Pharmacotherapy of Parturition and Lactation Flashcards
What is the therapy for Medical termination of pregnancy?
It is achieved by administering Mifepristone or methotrexate followed by misoprostol to expel uterine contents. Approved for gestational ages up to 49 days
What is the MOA of Mifepristone?
Progesterone receptor antagonist -> induces detachment of blastocyst
What is the MOA of Methotrexate?
Anti-folate-> feticidal action on blastocyst
What is the MOA of Misoprostol?
PGE1 - contract uterus and expels uterine contents
What are the AE of Mifepristone, methotrexate and misoprostol?
Nausea, diarrhea, fever, excessive uterine bleeding, uterine rupture, and incomplete abortion
What are the Tocolytic drugs?
Used to decrease uterine contractility and delay labor- pts diagnozed with preterm labor prior to 34 weeks and they also receive glucocorticoids for mature lung.
1) Terbutaline
2) Nifedipine
3) Indomethacin
What is the MOA of terbutaline?
Beta 2 agonist-> relaxation of myometrium
What is the use of terbutaline?
Preterm labor
What is the AE of terbutaline?
tachycardia, tremors, hypotension, hyperglycemia
C/I in women with cardiac disease, hypothyroidism, or diabetes mellitus
What is the MOA of Nifedipine?
Inhibits activity of myosin light chain kinase by decreasing intracellular Ca -> relaxation of myometrium
What is the use of nifedipine?
preterm labor
What are the AE of nifedipine?
nausea, flushing, headache, dizziness and palpitations
What is the MOA indomethacin?
inhibits cyclooxygenaase activity to decrease PG synthesis (PGs normally stimulate sensitize the myometrium to contractile stimuli)
What is the use of indomethacin?
preterm labor
What is the AE of indomethasone?
nausea, vomitting, gastritis in mothers
*** premature closure of ductus arteriosus in fetus
What are the drugs used for induction and maintenance of labor?
involves stimulation of uterine contractions to accomplish delivery prior to onset of spontaneous labor - intravaginal PGs are used to dilate the cervix followed by oxytocin to augment labor
1) Misoprostol
2) Dinoprostone
3) Oxytocin
What is the MOA for misoprostol?
Prostaglandin analog help ripen cervix and initiate labor (PGE1)
What is the use for misoprostol?
labor
What is the MOA of Dinoprostone?
Prostaglandin analogs help ripen cervix and initiate labor (PGE2)
What is the use of Dinoprosterone?
Labor
What is the MOA of oxytocin?
Augments force and frequency of uterine contractions; iv admin, short half life so easy to control
What is the use of oxytocin?
labor
What is the AE of oxytocin?
Water intoxication, excessive uterine contractions and uterine rupture
What are the drugs used for postpartum hemorrhage?
can be treated with oxytocin, ergonovine or misoprostol (rectal admin)
What is the MOA of ergonovine?
partial agonist at 5-HT2 and alpha receptors -> sustained contraction of uterine muscles stops bleeding
What is the use of ergonovine?
post partum hemorrhage
What is the AE of ergonovine?
CI in HTN, liver/ kidney disease, sepsis
What are the drugs used for lactation?
Metoclopramide, Domperidone, Bromocriptine, Cabergoline, oral contraceptives
What is the MOA of Metoclopramide and Domperidone?
dopamine antagonist - increase milk production by increasing prolactin secretion
What is the MOA of Bromocriptine and Cabergoline?
Suppress milk production by decreasing prolactin secretion
What is the MOA of oral contraceptives
Estogens may suppress lactation, but combined OCs not recommended immediately post partum (progestin - only preps preferred)
What is FDA pregnancy category A?
Studies show no risk to human fetus
What is FDA pregnancy category B?
Animals studies show no risk
What is FDA pregnancy category C?
Animals studies show risk
What is FDA pregnancy category D?
Positive evidence of human fetal risk
What is FDA pregnancy category X?
Contraindicated in pregnancy
