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Pharmacology > Exam 11: Oxytocics > Flashcards

Exam 11: Oxytocics Flashcards

1
Q

What hormone ratio is important in promoting parturition?

A

Increased estrogen to progesterone

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2
Q

What hormone prevents contractions throughout pregnancy?

A

Progesterone

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3
Q

Two mechanisms behind progesterone preventing uterine contractions

A
  1. Hyperpolarizing membrane potential of smooth muscle cells

2. Promoting Ca2+ storage in the sarcoplasmic reticulum

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4
Q

3 mechanisms behind estrogen promoting contractions

A
  1. Induction of Na+ channels
  2. Induction of gap junctions
  3. Induction of oxytocin receptors
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5
Q

What causes softening/ripening of the cervix for parturition?

A

Prostaglandins

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6
Q

3 uses for Oxytocics

A
  1. Induction or augmentation of labor
  2. Control of postpartum uterine hemorrhage (the number 1 cause of maternal mortality)
  3. Induction of abortion or expulsion of dead fetus after intrauterine death
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7
Q

2 uses of Tocolytics

A
  1. Delay or prevention of preterm labor

2. Slow or arrest delivery so therapeutic actions can be taken

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8
Q

Definition of pre-term labor

A

Before 37 weeks

Contractions every 10 minutes lasting 30 seconds

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9
Q

Chemical composition of Oxytocin

A

Nonapeptide (9 amino acids)

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10
Q

Oxytocin mechanism

A

Gq (increased calcium, phospholipase C)

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11
Q

What causes increased sensitivity of the uterus to oxytocin in gestation?

A

Estrogen

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12
Q

Goal of IV oxytocin in labor induction

A

3-5 contractions of 60-90 seconds per 10 minute period without fetal distress

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13
Q

Most common indication for Oxytocin use in labor induction

A

Prolonged pregnancy (42 weeks)

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14
Q

4 reasons for oxytocin labor induction

A
  1. Mother or fetus is at risk and you need to deliver now
  2. Premature rupture of membranes
  3. Prolonged pregnancy
  4. Selective induction (mom’s choice)
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15
Q

Oxytocin effects on breast

A

Contracts myoepithelial cells forcing milk out of the alveoli of the breast

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16
Q

CV side effects of Oxytocin

A

Hypotension
tachycardia
arrhythmia

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17
Q

Electrolyte abnormality associated with Oxytocin use

A

Hyponatremia due to antidiuretic effect and water retention

Can lead to seizures and death

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18
Q

Serious fetal complication associated with oxytocin use

A

Sustained contraction/hyperstimulation can interfere with fetal circulation

19
Q

Oxytocin contraindications (3)

A
  1. Abnormal fetal position
  2. Fetal distress
  3. Previous uterine surgery
20
Q

What happens to prostaglandin production in pregnancy?

A

Increases in the 3rd trimester from the placenta and endometrium

21
Q

PG effect on the uterus (mechanism)

A

Cause contractions by mediating an increase in intracellular calcium

22
Q

PG effects on cervix (mechanism)

A

Cervical ripening by increasing secretion of collagenase

23
Q

Dinoprostone

A

PGE2

24
Q

Prepidil, Cervidil

A

PGE2 preparations used for cervical ripening

25
Q

2 side effects of PGE2 preparations (prepidil, cervidil)

A
  1. GI disturbance

2. Uterine hyperstimulation

26
Q

PGE2 contraindications

A

Same as oxytocin

  1. Abnormal fetal position
  2. Fetal distress
  3. Previous uterine surgery
27
Q

15-methyl PGF2alpha (Carbaprost) Tromethamine

2 uses

A

2nd line drug to control postpartum bleeding after oxytocin or ergot alkaloids
Can also induce abortion in the second trimester

28
Q

Misoprostol

A

PGE1 analog
Used to terminate early pregnancies (up to 49 days from LMP)
Promotes uterine contractions and causes detatchment

29
Q

Ergonovine and Methylergonovine

A

Ergot Alkaloids
Binds alpha-1 receptors, causing an increase in Ca2+ and uterine contractions
Used for postpartum or post abortion bleeding

30
Q

Ergonovine and Methylergonovine uses

A

Postpartum or post abortion bleeding

DO NOT use for labor induction or augmentation

31
Q

Ergot alkaloid side effects

A

Think alpha 1
HTN due to vasoconstriction
NVD
Gangrene of the fingers/toes

32
Q

Ergot alkaloid contraindications

A

HTN
CV disease
Liver or kidney disease

33
Q

Mifepristone

A

Progesterone antagonist

34
Q

Mifepristone use, mechanism

A

Termination of pregnancy up to 49 days from LMP
Progesterone antagonist
Causes detachment of the products of conception

35
Q

Sodium Chloride 20%, urea 40 50% injection mechanism

A

Damages mucosa of uterus causing release of Prostaglandins leading to uterine contractions

36
Q

Sodium Chloride 20%, urea 40 50% injection use

A

late term abortions

37
Q

FDA approved tocolytic agent

A

There isn’t one

38
Q

When are tocolytics used/

A

to delay premature labor up to 24 hours in patients between 24 and 34 weeks gestation

39
Q

Indomethacin

A

PG-synthetase inhibitor
use to prevent labor at weeks 24-32.
Dont use it after 32 weeks or you may cause closure of ductus arteriosus and oligohydramnios

40
Q

nifedipine mechansim

A

inhibits contractions by decreasing intracellular calcium

41
Q

Nifedipine use in pregnancy

A

used as a tocolytic between 32-34 weeks because you wouldn’t want to use indomethacin that late

42
Q

Terbutaline

A

B2 agonist
Inhibits contraction
Very dangerous to mother and fetus
Difficult to dose correctly

43
Q

Mg sulfate

A

Tocolytic
decreases intracellular calcium
Not very effective at delaying birth

Pharmacology (34 decks)

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