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High Risk Maternity Drugs > Drugs that affect uterine motility (Contractility) > Flashcards

Drugs that affect uterine motility (Contractility) Flashcards

1
Q

Uterine stimulants

A

promote/stimulate uterine contractility

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2
Q

Oxtyocics

A

oxytocin, pitocin, syntocinon

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3
Q

Therapeutic actions of Oxytocics

A

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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4
Q

Pharmacokinetics of Oxytocics

A

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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5
Q

Indications for use of Oxytocics

A
  • 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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6
Q

Drug interactions of oxytocics

A
  • severe hypertension may result if oxytocin given after administration of vasopressors
  • Hypotension may result if used concurrently with cyclopropane anesthesia
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7
Q

Complications/ side-effects of oxytocin

A
  • 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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8
Q

Contraindications of Oxytocics

A
  • 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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9
Q

Implications of Oxytocics

A

*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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10
Q

Indications for use when initiating labor

A
  • 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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11
Q

Favorable indicatiors

A

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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12
Q

Nursing interventions/ responsibilities related to Oxytocics

A
  • 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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13
Q

Ergot Alkaloids

A
  • sustained uterine contractions
  • Methylergonovine (Methergine)
  • Ergotrate ( Ergonovine)
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14
Q

Pharmacokentics of Ergot alkaloids

A
  • 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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15
Q

Drug interatctions with Ergot alkaloids

A
  • parenteral sympathomimetics and other ergot alkaloids administered together to result in increased vasomotor action and can lead to hypertension
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16
Q

Indication of use of Ergot alkaloids

A
  • post abortion and postpartum period only
  • increase uterine tone
  • decrease bleeding
17
Q

Adverse side effects of Ergot alkaloids

A
  • SEVERE HYPERTENSION
  • bradycardia
  • N/V
  • seizures and gangrene with overdose
18
Q

Contraindications of Ergot alkaloids

A
  • prior to delivery of placenta
  • if there is uterine sepsis
  • for threatened spontaneous abortion
  • if preeclampsia/eclampsia
19
Q

Nursing implications/ considerations of Ergot alkaloids

A
  • 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)
20
Q

Prostaglandins

A

Hormone which are synthesized in all body tissues

clinical uses are limited- usually given in conjunction with oxytocin

21
Q

Therapeutic actions of Prostaglandins

A
  • 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
22
Q

Pharmacokinetics of Prostaglandins

A

mechanism of action not fully determined

23
Q

Drug interactions of prostaglandins

A

increases action of oxytocic drugs

24
Q

Prostaglandins Contraindicated for patients with

A
  • acute pelvic inflammatory disease (PID)
  • Uterine fibroids
  • Cervical stenosis
  • Cardiac pulmonary, renal or hepatic disease
25
Q

Adverse side effects of Prostaglandins

A
  • 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
26
Q

Nursing implications of prostaglandins

A
  • administered intravaginally after warmed to room temperature
  • carefully monitor uterine activity and fetal status ( hypertonic contractions and fetal distress)
27
Q

Prostaglandins most commonly utilized:

A
  1. Dioprostone (cervidil, prepidil gel)
  2. Misoprostol (cytotec)
  3. Carboprost tromethamine (hemabate, prostin/15m)
28
Q

Misoprostol

A
  • 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
29
Q

Carboprost tromethamine

A

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

30
Q

Progesterone Receptor Antagonist

A

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
31
Q

Most common side effects

A

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

32
Q

In medical abortion blockage of progesterone receptors directly causes

A

endometrial decidual degeneration
cervical softening and dialation
release of endogeneou prostaglandins

33
Q

Tocolytics

A

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

34
Q

Goal of tocolytic therapy

A
  • 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)

High Risk Maternity Drugs (1 decks)

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