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KG - Pharmacology 2 > Kg - Pharm 2 Exam 3, Uterine Drugs > Flashcards

Kg - Pharm 2 Exam 3, Uterine Drugs Flashcards

1
Q

types of drugs used for uterine contraction?

A
  • estrogens
  • prostaglandins
  • oxytocin
  • stretching
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2
Q

types of drugs used for uterine relaxation?

A
  • beta adrenergic drugs (b2 relax all smooth muscle)
  • progesterone
  • alcohol
  • MgSO4
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3
Q

DOC for inducing labor at term? (and why?)

A

oxytocin

- NUMBER AND SENSITIVITY OF OXYTOCIN RECEPTORS in uterus increase just prior to delivery

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4
Q

what is useful to induce abortions during second trimester? (and why?)

A

prostaglandins
- uterus gen resistant to stimulation during 2nd trimester, but prostaglandins can CAUSE STRONG LABOR LIKE CONTRACTIONS at this stage

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5
Q

in postpartum hemorrhage, why is uterine massage 1st line treatment?

A

physical stretching stimulates uterine muscle contractions

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6
Q

how/when is oxytocin usu released?

A

in response to suckling/cervical pressure

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7
Q

oxytocin - indications/therapeutic effects?

A

DOC to INDUCE LABOR AT TERM IF INDICATED

  • causes timed contractions
  • IV infusion preferred
  • augment labor in pts w/ uterine dysfunctional inertia

FOR PREVENTION OF HEMORRHAGE
- IM route preferred

STIMULATION OF MILK LET DOWN REFLEX
- nasal application method preferred

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8
Q

oxytocin - adverse effects

A
  • WATER INTOXICATION w/ convulsions
  • -> bc of ADH like effect (only if doses large/prolonged infusion)
  • UTERINE RUPTURE w/ large dose
  • allergy
  • ANAPHYLAXIS
  • SINUS BRADYCARDIA of fetus
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9
Q

oxytocin - pharmacokinetics?

A
  • very short half life 1-6 min

- inactivated by liver/kidneys

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10
Q

oxytocin - contraindications/precautions?

A

anything that prevents vaginal delivery

  • malpresentation
  • cephalopelvic disproportion
  • placenta previa
  • uterine scar
  • unengaged head
  • cervical scarring
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11
Q

Ergot alkaloids - MOA

A
  • contraction of uterine smooth muscle via activation of serotonin and alpha adrenergic receptors
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12
Q

ergot alkaloids - indications/therapeutic effects

A
  • AFTER COMPLETION OF LABOR/DELIVERY OF PLACENTA to produce firm uterine contraction to decrease uterine bleeding
    –> 2nd line after massage and oxytocin have failed
    (for same reasons following suction abortion)
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13
Q

ergot alkaloids - pharmacokinetics

A
  • rapid action (30-40 sec after IV, 10 min after oral use)

- lasts several hours

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14
Q

ergot alkaloids - adverse effects

A
  • transient hypertension (contracts all smooth muscle)

- angina, MI

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15
Q

ergot alkaloids - contraindications/precautions?

A
  • NEVER USED TO INDUCE LABOR (would cause fetal hypoxia)

- OBLITERATIVE VASCULAR/CAD

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16
Q

dinoprostone - indications/therapeutic effects

A
  • expulsion of uterine contents (intrauterine fetal death, miscarriage, elective abortion)
  • cervical ripening prior to delivery at term
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17
Q

dinoprostone - pharmacokinetics

A

abortion:
- one suppository in vagina (subsequent q 3-5 hrs until abortion occurs)

for cervical ripening:
- apply gel to cervix

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18
Q

dinoprostone - adverse effects

A
  • GI, VOMITING, DIARRHEA***

- fever, chills, HA

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19
Q

dinoprostone - contraindications/precautions

A

abortion - NOT TO BE USED w/:

  • acute pelvic inflammation
  • ACUTE CARDIAC, PULMONARY, RENAL, HEPATIC DZ
  • ASTHMA, HTN, ANEMIA, JAUNDICE, EPILEPSY

for cervical ripening:

  • fetal distress
  • hx difficult deliveries or c-section
20
Q

carboprost tromethamine - indications/therapeutic effects?

A
  • induce abortion in 13th/20th wk
  • postpartum bleeding due to uterine atony
  • -> 3rd like after massage, oxytocin, ergots
21
Q

dinoprostone - info?

A

synthetic prostaglandin E2

22
Q

carboprost tromethamine - info?

A

derivative of PGF2

23
Q

carboprost tromethamine - pharmacokinetics?

A
  • IM

- methylation increases half life from 15 sec to 8 min

24
Q

carboprost tromethamine - adverse effects?

A
  • not serious if used properly
  • systemic PG actions often diagnosed as anaphylactic shock
  • VOMITING, DIARRHEA
  • fever, rash
25
Q

carboprost tromethamine - contraindications/precautions?

A

NOT TO BE USED IN PTS w/:

  • acute pelvic inflammation
  • ACUTE CARDIAC, PULMONARY, RENAL, HEPATIC DZ
  • ASTHMA, HTN, ANEMIA, JAUNDICE, EPILEPSY
26
Q

goal of uterine relaxants?

A

prevent premature labor/delay premature delivery until term/until fetus has matured to 37th week

  • IF NEEDED, delivery can be before 37th week if fetal lungs developed (corticosteroids!)
  • NO OPTION IS FDA APPROVED or DOC
27
Q

MgSO4 - MOA

A

mechanism unknown

- probably relaxes uterus by direct effect

28
Q

MgSO4 - indications/therapeutic effect?

A
  • considered 1st like drug

- can prevent convulsions in pre-eclampsia and treat eclampsia (FDA app)

29
Q

MgSO4 - pharmacokinetics?

A
  • IV, slowly
30
Q

MgSO4 - adverse effects?

A
  • flushing, diaphoresis,hypotension
  • depressed DTRs, muscle paralysis, weakness, lethargy, hypothermia
  • circulatory collapse, cardiac/respiratory depression
31
Q

nifedipine - info?

A

CCB

32
Q

nifedipine - MOA?

A

inhibits Ca2+ influx (muscle contraction)

33
Q

nifedipine - indications/therapeutic effects?

A

becoming 1st line agent for uterine relaxation

34
Q

indomethacin - info?

A

first 2nd line drug to delay labor

35
Q

indomethacin - MOA?

A
  • strong inhibitor COX enzyme

- reduction prostaglandin synthesis

36
Q

indomethacin - adverse effects?

A
  • maternal GI irritation, peptic ulceration, thrombocytopenia, allergic rxn, HA, dizziness
  • reports abt PARTIAL CLOSURE OF FETAL DUCTUS ARTERIOSUS, impaired renal function, bronchopulmonary dysplasia, persistent HTN in neonatal period
37
Q

progesterone - indications/therapeutic effects?

A
  • more effective than placebo in maintaining length of pregnancy when given PROPHYLACTICALLY from 16th to 37th week or until delivery
  • -> NOT EFFECTIVE FOR ACUTE TREATMENT
  • for high risk women/women w/ hx preterm births
38
Q

nitroglycerine - info

A

EMERGENCY USE ONLY - in case of uterine rupture!

39
Q

nitroglycerine - indications/therapeutic effects?

A

quick uterine relaxation, EMERGENCY ONLY

40
Q

nitroglycerine - contraindications/precautions?

A
  • uncorrected hypovolemia
  • severe anemia
  • increased intracranial pressure
  • constrictive pericarditis/pericardial tamponade
  • hypersensitivity
41
Q

ethanol - info

A

historically used in rural areas

42
Q

ethanol - MOA?

A

direct relaxant effect on myometrium and inhibition of oxytocin release

43
Q

ethanol - indications/therapeutic effects?

A

inhibit premature labor

44
Q

ethanol - pharmacokinetics?

A
  • loading dose (10% injection) for 2 hrs w/ maintenance infusion rate for up to 10 hrs
45
Q

oxytocic = ___?

A

uterine contractions

46
Q

tocolytic = ___?

A

uterine relaxation

KG - Pharmacology 2 (10 decks)

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