Tocolytics/PTL

Question 1

Nifedipine
MOA/Dose/A/E
CIN

Answer 1

MOA: CCB
Dose: 30 mg loading, then 10 mg q 4-6 hrs
Maternal AE: dizziness, flushing, suppression of heart rate, contractility
Fetal AE: none
CIN: HYPOTENSION, AORTIC INSUFFICIENCY (or other preload dependent lesions)

when used with mag, can cause pulmonary edema

Question 2

Terbutaline
MOA/Dose/A/E
CIN

Answer 2

MOA: beta 2 adrenergic receptor agonist- relaxation of smooth muscle found in bronchial, vascular and uterine tissues

Dose: 0.25 mg subQ every 20 min to 30 hours

Maternal A/E: tachycardia, HYPOTENSION, tremor, palpitations, SOB, pulmonary edema, hypokalemia, hyperglycemia

Fetal A/E: tachycardia
CIN: tachycardia sensitive cardiac disease, poorly controlled DM

Question 3

Tranxexamic Acid
-MOA
-Dosing
-CIN

Answer 3

plasmin inhibitor, stabilizes fibrin matrix
1 gram IV in 100 ml solution, given over 10 minutes
CIN: history of color blindness, VTE, concomitant use of COCP

Question 4

Indocin
MOA/Dose/A/E
CIN

Answer 4

MOA: NSAID
Dose: if < 32 weeks
50-100 mg po loading then half q 4-6 hours

Maternal: nausea, GERD, gastritis, emesis, plt dysfunction

Fetal: contracted ductus arterioles, olighydramnios, NEC, PDA, especially if used > 2 days
CIN: bleeding or plt disorder, hepatic or renal dysfunction, GI ulcerative disease, asthma (if hypersensitivity to ASA)

Question 5

PPROM Antibiotics

Answer 5

Total treatment x 7 days
Amp 2 grams IV x 48 hours + Azithromycin 1 gram po
Amoxicillin 500 po 8 hrs x 5 days

Question 6

What are CIN to tocolytics?

Answer 6

IUFD
Infection
NrFHT
Pre-eclampsia with severe, eclampsia
Maternal bleeding with HD instability