L43- Contraceptives (uterine drugs) Flashcards
Oxytocics:
- (1) is the goal with (2) consideration
- (3) is induced to improve goal of (1) via (4) agents
1- labor induction
2- maternal and fetal risks
3- cervical ripening (reduce rate of failed induction)
4- PGs: dinoprostone, misoprostol
PGs:
- (1) effect on uterus
- (2) is only administered if necessary (include route)
1- ripens cervix and some uterine contraction stimulation
2- oxytocics (oxytocin –> IV infusion)
Dinoprostone:
- synthetic PG-(1)
- (2) route of administration
Misoprostol:
- PG-(3) analog
- (4) route of administration
1- PG-E2
2- vaginal insert, cervical gel
3- PG-E1
4- intravaginally, po, SL
PG AEs
- fever, chills
- v/d
- tachysystole
Oxytocin stimulates (1) receptors to increase (2) intracellularly and activate (3). It will also increase (4) synthesis for (5) purpose.
1- Gq 2- Ca++ 3- MLCK --> uterine contraction 4- PG synthesis 5- uterine contractions
(1) is the most common cause of postpartum hemorrhage, usually treated with (2) and (3)- which includes (4)
1- uterine atony
2- uterine massage
3- oxytocic drugs
4- oxytocin (IM, unless already receiving IV infusion) –> ergot alkaloids –> PGs
Ergot alkaloids, mainly (1), is used for (2) associated with labor. (1) will stimulate (3), the effect is increased during pregnancy.
1- methylergonovine
2- postpartum hemorrhage
3- partial α-agonist, serotonin agonist
Methylergonovine AEs, contraindications
AEs: generally minimally severe
-HTN, HA, n/v, chest pains
Contraindications:
- angina, MI,
- CVA, ischemic attack
- HTN
- pregnancy
describe the PGs used for postpartum hemorrhage:
- PG analog type
- route of administration
Carboprost Tromethamine:
-PG-F2α given IM
Misoprostol:
-PG-E1 given vaginally, po
(1) define preterm
(2) criteria for preterm Tx
(3) preterm Tx
1- before 37 wks
2- <34wks
3- tocolytics (uterine relaxants), glucocorticoids
describe purpose of components of preterm Tx
Tocolytics: uterine relaxant to delay delivery (bides time)
Glucocorticoids (need time for max effect) –> fetal lung development
-dec risk of neonatal ARDS, intracranial bleeding, mortality
list the tocolytics (indicate drug of choice)
(no drug of choice, most common:)
- Mg sulfate
- indomethacin
- nifedipine
- atosiban (not in US)
- β2 agonist
MgSO4(2-) AEs
(tocolytic: uterine relaxant)
Maternal:
-cardiac arrest
-respiratory distress
Fetal:
-respiratory and motor depression
Indomethcin use in labor, explain + AEs
(tocolytic: uterine relaxant)
NSAID –> dec PGs –> inhibit labor and uterine contractions
Note- most effective after 32wks
-Fetal AE –> oligohydraminos via dec RBF (used more than 48hrs) OR premature ductus arteriosus closure
Nifedipine use in labor, explain + AEs
(tocolytic: uterine relaxant)
- blocks Ca into myometrial cells –> inhibits contractions
- effective and safe, most efficacious
AEs, maternal: tachycardia, palpitations, flushing, HAs, dizziness, nausea
