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Pharmacology > Lecture 10: Drugs Affecting Uterine Motility > Flashcards

Lecture 10: Drugs Affecting Uterine Motility Flashcards

1
Q

True or False: At the time of birth, there is an increase progesterone:estrogen ratio, which is thought to be crucial for promoting paturition

A

False - there is an increased ESTROGEN:PROGESTERONE

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2
Q

Throughout pregnancy, ____ helps to prevent myometrium from contracting
A. Progesterone
B. Estrogen

A

A. progesterone

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3
Q

What are the two ways by which progesterone prevents myometrium contractions during pregnancy?

A
  1. Hyperpolarizes membrane potential of myometrial SM cells
  2. Promotes calcium storage in sarcoplasmic reticulum
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4
Q

True or False: Estrogen induces expression of GAP junctions, which allows for coordinated contractions during pregnancy

A

True

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5
Q

True or False: Estrogen induces a decrease in the number of oxytocin receptors in the myometrium so that during the 20th-39the week of gestation, the myometrium is highly sensitive to oxytocin

A

False - estrogen induces an INCREASE in the number of oxytocin receptors

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6
Q

____ induces expression of Na channels on myometrial cells, which aids depolarization and, thus, contraction
A. Progesterone
B. Calcium
C. Testosterone
D. Estrogen

A

D. Estrogen

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7
Q

Increased production of ___ by the placenta (near the time of birth) is important for softening and dilating the cervix (cervical ripening) and inducing contractions of the uterus
A. Testosterone
B. Calcium
C. Estrogen
D. Prostaglandins

A

D. Prostaglandins

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8
Q

What are three clinical uses of oxytocics?

A
  1. Induce labor
  2. Control post-partum hemorrhage s/p delivery of fetus and placenta
  3. Induce abortion or expel fetus
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9
Q

What are three clinical uses of oxytocics?

A
  1. Induce labor due to prolonged pregnancy
  2. Control post-partum hemorrhage s/p delivery of fetus and placenta
  3. Induce abortion or expel fetus
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10
Q

Main use of misoprostol, an oxytocics?
A. Induce labor
B. Induce early-term abortion
C. Control post-partum hemorrhage

A

B. Induce abortion

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11
Q

Misoprostol (PGE1 analog) is use with _____
A. Dinoprostone
B. Mifepristone
C. Ergonovine Maleate

A

B. Mifepristone

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12
Q

Main use of ergonovine maleate and methylergonovine maleate?
A. Control post-labor hemorrhaging
B. Induce abortion
C. Induce labor

A

A. Control post-labor hemorrhaging

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13
Q

What is the main use of Intra-amniotic NaCl 20% Injection?
A. Control post-labor hemorrhaging
B. Induce early-term abortion
C. Induce labor
D. Induce late-term abortion

A

D. Induce late-term abortion (also release endogenous oxytocin)

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14
Q

True or False: Ergot Alkaloids are useful drugs for inducing labor

A

False - they are NOT; main use is control of postpartum hemorrhaging

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15
Q

How do prostaglandins cause cervical ripening?

A

Increase collagenase secretion and myometrial contraction

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16
Q

True or False: Oxytocin is dose to effect - meaning that, once you get the desired response, you can reduce dose

A

True

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17
Q

The goal of providing ____ is to get a pattern of 3-5 contractions of 60-90 min duration per 10 min period w/o fetal distress
A. Progesterone
B. Estrogen
C. Oxytocin

A

C. Oxytocin

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18
Q

Most common reason for oxytocic use?

A

Prolonged pregnancy - induce labor

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19
Q

How does oxytocin affect breast tissue?

A

Stimulates myoepithelial cell contraction in breast, which forces milk from alveoli

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20
Q

True or False: Oxytocin reduces postpartum hemorrhage after delivery of fetus/placenta

A

True

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21
Q

How does oxytocin affect systolic and diastolic BP?

A

Decreases both

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22
Q

How does oxytocin affect HR?

A

Increases it
- Can lead to arrythmia

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23
Q

How can oxytocin lead to seizures and death?

A

Oxytocin exhibits an anti-diuretic effect and hyponatremia, secondary to H2O retention

24
Q

How can oxytocin interfere with fetal circulation and constriction?

A

Oxytocin can interfere with fetal circulation because it allows for:
1. sustained uterine contractions
2. uterine hyperstimulation

25
Q

What are the three contraindications for both oxytocin and dinoprostone?

A
  1. Abnormal fetal position
  2. Fetal distress
  3. Previous uterine surgery
26
Q

The uterus is sensitive to ___ throughout the duration of the pregnancy
A. progesterones
B. estrogens
C. prostaglandins

A

C. prostaglandins

27
Q

Why does prostaglandin production increase in the 3rd trimester?

A

Increased production by placenta, fetal membranes, and endometrium (decidua)

28
Q

Prostaglandins bind to receptors in the myometrium and cause ____ of the uterus

A

contraction

29
Q

Binding of prostaglandins to EP1 and FP receptors mediates in increased in intracellular ____

A

calcium

30
Q

How do prostaglandins cause cervical ripening?

A

By increasing secretion of collagenase

31
Q

Which drug/s is/are used for cervical ripening?
A. Mifepristone and Misoprostol
B. Tromethamine and Oxytocin
C. Dinoprostone

A

C. Dinoprostone (Cervidil/Prepidil)

32
Q

True or False: GI disturbances are commonly seen with Dinoprostone

A

True

33
Q

What is an AE associated with dinoprostone?
A. Uterine hypostimulation
B. Uterine hyperstimulation

A

B. Uterine hyperstimulation

34
Q

If you need to control postpartum bleeding that is not responsive to oxytocin or ergot alkaloids, which drug should you use?
A. Prostaglandin
B. Carboprost Tromethamine
C. Nifedipine
D. Dinoprostone

A

B. Carboprost Tromethamine (IM)

35
Q

In addition to controlling postpartum bleeding, Carboprost Tromethamine can also …

A

Induce abortion in 2nd trimester

36
Q

The PGE1 analog Misprostol is used with the anti-progestin RU486 _____ for the termination of early pregnancies

A

Mifepristone

37
Q

____ causes progesterone antagonism, which causes detachment of products of conception ; also SENSITIZES uterus to actions of prostaglandins by inhibiting prostaglandin dehydrogenase
A. Mifepristone
B. Misoprostol

A

A. Mifepristone

38
Q

True or False: Misoprostol promotes uterine contractions

A

True

39
Q

Which adverse effect is associated with Misoprostol?
A. Hypotension and Hyponatremia
B. GI disturbances
C. Anti-diuretic effect
D. Vaginal bleeding, abdominal cramps

A

D. Vaginal bleeding, abdominal cramps

40
Q

Which class of drugs binds to alpha-1 adrenergic receptors in the myometrium, which increases the intracellular free calcium, leading to uterine contractions?
A. Prostaglandins
B. Oxytocin
C. Ergot Alkaloids

A

C. Ergot Alkaloids

41
Q

Primary use of ergot alkaloids?

A

Treat postpartum or postabortion bleeding

42
Q

Nausea/vomit/diarrhea, as well as gangrene (fingers/toes) and HTN are adverse effects associated with:
A. Prostaglandins
B. Oxytocin
C. Ergot Alkaloids
D. Mifepristone
BE Misoprostol

A

C. Ergot Alkaloids

43
Q

If you have a patient with HTN and postpartum/post-abortion bleeding, which ergot alkaloid is a better selection?
A. Ergonovine Maleate
B. Methylergonovine Maleate

A

B. Methylergonovine Maleate (less likely to exacerbate HTN)

44
Q

Ergot alkaloids are contraindicated in which three patient populations?

A

Patients with: 1. HTN, 2. CVD, and 3. Hepatic/Renal Disease

45
Q

____, an anti-progesterone or progesterone antagonist, causes detachment of products of conception from the uterus

A

Mifepristone

46
Q

True or False: Mifepristone is used to terminate pregnancy up to 49 days from LMP

A

True

47
Q

How does Na/Cl Injection induce late term abortions?

A

Damages mucosal membranes of uterus => prostaglandin release => uterine contractions

48
Q

Which four AE are associated with Na/Cl Injection use?

A

Fever
Flush
Nausea
Vomiting

49
Q

What is the primary clinical use of tocolytics?

A

Delay or prevent preterm labor

50
Q

True or False: If labor occurs before 24 weeks of gestation, tocolytic therapy is usually initiated

A

False - usually NOT

51
Q

____ is the only current FDA approved tocolytic agent
A. Indomethachin
B. Hydroxyprogesterone caproate
C. Nifedipine
D. Tertbutaline

A

B. Hydroxyprogesterone caproate

52
Q

Which of the following tocolytics blocks the production of prostaglandins by inhibiting COX enzyme?
A. Nifedipine (CCB)
B. Tertbutaline
C. Indomethacin

A

C. Indomethacin

53
Q

Indomethacin should be used for women who are 24-32 weeks of gestation. What happens if used after 32 weeks?

Which drug can be used in women at 32-34 weeks of gestation?

A

Premature closure of DA and oligohydramnios may occur

  • Nifedipine
54
Q

____, a calcium channel blocker, inhibits myometrial contractions by decreasing intracellular calcium
A. Nifedipine
B. Tertbutaline
C. Indomethacin

A

A. Nifedipine

55
Q

Which tocolytic is an agonist for B2 adrenergic receptors in the myometrium, acts on cAMP, and inhibits contraction?
A. Tertbutaline
B. Indomethacin
C. Nifedipine

A

A. Tertbutaline

56
Q

___ is a tocolytic with a black box warning, may cause death in mom and fetus. Do not use more than 72 hrs to delay labor, only use injectable.

A

Tertbutaline

57
Q

Which tocolytic is used in pregnant mothers with a h/o premature babies?

A

Hydroxyprogesterone caproate

Pharmacology (53 decks)

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