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Reproductive > PHARM: Drugs that Affect Labor > Flashcards

PHARM: Drugs that Affect Labor Flashcards

1
Q

List some ACOG indications for elective induction of labor.

A
  • Pre-eclampsia/Eclampsia (and other HTN disorders)
  • Maternal Diabetes
  • Premature rupture of membranes
  • Chorioamnionitis
  • Intrauterine fetal growth restriction
  • Fetal Demise
  • Postterm Pregnancy (at 41 weeks)
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2
Q

List some contraindications to labor induction.

A 
active genital herpes infection
placenta or vasa previa
umbilical cord prolapse
fetal malpresentations
previous classical uterine incision
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3
Q

What is an “Oxytocic” drug?

A

a drug to induce labor

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4
Q

What is a “tocolytic” drug?

A

drug to prevent labor

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5
Q

What is pitocin?

A

synthetic analog of oxytocin that leads to uterine SM contractions→ stimulate labor

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6
Q

List the prostaglandins used to induce labor.

A

Dinoprostone
Misoprostol
Carboprost Tromethamine

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7
Q

What is dinoprostone?

A

PGE2 analog

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8
Q

What is misoprostol?

A

PGE1 analog

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9
Q

What is carboprost tromethamine?

A

15-methyl PGF-2alpha

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10
Q

List two tocolytics used to delay labor.

A

Magnesium Sulfate

Indomethacin

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11
Q

Which patients are good candidates for indomethacin?

A

useful in patients less than 32 weeks gestation

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12
Q

List some OTCs/herbal remedies used to induce labor.

A

Caster Oil
Blue Cohosh
Black Cohosh
Oil of the Evening Primrose

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13
Q

How do prostaglandin E analogs work in pregnant women?

A

blocks progesterone and cause a local inflammatory response (PGE2 stimulates cervical ripening)

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14
Q

How does carboprost tromethamine work?

A

binds to progesterone receptors on the myometrium to stimulate uterine contractions

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15
Q

MOA: prevents preterm labor by blocking membrane intracellular calcium channels which decreases myometrial contractility

A

magnesium sulfate

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16
Q

MOA: Nonselective COX inhibitor used to treat pre-term labor: blocks formation of gap junctions in the myometrium that increase intracellular calcium and facilitate myometrial contractility.

A

Indomethacin

17
Q

MOA: Herb with oxytotic effects used for labor induction

A

Blue Cohosh

18
Q

MOA: Herb with estrogenic effects used for cervical ripening

A

Black Cohosh

19
Q

MOA: Potentiates effects of prostaglandins for cervical ripening

A

Oil of the Evening Primrose

20
Q

What is the most commonly used herbal therapy to stimulate labor?

A

caster oil

21
Q

TOXICITY: Uterine hyperstimulation; post-partum hemorrhage; antidiuretic effect (water intoxication and hyponatremia)

A

Pitocin

22
Q

TOXICITY: Abruption, intrapartum and postpartum hemorrhage; alteration of FHR and uterine rupture; GI side effects and fever are uncommon with vaginal administration

A

PGs

23
Q

TOXICITY: 60% of women have flushing, nausea, blurry vision, headache, lethargy, hypotension and pulmonary edema; Mg toxicity (loss of patellar reflexes)

A

Magnesium Sulfate

24
Q

TOXICITY: nausea, vomiting, gastroesophageal reflux, and gastritis. In addition, platelet dysfunction

A

indomethacin

25
Q

TOXICITY: Precipitate labor, abruption, severe gastric cramping, diarrhea and dehydration

A

caster oil

26
Q

TOXICITY: Can lead to abortion because of vasodilatory effects

A

Black Cohosh

27
Q

FETAL TOXICITY: May lead to primary premature closure of the DA or oligohydramnios in fetus with long-term use; possible necrotizing enterocolitis, intraventricular hemorrhage, and cardiac, pulmonary, and renal abnormalities

A

Indomethacin

28
Q

What drug is contraindicated in women with myasthenia gravis and should be used in caution in the setting of renal insufficiency because it is excreted by the kidneys.

A

Magnesium sulfate

29
Q

How long must you wait to give oxytocin after misoprostol?

A

4 hours

30
Q

How long must you wait to give oxytocin after Dinoprostone?

A

.5-1 hours

31
Q

What is the ROA of dinoprostone?

A

Time released suppository left in place for 12 hours

32
Q

Why does the half life of Pitocin alter adverse effects?

A

Half life is 10-12 minutes so complications like hyperstimulation are rapidly reversible

33
Q

During pregnancy, the placenta releases what hormone that hyperpolarizes the smooth muscle membrane to make it non-excitable and prevents arachidonic acid release (so no PG synthesis)?

A

progesterone

34
Q

What happens to the uterus as parturition approaches?

A

estrogen is increased relative to progesterone and increases the number of receptors for contractile agonists and increases the number of gap junctions that electrically couple myometrial cells

35
Q

What are the major uses of oxytocics?

A

Induce Labor
Control postpartum uterine hemorrhage
Induce uterine contraction post C-section/uterine surgery
Induction of therapeutic abortion

36
Q

What is the major indication for a tocolytic?

A

slow or arrest delivery for brief periods for therapeutic measures like glucocorticoid therapy to increase fetal surfactant

Reproductive (21 decks)

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