Tocolytics & uterotonics part 2

Question 1

Cyclooxygenase inhibitors work by

Answer 1

cyclooxygenase converts arachidonic acid to prostaglandin H2
prostaglandins enhance formation of myometrial gap junction
cyclooxygenase inhibitors reduce prostaglandin levels

Question 2

Cyclooxygenase inhibitor examples include

Answer 2

indomethacin- nonselective cox inhibitor

celecoxib- Cox 2 selective inhibitor

Question 3

Anesthetic implications of cylcooxygenase inhibitors include

Answer 3

platelet inhibition associated with the nonselective COX inhibitors - transient and reversible

Question 4

Oxytocin receptor antagonists examples include

Answer 4

atosiban

Question 5

Atosiban works to block

Answer 5

the normal effects of oxytocin in the uterus

-not approved for use in the US

Question 6

The muscle relaxant of choice for a RSI for parturients is

Answer 6

succinylcholine

-magnesium sulfate potentiates both types of muscle relaxants

Question 7

The leading cause of postpartum hemorrhage is

Answer 7

uterine atony

-the second is the administration of oxytocin

Question 8

Oxytocin is an

Answer 8

endogenous hormone produced by the posterior pituitary gland

-lowers threshold for depolarization of uterine smooth muscle

Question 9

The dosing of oxytocin is

Answer 9

20-40 units/L of isotonic solution IV over 15 to 20 minutes

Question 10

_____ is used prophylactically to reduce blood loss after delivery

Answer 10

oxytocin

Question 11

Infusions of ______ at a low controlled rate are used to induce labor

Answer 11

oxytocin

Question 12

Anesthetic implications of oxytocin include

Answer 12

this drug causes a degree of vasodilation or decreased SVR which can result in significant hypotension and tachycardia

Question 13

The second line of treatment for uterine atony is

Answer 13

ergot alkaloids

-produce tetanic uterine contractions resting their use during the postdelivery period

Question 14

The mechanism of action of ergot alkaloids is thought to

Answer 14

be a alpha adrenergic agonist effect

Question 15

Methergine dose is

Answer 15

0. 2 mg IM- contractions occur within minutes of administration
   - dose may be repeated in 15 to 20 minutes; total dose of 0.8 mg

Question 16

IV administration of methergine may result in

Answer 16

profound hypertension
severe nausea & vomiting
cerebral hemorrhage

Question 17

Anesthetic implications of ergot alkaloids include

Answer 17

do not use in women with hypertension, PVD or ischemic heart disease
monitor BP carefully and have vasodilating drugs available
N/V

Question 18

_______ are 80-90% effective in PPH refractory to oxytocin and ergot alkaloids

Answer 18

prostaglandins

Question 19

The mechanism of action of prostaglandins is to

Answer 19

increase myometrial calcium levels and subsequently increases MLCK activity and uterine contraction

Question 20

Describe the hemabate dose

Answer 20

250 mcg IM or directly into the myometrium

repeat every 15 to 30 minutes to a total dose of 2 mg

Question 21

Anesthetic implications of prostaglandins include

Answer 21

all of these drugs have detrimental side-effects

avoid in patients with reactive airway disease b/c can result in bronchospasm- carboprost