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Pharmacology I - CP > Tocolytics and Uterotonics > Flashcards

Tocolytics and Uterotonics Flashcards

1
Q

What interventions are used to prevent and treatment postpartum hemorrhage?

A

uterogenics (oxytocin, methylergonovine, prostaglandins, misoprostal

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2
Q

Why are ergot alkaloids (Methergine) not administered IV?

A

because of their potent vascular effects, profound hypertension, nausea and vomiting, cerebral hemorrhage

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3
Q

What is the dose and route of administration for Methergine?

A

0.2 mg IM, can be repeated 15-20 minutes, total dose 0.8

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4
Q

What do ergot alkaloids cause besides uterine contraction?

A

increase in blood pressure, central venous pressure, pulmonary capillary wedge pressure

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5
Q

What can prostaglandins cause besides uterine contraction?

A

nausea, bronchospasm, increased pulmonary vascular resistance

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6
Q

How is Hemabate administered?

A

IM or directly into uterine muscle

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7
Q

How is preeclampsia defined?

A

systolic HTN of 140mmHg or higher or diastolic of 90mmHg or higher after 20weeks gestation with proteinuria

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8
Q

What is the one way to end preeclampsia?

A

delivery

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9
Q

Risk of postpartum hemorrhage interventions

A

large bore IV, has volume resuscitation, have fluid warmer available, T&C, CBC, coags

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10
Q

In terms of preeclampsia what can be done to enhance fetal lung maturity if no severe features are occurring?

A

corticosteroid administration

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11
Q

Magnesium sulfate MOA

A

alter calcium transport and availability for muscle contraction, competes with calcium reducing myometrial contractility, hyperpolarization leads to inhibition of MLCK activity = relaxation of vascular, bronchial, uterine smooth muscle, vasodilation

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12
Q

Magneisum sulfate Indications

A

preeclampsia (decreases SVR and BP, anticonvulsant, decreases fibrin deposition improving circulation to visceral organs)

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13
Q

Magnesium sulfate Administration

A

Loading dose 4-6 grams IV in 50mL over 20-30minutes

Infusion 1-2g/hr, continued thru delivery up to 24 hours post delivery

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14
Q

Therapeutic Magnesium level

A

4-9 mEq/L (normally 1-3)

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15
Q

Magnesium sulfate Side effects

A

transient hypotension, sedation, skeletal muscle weakness, CNS depression

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16
Q

Magnesium sulfate overdose

A

discontinue infusion, secure the airway, IV CaCl, diuresis

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17
Q

What do tocolytics do?

A

relax the uterine muscle, slow down delivery

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18
Q

What are tocolytics concomitantly administered with?

A

corticosteroids for lung protection of neonate, prior to 33 weeks gestation, maximum benefit 48 hours

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19
Q

Types of tocolytics

A

magnesium sulfate, calcium channel blockers, b-adrenergic agonists, nitric oxide donors, cyclooxygenase inhibitors, oxytocin antagonists

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20
Q

neonatal side effects of magnesium sulfate

A

hypotonia, respiratory depression (RARE)

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21
Q

What can happen when serum magnesium is >12mg/dL

A

respiratory depression

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22
Q

what can happen when serum magnesium is 25 mg/dL

A

cardiac arrest

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23
Q

What can happen when serum magnesium is 7-9mg/dL

A

anticonvulsant

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24
Q

What can happen when serum magnesium is 10-12mg/dL

A

tendon reflexes abolished

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25
Q

what can happen when serum magnesium 15-20mg/dL

A

SA and AV blocks, respiratory arrest

26
Q

What calcium channel blocker do we use as a tocolytic and why?

A

nifedipine, it can be given PO or sublingually

27
Q

Mechanism of action of Nifedipine

A

block influx of Ca2+, block release of Ca2+ from SR, inhibit Ca2+-dependent MLCK mediated phosphorylation

28
Q

How long can birth be delayed for with use of nifedipine?

A

2-7 days

29
Q

Side effects of Nifedipine

A

hypotension, dyspnea, pulmonary edema, tachycardia, HA

Avoid concomitant use with magnesium sulfate

30
Q

How do B2 agonists work?

A

stimulates B2 receptors causing smooth muscle relaxation, inhibit myometrial contractility, increase progesterone production

31
Q

what does progesterone cause?

A

histologic changes in myometrial cells that limit the spread of contractile impulses

32
Q

Which B2 agonist do we use the most?

A

Terbutaline

33
Q

What are the hazards of B2 stimulation?

A
  • increased blood sugar and insulin levels in mom

- neonatal hypoglycemia and tachycardia

34
Q

Side effects in mom and fetus with B2 agonists

A 
vasodilation
tachycardia
dysrhythmias
ischemia
hypotension
pulmonary edema
HA
hyperglycemia
hypokalemia
increased plasmin renin and vasopressin
35
Q

How long should anesthesia be delayed for with B2 agonist administration if possible?

A

60 minutes to allow HR to come down

if not possible don’t give drugs to increase HR

36
Q

How should hypotension be treated with B2 agonist administration?

A

phenylephrine or ephedrine

37
Q

Which nitric oxide donor do we administer?

A

nitroglycerine

38
Q

How do nitric oxide donors work?

A

increasing cyclic guanosine monophosphate (cGMP), inactivates MLCK = smooth muscle relaxation

39
Q

Side effects of nitric oxide donors

A

HA, hypotension

40
Q

What does cyclooxygenase do?

A

converts arachidonic acid to prostaglandin h2 which enhance formation of myometrial gap junctions increasing available Ca2+

41
Q

How cyclooxygenase inhibitors work?

A

reduce prostaglandin levels by inhibiting COX enzymes from converting arachidonic acid = decreased uterine contraction

42
Q

Which nonselective COX inhibitor do we use?

A

Indomethacin

43
Q

Which COX-2 selective inhibitor do we use?

A

Celecoxib

44
Q

Anesthetic implications of COX inhibitors

A

platelet inhibition with nonselective COX inhibitors

45
Q

Which muscle relaxant is preferred for RSI with tocolytics?

A

Succinylcholine

46
Q

What do uterotonics do?

A

cause contraction

47
Q

What is the leading cause of postpartum hemorrhage?

A

uterine atony

48
Q

What intervention should be tried first post delivery for PPH?

A

fundal massage and then oxytocin

49
Q

What is oxytocin?

A

endogenous hormone produced by posterior pituitary gland that lowers the threshold for depolarization of uterine smooth muscle

50
Q

What synthetic oxytocin do we give?

A

Pitocin - octapeptide

51
Q

Pitocin administration

A

20-40 units/L over 15-20minutes post delivery as soon as cord is cut, also used prophylactically to reduce blood loss, never bolus

52
Q

Pitocin administration to induce labor

A

infusions at low controlled rates

53
Q

Side effects of pitocin

A

vasodilation or decreased SVR = hypotension and tachycardia

54
Q

2nd line of treatment for uterine atony

A

ergot alkaloids

55
Q

which ergot alkaloid do we use?

A

Methergine - synthetic, MOA is not clear

56
Q

Contraindications for ergot alkaloids

A

preexisting hypertension, PVD, ischemic heart disease

57
Q

what can we give if methergine is contraindicated or not effective?

A

prostaglandins (hemabate)

58
Q

MOA of Hemabate

A

increases myometrial calcium levels, increases MLCK activity = uterine contraction

59
Q

Administration of Hemabate

A

250 mcg IM or directly into myometrium, repeat every 15-30minutes, total dose 2mg

60
Q

Administration of Misoprostol

A

800-1000mcg, sublingual or buccal

61
Q

Use of Carboprost (prostaglandin) can result in __ with women with reactive airway disease

A

bronchospasm, Va/Q mismatch, hypoxemia

Pharmacology I - CP (8 decks)

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