase calcium -> MLCK -> contraction increases PG synthesis which further stimulates contraction of uterus

3

Oxytocin Indication

**DOC for induction of labor**
Augment dysfunctional labor
**Limit post partum hemorrhage**
Challenge test -> fetal hypoxia -> measure heart rate
Induce abortion

4

Oxytocin Adverse

Rare: fetal distress, placental abruption, uterine rupture

Activate vasopressin receptors -> fluid retention, hyponatremia, seizures and death

Hypotension when given as a bolus

5

Uterine stimulants

Oxytocin
Eronovine
Methylergonovine
Carboprost
Tromethamine
Dinoprostone
Misoprostol

6

Ergonovine and Methylergonovine description

Partial alpha agonist and some 5-HT

Sensitivity to ergo alkaloids increases dramatically during pregnancy

7

Ergonovine and Methylergonovine indication

Second line for post partum hemorrahge when oxytocin is ineffective (or use both)
**Found in breast milk**

8

Ergonovine and Methylergonovine Adverse

HTN, HA, seizure, nausea, vomiting, chest pain, leg cramps
****Gangrene in nursing infant***

9

Ergonovine and Methylergonovine contraindications

Angina
MI
Pregnancy
CVA
HTN

10

Carboprost and Tromethamine description

PGF2 alpha analog

11

Carboprost and Tromethamine indication

Induce abortion in second trimester
Post - partum hemorrhage (3rd line of treatment)

12

Carboprost and Tromethamine PK

IM

13

Ergonovine and Methylergonovine PK

IM
Found in breast milk

14

Oxytocin PK

IV (slow)
IM
Nasal spray

15

Dinoprostone description

PGE2

16

Dinoprostone indication

Induce abortion in second trimester
Evacuate uterus after missed abortion
**Benign hydatiform mole**
Ripen the cervix

17

Dinoprostone PK

Vaginal insert or suppository

Cervical gel

18

Misoprostol description

PGE1 analog
*Not FDA approved for OB use (only approved for use with NSAID induced gastric ulcers)

19

Misoprostol indication

Ripen cervix
Induce labor
Post-partum hemorrhage

20

Tocolytics (uterine relaxants)

Magnesium sulfate
Indometahcin
Nifedipine
Atosiban
Terbutaline (beta 2 agonist)

21

Magnesium sulfate

**Similar efficacy to terbutaline with better tolerance**
Uncouples excitation contraction in myometrium (opposes calcium)****

22

Magnesium sulfate indication

Most popular tocolytic

23

Magnesium sulfate PK

crosses the placenta

24

Magnesium sulfate adverse

Respiratory depression
Cardiac arrest

25

Indomethacin description

NSAID

26

Indomethacin Mechanism

Inhibit PG synthesis (which stimulates uterine contraction)

27

Indomethacin indication

Delay preterm labor

28

Indomethacin PK

Crosses placenta

29

Indomethacin adverse

Oligohydramnios due to a decreas in fetal renal blood flow (48h)
Premature closure of ductus arteriousus

30

Indomethacin contraindications

Not recommended after 32 weeks because AE are more common

31

Nifedipine description

Calcium channel blocker
Effective and safe

32

Nifedipine mechanism

Inhibits contractility
Decreases calcium -> decreases MLCK

33

Nifedipine indication

more successful prolongation of preterm pregnancy

34

Nifedipine adverse

Maternal tachycardia
palpitations
flushing, nausea
HA and dizziness

35

Atosiban description

Competitive oxytocin receptor antagonist; not available in the U.S.

36

Terbutaline (beta two agonist) description

Activates Gs->increases cAMP -> increases PKA -> phosphorylates SM-MLCK -> SM-MLCK has decreased affinity for calcium-calmodulin complex -> myosin is not phosphorylated -> smooth muscle relaxation

Phased out and replaced by magnesium sulfate due to AE

37

Terbutaline (beta two agonist) indication

Injectable terbutaline needs to be limited to 72 hrs or less

Oral terbutaline should not be used to treat preterm labor

38

Terbutaline (beta two agonist) adverse

Palpitation, tremor
Nausea, vomiting
Anxiety
Chest pain and dyspnea
Hyperglycemia
Hypokalemia
Hypotension

Pulmonary edema
Cardiac insufficiency
Arrhythmia, MI
Maternal death

39

Terbutaline contraindication

Got a black box warning in 2011