sustained uterine contractions Methylergonovine (Methergine) Ergotrate ( Ergonovine)

Drugs that affect uterine motility (Contractility) Flashcards by melissa linger

Uterine stimulants

promote/stimulate uterine contractility

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Oxtyocics

oxytocin, pitocin, syntocinon

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Therapeutic actions of Oxytocics

promote an increase in force, frequency and duration of uterine contractions

initiates and or stimulates uterine contractions
stimulates milk letdown reflex

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Pharmacokinetics of Oxytocics

functions similarly to natural oxytocin (hormone produced in hypothalamus & stored in posterior pituitary)

absorption- well absorbed from nasal mucosa
distribution
widely distributed in extracellular fluid
small amounts reach fetal circulation
metabolism/excretion- rapidly metabolized by kidney adn liver
half life 3-9 minutes

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Indications for use of Oxytocics

Induction of labor- initiate uterine contractions prior to spontaneous onset of labor and/or contractions that will lead to labor and delivery
Increase effectiveness of contractions- when inadequate or ineffective uterine contractions during labor
Postpartum- control bleeding and promote involution
Stimulation of milk letdown reflex- in breastfeeding mothers

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Drug interactions of oxytocics

severe hypertension may result if oxytocin given after administration of vasopressors
Hypotension may result if used concurrently with cyclopropane anesthesia

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Complications/ side-effects of oxytocin

anti-diuretic effect- non electrolyte IV solutions should not be used for infusions may lead to water intoxication
increased cardiac output which may lead to increased blood pressure
IV bolus may lead to decreased blood pressure and tachycardia
Increase chance of neonatal hyperbilirubinemia
increased risk f abnormally strong or titanic contractions which leads to fetal distress (also placental perfusion decreases)
Uterine overstimulation
Increased risk of uterine rupture
Increased chance of placental abruption
associated with increased risk of epidurlal anesthesia and increased risk of c-section

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Contraindications of Oxytocics

Abnormal fetal lie, CPD, or cord presentation
Prior surgery or trauma to the uterus
Placental abnormalities- complete placenta previa or if a complete placental abruption has occurred or is suspected
Non-reassuring FHR, fetal distress; and or positive stress test (OCT)
Active gental herpes
Abnormalities of uterus, cervix, pelvis, or vagina that are not compatible with a vaginal delivery
Invasive cervical cancer

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Implications of Oxytocics

*THE FDA RECOMMENDS THE USE OF PITCOIN ONLY WHEN MEDICALLY INDICATED. IT SHOULD NOT BE GIVEN FOR ELECTIVE INDUCTION OF LABOR

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Indications for use when initiating labor

Inadequate uterine contractions after PROM
Post- term fetus or IUGR
Fetus is jeopardy if no delivered ASAP
Maternal medication problems ( severe Rh incompatibility, isoimmunizaton, diabetes or renal disease
Preeclampsia/Eclampsia and or HELP
intrauterine fetal demise (stillbirth)
Logistics- history of precipitous labors (especially when must travel long distance for delivery)

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Favorable indicatiors

conditions necessary for successful induction

Bishops Pelvic Score- the higher the score the greater the chance of a favorable outcome
0 to 3 for each of area
cervical dilation
cervical effacement
cervical consistency (firm, medium, or soft)
station- related to ishial spines
position (posterior vs anterior)

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Nursing interventions/ responsibilities related to Oxytocics

monitor contractions- frequency, duration, and strength
Give IV piggyback with infusion pump
Monitor FHR and maternal vital signs
Stop infusion if unfavorable FHR
Use electrolyte solution to lessen chance of antidiuretic effect
monitor for water intoxication

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Ergot Alkaloids

sustained uterine contractions
Methylergonovine (Methergine)
Ergotrate ( Ergonovine)

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Pharmacokentics of Ergot alkaloids

effect uterine and smooth muscle stimulates adrenergic, dopaminergic, and serotonergic receptors which results in
stimulation of uterine contractions
constriction of arterioles and veins

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Drug interatctions with Ergot alkaloids

parenteral sympathomimetics and other ergot alkaloids administered together to result in increased vasomotor action and can lead to hypertension

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Indication of use of Ergot alkaloids

post abortion and postpartum period only
increase uterine tone
decrease bleeding

Adverse side effects of Ergot alkaloids

SEVERE HYPERTENSION
bradycardia
N/V
seizures and gangrene with overdose

Contraindications of Ergot alkaloids

prior to delivery of placenta
if there is uterine sepsis
for threatened spontaneous abortion
if preeclampsia/eclampsia

Nursing implications/ considerations of Ergot alkaloids

Caution if history of cardiovascular, renal or hepatic dysfunction
Due to adverse side effects- usually reserved for use with severe and/or life threatening uterine bleeding
Monitor vital signs and uterine response during and after parenteral administration until patient stabilized (usually 1-2 hrs)

Prostaglandins

Hormone which are synthesized in all body tissues

clinical uses are limited- usually given in conjunction with oxytocin

Therapeutic actions of Prostaglandins

Induce abortion
Evacuate uterus with missed abortion, begin hydatidiform mole, or intrauterine fetal death up to 28 weeks gestation
induce cervical ripening
control postpartum hemorrhage
stimulates myometrium (smooth muscle layer of uterus) to contract and lead to hemostasis at placental attachment site

Pharmacokinetics of Prostaglandins

mechanism of action not fully determined

Drug interactions of prostaglandins

increases action of oxytocic drugs

Prostaglandins Contraindicated for patients with

acute pelvic inflammatory disease (PID)
Uterine fibroids
Cervical stenosis
Cardiac pulmonary, renal or hepatic disease

Adverse side effects of Prostaglandins

* Dizziness, headache, fainting flushing * acute hypertension chest pain and dysrthymias (Due to stimulation of smooth muscle) * sustained uterine contractility may lead to cervical lacerations and uterine ruputre

Nursing implications of prostaglandins

* administered intravaginally after warmed to room temperature * carefully monitor uterine activity and fetal status ( hypertonic contractions and fetal distress)

Prostaglandins most commonly utilized:

1. Dioprostone (cervidil, prepidil gel) 2. Misoprostol (cytotec) 3. Carboprost tromethamine (hemabate, prostin/15m)

Misoprostol

* cervical ripening is unlabeled use - oxytocin may be started 1 hour after 1st dose - decreased acid secretion and protects GI mucosa ( most commonly used for NSAID-induced ulcers) * most common side effects are diarrhea and abdominal pain

Carboprost tromethamine

dose: 250 mcg IM (Deep IM) - induce pharmacologic abortion between 13-20 weeks - control postpartum bleeding * most common side effects is vomiting and diarrhea

Progesterone Receptor Antagonist

Mifepristone (Mifeprex, RU-486) synthetic steroid/abortifacient * medical termination of pregnancies up to 49 days gestation * softening and dilation of the cervix prior to mechanical cervical dilation for pregnancy termination * labor induction when fetal death inutero * prevents ovulation when taken daily (2mg/day) * 10 mg given prior to ovulation delays ovulation by 3-4 days

Most common side effects

nearly all women experience abdominal pain uterine cramping, vaginal bleeding and spotting for an average of 9-16 days

In medical abortion blockage of progesterone receptors directly causes

endometrial decidual degeneration cervical softening and dialation release of endogeneou prostaglandins

Tocolytics

uterine relaxants drugs that relax uterine smooth muscle to inhibit uterine contractions during preterm labor * not used before 20 weeks gestation*

Goal of tocolytic therapy

* inhibit/interrupt uterine contractions and provide increased time inutero for fetal growth and development * delay delivery in order to allow antenatal steroids to be effects * allow safe transport of mother ( with baby still inutero)