FRS Abortifacients

Question 1

Abortifacients

Answer 1

Dinoprostone

Drugs used to evacuate the uterus by stimulating intense uterine contractions.

Question 2

Types of Abortifacients

Answer 2

• Carboprost (hemabate)- an IM drug used to terminate early pregnancy, evacuate a missed abortion, or control postpartum hemorrhage.
• Dinoprostone (cervidil, prepidil gel, prostin E2) and mifepristone (RU-486, mifeprex)- is a prostaglandin that stimulates uterine contractions- given by intravaginal suppository
  Used to stimulate cervical ripening before labor.
• Mifepristone – acts as an antagonist of progesterone sites in the endometrium, allowing local prostaglandins to stimulate uterine contractions and dislodge or prevent implantation of any fertilized egg.
  (Given orally, 5-7 days for desired effects).

Question 3

Therapeutic Action & Indications

Answer 3

• Stimulates uterine activity, dislodging any implanted trophoblast and preventing implantation of any fertilized egg.
• Stimulates the myometrium of the pregnant uterus to contract, evacuating the contents of the uterus.

Question 4

Uses

Answer 4

To terminate pregnancy 12 – 20 weeks from the date of the last menstrual period.

Carboprost- used to treat postpartum hemorrhage not responsive to usual therapy

Dinoprostone – used to stimulate cervical ripening before induction of labour.

Mifepristone- approved for use during the first 49 days of pregnancy.

Carboprost and dinoprostone – used to evacuate the uterus after a missed abortion or fetal death

Question 5

Pharmacokinetics

Answer 5

• Drugs well absorbed, metabolized in the liver, and excreted in the urine.
• Due to effects on the uterus, used during pregnancy only to end the pregnancy.
• Not recommended for use during lactation- potential for serious effects on the neonates. If used then another method of breast feeding should be used.
• Route- intravaginal
• Onset-10min
• Peak- 15min
• Duration- 2-3h
• T1/2 – 5-10hrs, with tissue metabolism and excretion in the urine

Question 6

Contraindications & Caution

Answer 6

• Not to be used with any known allergy to abortifacients or prostaglandins
• Not be used after 20 weeks from last menstrual period,
• Not be used if experiencing- cardiovascular, hepatic, renal or pulmonary disease
• Caution used with any history of asthma hypertension or adrenal disease and with vaginitis or scarred uterus.

Question 7

Adverse Effects

Answer 7

• Headache
• Hypertension
• Vomiting
• Diarrhea
• Nausea
• Uterine or vaginal pain
• Backache
• Uterine rapture

Question 8

Nursing Implications

Answer 8

Administer via route indicated

Confirm age of pregnancy before administering (ensure appropriate use)

Provide thorough patient teaching, include measures to avoid adverse affects and warning signs of problems to report, to enhance patient knowledge of drug therapy