Uterine Atony Meds

Question 1

How much can atonic uterus lose?

Answer 1

up to 2 liters of blood in 5 minutes

Question 2

Uterine massage

Answer 2

Massage uterus plus medications to promote contraction

Question 3

1 cause of PPH

Answer 3

Most common cause of postpartum hemorrhage is UTERINE ATONY. Initiate MTP(massive transfusion protocol) with massive hemorrhage.

Question 4

1st line treatment?

Answer 4

Oxytocin:(Pitocin) 1st line tx

Question 5

Oxytocin - dosing

Answer 5

30 units in 500cc IV drip Lactated Ringers premix.

Question 6

Oxytocin - MOA

Answer 6

Hormone peptide formed from 9 amino acids (released from posterior pituitary).
As medication: Increases intracellular calcium in uterine myofibrils. Also increases local prostaglandin production.

Question 7

Oxytocin - onset, DOA, excretion

Answer 7

Onset: 1 min
1/2 life: 3-5 minutes
Excretion: urine

Question 8

Oxytocin - side effects

Answer 8

systemic vasodilator –> can aggravate hypotension
Rare: arrhythmias

Question 9

2nd line tx?

Answer 9

Methylergonovine (Methergine): Ergot alkaloid

Question 10

Methergine - administration

Answer 10

Administer INTRAMUSCULARLY- quadriceps or deltoid IM only dose is .2mg IM

IM dose can be repeated 2-4 hours

(Refrigerated)

Question 11

Methergine: MOA

Answer 11

Enhances uterine contractility and causes vasoconstriction. Contracts upper and lower uterus simultaneously

Question 12

Methergine - metabolism

Answer 12

Liver

Question 13

Methergine - side effects

Answer 13

Often increases blood pressure
Other rare side effects: N/V, pulmonary edema, coronary vasospasm/ Myocardial infarction.

Question 14

Methergine - contraindications

Answer 14

Contraind in Preeclamptic or Hypertension.
Relative contraindication: coronary artery disease.

Question 14

Methergine - contraindications

Answer 14

Contraind in Preeclamptic or Hypertension.
Relative contraindication: coronary artery disease.

Question 15

3rd line tx?

Answer 15

Carboprost (Hemabate): 15-methyl prostaglandin F2 alpha.

Question 16

Hemabate - admin

Answer 16

INTRAMYOMETRIALLY IM dose .25mg…..dose can be repeated every 15 minutes to total of 2mg.

Question 17

Carboprost (Hemabate): contraindications

Answer 17

Asthmatics d/t Known abnormal ventilation perfusion ratios, hypoxemia.

Question 18

Carboprost (Hemabate): side effects

Answer 18

Diarrhea, tachycardia, fever.

Question 19

Carboprost (Hemabate): contraindications

Answer 19

Relative contraindication: hepatic, cardiac, renal disease.

Question 20

4th line tx

Answer 20

Misoprostol(Cytotec): Prostaglandin E1 analog

Question 21

Misoprostol (Cytotec): admin

Answer 21

OFF LABEL used RECTALLY 800-1000mcg

Question 22

Misoprostol (Cytotec): side effects

Answer 22

Diarrhea (10%), abdominal pain, dyspepsia

Question 23

Misoprostol (Cytotec): onset, DOA

Answer 23

Rectal dose onset one hour with DOA of 4 hours (Sublingual in literature 400mcg SL with 30 min onset and DOA of 2 hours)

Question 24

TXA drug class

Answer 24

TXA is antifibrinolytic-synthetic analog of Lysine amino acid

Question 25

TXA dosing

Answer 25

1 gram diluted IVPB in 100cc NS over 10 minutes then infuse 1 gram IV infusion in 250cc NS over 8 hours

Question 26

Fibrinogen Concentrate (RiaSTAP®) admin

Answer 26

Riastap has fibrinogen and human albumin within it): Reconstitute each vial with 50 mL Sterile Water for Injection. Gently swirl vial to ensure product is fully dissolved. Do NOT shake. Reconstituted solution should be colorless and clear to slightly opalescent

Question 27

Fibrinogen Concentrate - admin

Answer 27

Administration Instructions: Attach hanging device to vial. Insert dispensing pin into vial to allow for venting. Attach tubing. Each vial (50 mL) to be infused over 10 minutes (5 mL/min). One dose = 2 vials = approximately 2000 mg. No thawing and fast to administer.

Question 28

Fibrinogen Levels

Answer 28

Key new concept: Keep fibrinogen levels greater than 200mg/dL….Fibrinogen levels fall critically low earlier than other coagulation factors during post partum hemorrhage.
Give within 3hr PPH