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Common OB Medications Flashcards

1
Q

What is the trade name of oxytocin?

A

Pitocin

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2
Q

What is oxytocin used for?

A
  • induction of labor
  • control postpartum uterine bleeding
  • after suction D & C
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3
Q

What is the mechanism of action of oxytocin?

A
  • indirectly increases intracellular calcium
  • directly stimulates the oxytocin receptor on the myometrium
  • some antidiuretic effect
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4
Q

In what cases is oxytocin contraindicated?

A
  • fetal distress
  • unfavorable fetal positions
  • previous uterine rupture
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5
Q

What are the side effects of oxytocin?

A
  • flushing
  • brady/TACHYCARDIA
  • hyper/hypotension
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6
Q

Oxytocin Dosing

A

10-40 units in 1000 ml LR

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7
Q

Oxytocin onset and duration

A

Onset: immediate
Duration: within 1 hour

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8
Q

Oxytocin causes uterine contraction or relaxation?

A

uterine contraction

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9
Q

How many weeks of gestation does oxytocin work?

A

does not work until 12-14 weeks of pregnancy

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10
Q

What is the trade name of methylergonovine?

A

Methergine

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11
Q

Methylergonovine dosing and frequency

A

0.2 mg IM q 2-4 hours
MAX OF 5 DOSES

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12
Q

Methylergonovine onset and duration

A

Onset: 2-5 min
Duration: about 3 hours

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13
Q

T/F: methylergonovine can be given IV or IM

A

false
- methylergonovine can only be given IM, NEVER IV!!!

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14
Q

What drug class does methylergonovine fall under?

A

semisynthetic ergot alkaloid

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15
Q

How does methylergonovine work?

A

increases motor activity of the uterus (contraction) by acting directly on smooth muscle to increase tone, rate, and amplitude of contraction

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16
Q

What is the mechanism of action of methylergonovine?

A
  • arterial vasoconstriction by alpha stimulation
  • inhibition of endothelial derived relaxation factor release
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17
Q

When is methylergonovine contraindicated?

A
  • severe HTN
  • pregnancy induced hypertension (PIH)
  • cardiac disease
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18
Q

Methylergonovine causes uterine contraction or relaxation?

A

uterine contraction

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19
Q

What is the trade name of carboprost?

A

Hemabate

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20
Q

What are the side effects of carboprost?

A
  • airway constriction and wheezing
  • increased CO, BP, PVR (peripheral vascular constriction)
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21
Q

When is carboprost contraindicated?

A

asthma
- causes airway constriction and wheezing

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22
Q

Carboprost causes increased or decreased temperature? How does this happen?

A
  • increased temperature
  • effect on hypothalamic thermoregulation
  • can increase temp by 2 degrees
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23
Q

Carboprost can increase temperature by _____ degrees

A

2 degrees

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24
Q

What is the mechanism of action of carboprost?

A
  • synthetic analogue of prostaglandin F2 that stimulates uterine contraction
  • increase of myometrial calcium, stimulates smooth muscle of GI tract to cause diarrhea
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25
How does carboprost stimulate uterine contraction?
it is a synthetic analogue of prostaglandin F2
26
Carboprost increases ______________ , which stimulates smooth muscle of the GI tract to cause diarrhea
myometrial calcium
27
Carboprost dosing and frequency
250 mcq IM q 15-45 min MAX OF 8 DOSES
28
Carboprost onset and duration
Onset: immediate Duration: 2 hours
29
What is the trade name of misoprostol?
Cytotec
30
What drug class is misoprostol?
synthetic prostaglandin E1
31
What is misoprostol indicated for?
- uterine atony - abortions - cervial ripening - peptic ulcer disease
32
Misoprostol Dosing
1-2 tablets buccal (200 mcq each)
33
What are the possible routes of administration of misoprostol?
- buccally - rectally - vaginally (by OB)
34
Misoprostol onset and half time
Onset: rapid Half life: 20-40 min
35
Misopostol has potential to cause __________
diarrhea
36
What is magnesium sulfate (MgSO4) used for in OB?
- prevent eclamptic seizures (decreases incidence by 50%) - stop premature labor (tocolytic)
37
What effect does magnesium sulfate have at the NMJ?
inhibits release of acetylcholine
38
How does magnesium sulfate work?
- mild vasodilator that decreases uterine activity to increase uterine blood - dilates liver beds and kidneys to increase function - decreases SVR
39
Magnesium sulftate causes uterine contraction or relaxation?
uterine relaxation
40
Magnesium sulfate potentiates ___________ and _______________
nondepolarizers and depolarizers
41
What respiratory side effect comes with administering magnesium sulfate?
pulmonary edema - may be some correlation with chorioamnionitis
42
Magnesium sulfate dosing
- 4 grams over 20 min - 2-3 grams/hr infusion
43
Magnesium sulfate onset and duration
Onset: immediate Duration: 20-30 min (assuming good renal perfusion)
44
What do we have to check when administering magnesium sulfate?
- magnesium levels - deep tendon reflexes
45
How do you treat magnesium toxicity?
- 1 gram calcium gluconate over 2 min - fluids - diuresis - O2
46
Magnesium sulfate _____________ (crosses/does not cross) the placenta
crosses the placenta
47
What effect does magnesium sulfate have on the fetus/neonate?
- respiratory depression - apnea - decreased tone
48
Magnesium sulfate may cause muscle relaxation or contraction?
muscle relaxation (weakness)
49
What are therapeutic magnesium sulfate levels for use in OB?
4-8 mg/dL
50
At magnesium level of 5-10 mg/dl, what would you see?
- ECG - prolonged PR - widened QRS
51
What magnesium level would you begin to see decrease in deep tendon reflexes and respiratory depression?
10 mg/dl
52
What would you expect to see at a magnesium level of 10 mg/dl?
- decreased deep tendon reflexes - respiratory depression
53
What would you expect to see in an OB patient with magnesium levels between 4-8 mg/dl?
therapeutic effects
54
At what magnesium level would you begin to see respiratory arrest and ECG changes from SA/AV conduction?
15 mg/dl
55
At what magnesium level would you expect cardiac arrest?
25 mg/dl
56
What treatments may you consider for blood pressure control in parturients?
- labetalol - hydralazine - nipride - nitroglycerine - volume repletion (decrease ECF)
57
Labetalol is a _____________ antagonist
alpha and beta antagonist
58
What effects does labetalol have on the neonate if administered?
- possibly bradycardia - typically few neonatal complications
59
Labetalol has a _________ onset
rapid
60
How does hydralazine work?
potent vasodilator that decreases afterload, PVR, maternal BP, and uterine vascular resistance to increase uterine blood flow
61
When would you most see decrease in PVR with hydralazine administration?
volume repletion
62
What are potential side effects of hydralazine?
- maternal tachycardia (reflex sympathetic response to vasodilation) - vomiting - tremors
63
What is nipride used for in OB?
acute hypertensive crisis
64
How does nipride decrease blood pressure?
potent arteriolar dilator
65
Nipride has ______ onset and _______ duration
rapid onset and short duration
66
Maternal/fetal _________________ is a concern with nipride, but can be prevented with low doses at ________________
- cyanide toxicity - 5-10 mcg/kg/min
67
What dose should you keep nipride at for OB patients?
5-10 mcg/kg/min
68
How does nitroglycerine lower blood pressure?
venodilator to decrease cardiac filling pressures by acting on capacitance vessels
69
The patient may get reflex _______________ when nitroglycerine is used to lower blood pressure
reflex tachycardia
70
When would volume repletion be considered in OB?
severe pre-eclampsia
71
How would intravascular volume repletion be beneficial in OB?
- improve the low CO - normalize right/left cardiac filling pressures - improve CI - decrease maternal HR - decrease SVR and BP - improve fetal circulation

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