Prostaglandin Drugs

Question 1

Alprostadil (PGE1)

Injection/ Intraurethral/ IV
IV used for maintenance

Answer 1

Relaxation of arterial smooth muscle (vasodilation) …

1. keeps ductus arteriosus open
2. enhances penile erection

Uses: erectile dysfunction & patency of ductus arteriosus (keeps ductus open)

Adverse Effects: penile pain & urethral burning … intercourse with prego women / apnea in neonates

short half life, excreted in urine, metabolized in liver

Question 2

Misoprostol (PGE1 Analog)

Oral preferred, but IV can be used

Answer 2

Agonist at prostaglandin receptor(EP3 receptor)

1. stimulates mucous, electrolyte, bicarbonate, and fluid secretion in GI
2. reduces hist stimulated cAMP prod & gastric acid secretion

Uses: protective agent in NSAID therapy (ulcers): prophylactic, w/ mifepristone for abortion

Adverse Effect: IV risk of sepsis/ cramping/ diarrhea/ stimulate uterine contractions (Prego Category C)

Question 3

Dinoprostone (PGE2 Analog)

gel/ vaginal insert
Labor: IV

Answer 3

effects on cervical collagenase, promoting cervical softening
1. causes uterine contractions any time during prego

Uses:

1. ripening cervix for labor (drug first then oxytocin)
2. inducing abortion with misoprostol
3. missed abortion (expel remaining content)
4. benign hydatidiform mole (tumor removal)

Adverse effect: fever, decrease diastolic BP, chills, vomiting, diarrhea

Contraindication: acute pelvic inflammatory disease, pulmonary, renal or pelvic disease

Question 4

Latanoprost (ALL PGF2-alpha Analog)
Tafluprost
Travoprost
Bimatoprost

intraocular drops

Answer 4

increase outflow of aq. humor from ant. chamber via uveoscleral pathway

Uses:
1. elevated intraocular pressure due to open angle glaucoma or ocular hypertension

Adverse Effects: irreversible brown pigmentation of iris & eyelashes/ drying of the eyes/ conjunctivitis

administered as pro-drug- metabolized by esterases

Question 5

Bimatoprost (PGF2-alpha Analog)

Answer 5

increase percent of eyelash growth phase & prolongs growth phase

Uses: Hypotrichosis (lack of adequate eye lashes)

Question 6

Carboprost (PGF2-alpha Analog)

IM

Answer 6

Stimulates uterine contraction

Uses: induces 2nd semester abortion, refractory postpartum uterine bleeding (that hasnt responded to other methods)

Adverse Effects: pulmonary edema, endometritis , septic shock, incomplete abortion, uterine hemorrhage, anaphylactic shock, vomitting, nausea, diarrhea

Contraindication: acute pelvic inflammatory disease,cardiac, pulmonary, renal, hepatic disease

Question 7

Epoprostenol (PGI2)
    Continuous IV
Iloprost (PGI2 Analog)
     Inhaled 
Treprostinil (PGI2 Analog)
    Subcu, IV, Infusion, Inhaled

Answer 7

directly relax vascular smooth muscle cells - improving exercise tolerance, symptoms, and diminish clinical deterioration

Uses: Pulmonary Arterial Hypertension

Adverse Effects: flushing, jaw pain, headache, hypotension, diarrhea. nausea, cough, bronchoconstriction