Medications

Question 1

Methergonovine

Answer 1

MOA: ergot alkyloid > vasoconstriction and uterine contractions
Dose: 0.2 mg q 15 mins IM or IMM (really q2h, max 5 doses)
CI: hypertension
SE: dizziness, palpitations

Question 2

Carboprost / Hemabate

Answer 2

MOA: PGF-2alpha receptor > uterine contractions
Dose: 250 mcg q 15 mins x8 IM or IMM
CI: asthma
SE: low fever, diarrhea

Question 3

Misoprostol for:
PPH
IOL
Termination

Answer 3

MOA: PGE1 > uterine smooth muscle contractions, cervical collagen degradation
Dose:
- PPH: 600-1000 mg x1
- MAB up to 70d: 800 mg buccally (x30 min) or vaginally
- IOL:

CI: none, no proven teratogenicity
SE: mild fever, GI upset

Question 4

TXA for
PPH
AUB

Answer 4

MOA: antifibrinolytic, binds to lysine on plasminogen, prevents plasmin from binding fibrin and stabilizes clot
Dose:
- PPH: 1 gram w/in 3 hrs
- AUB: 1300 mg TIX x 5 days
CI: Hx of VTE, active VTE, intracranial bleeding, > 3 hrs from event
SE: VTE, HA, nausea