PPH meds

Question 1

What is the dose/route of Methylergonovine maleate (Methergine)?

After giving the 1st dose, how often can you repeat it?

Answer 1

0.2 mg IM

• May repeat in 5 min.
• thereafter, q2-4 hours

P.S. Do NOT give IV –> risk of sudden vasospasm, HTN, and CVA

Question 2

What is the onset and when does the peak action of Methergine take place?

Answer 2

Onset: 2-5 min.
Peak: 20-30 min.

Question 3

Contraindications to Methergine?

Answer 3

HTN, PEC

Question 4

Side effects of Methergine?

Answer 4

HTN, cramping, N/V, seizure, HA

*tip: take pt’s BP prior to administration

Question 5

What is the dose/route of Oxytocin (Pitocin)?

Answer 5

10-80u in 250-500 mL of NS or LR (IV)
OR
10u IM injection

Question 6

What is the onset of Pitocin?
How long does it take to become effective?
What is the duration of IM Pitocin’s effectiveness?

Answer 6

Onset: 2-3 min.
Effective in 15-30 min.
Duration: 2-3 hrs if given IM

Question 7

Contraindications to Pitocin?

Answer 7

Hypersensitivity

?!?!

Question 8

Side effects of Pitocin?

Answer 8

Cramping; large doses can cause hyponatremia

Rapid infusion of undiluted bolus can cause cardiac collapse

Question 9

What is the dose/route of carboprost tromethamine (Hemabate)?

How many doses can you give, and how often?

Answer 9

250 mcg IM

q15-90 min.; up to 8 doses

Question 10

How long does it take for Hemabate to be at its peak action?

Answer 10

30 min.

P.S. it’s less effective than Methergine

Question 11

Contraindications to Hemabate?

Answer 11

asthma, CAD, pulmonary/ renal/ and hepatic disease

Question 12

Side effects of Hemabate?

Answer 12

N/V, diarrhea, bronchospasm, HTN

- pyrexia is common

Question 13

What is the dose/route of dinoprostone (Cervidil, Prepidil, or Prostin E2)?

How often can you give it?

Answer 13

20 mg vaginal or rectal suppository

May repeat q2hrs

Question 14

What is the onset of action of Cervidil/ Prepidil?

Answer 14

10 min.

Question 15

Contraindications to Cervidil/ Prepidil?

Answer 15

Hypotension or CAD

Question 16

Side effects of Cervidil/ Prepidil?

Answer 16

N/V/D

- pyrexia is common

Question 17

What is the dose/route of misoprostol (Cytotec)?

When can you give it again?

Answer 17

600-800 mcg sublingual
OR
800-1000 mcg per rectum

• Can’t! Just 1 dose.

Question 18

What is the onset of action of misoprostol (Cytotec)?

What is the peak action (sublingual and rectal)?

Answer 18

Onset: 3-5 min.
Peak sublingual peak: 30 min.
Peak rectally: 40-60 min.

Question 19

Contraindications to misoprostol (Cytotec)?

Answer 19

None known!

Question 20

Side effects of misoprostol (Cytotec)?

Answer 20

N/V/D, abdominal pain

- pyrexia can occur w/ higher doses

Question 21

What is the dose/route of tranexamic acid (Cyklokapron)?

Answer 21

TXA (standard concentration 1000mg/100ml NS)
- use within first 3 hrs of hemorrhage

Loading dose: 1000mg IV over 10 minutes
- may repeat in 30 min. if bleeding persists

Question 22

Contraindications to TXA?

Answer 22

• Thromboembolic disorders
• Acquired defective color vision
• Subarachnoid hemorrhage
• Hypersensitivity to TXA

Question 23

Side effects of TXA?

Answer 23

• Seizures, HA, dizziness
• Visual abnormalities
• Hypotension, thromboembolism, thrombus
• N/V/D
• Pain at IV site