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Pharmacology > Uterine Drugs > Flashcards

Uterine Drugs Flashcards

1
Q

Oxytocin description

A

Peptide hormone secreted by the posterior pituitary -> milk ejection
Uterus becomes more sensitive to oxytocin during second half of pregnancy

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2
Q

Oxytocin mechanism

A

Activates Gq->Increase calcium -> MLCK -> contraction increases PG synthesis which further stimulates contraction of uterus

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3
Q

Oxytocin Indication

A 
**DOC for induction of labor**
Augment dysfunctional labor
**Limit post partum hemorrhage**
Challenge test -> fetal hypoxia -> measure heart rate
Induce abortion
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4
Q

Oxytocin Adverse

A

Rare: fetal distress, placental abruption, uterine rupture

Activate vasopressin receptors -> fluid retention, hyponatremia, seizures and death

Hypotension when given as a bolus

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5
Q

Uterine stimulants

A 
Oxytocin
Eronovine
Methylergonovine
Carboprost
Tromethamine
Dinoprostone
Misoprostol
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6
Q

Ergonovine and Methylergonovine description

A

Partial alpha agonist and some 5-HT

Sensitivity to ergo alkaloids increases dramatically during pregnancy

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7
Q

Ergonovine and Methylergonovine indication

A

Second line for post partum hemorrahge when oxytocin is ineffective (or use both)
Found in breast milk

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8
Q

Ergonovine and Methylergonovine Adverse

A

HTN, HA, seizure, nausea, vomiting, chest pain, leg cramps

*Gangrene in nursing infant

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9
Q

Ergonovine and Methylergonovine contraindications

A 
Angina
MI
Pregnancy
CVA 
HTN
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10
Q

Carboprost and Tromethamine description

A

PGF2 alpha analog

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11
Q

Carboprost and Tromethamine indication

A

Induce abortion in second trimester

Post - partum hemorrhage (3rd line of treatment)

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12
Q

Carboprost and Tromethamine PK

A

IM

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13
Q

Ergonovine and Methylergonovine PK

A

IM

Found in breast milk

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14
Q

Oxytocin PK

A

IV (slow)
IM
Nasal spray

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15
Q

Dinoprostone description

A

PGE2

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16
Q

Dinoprostone indication

A

Induce abortion in second trimester
Evacuate uterus after missed abortion
Benign hydatiform mole
Ripen the cervix

17
Q

Dinoprostone PK

A

Vaginal insert or suppository

Cervical gel

18
Q

Misoprostol description

A

PGE1 analog

*Not FDA approved for OB use (only approved for use with NSAID induced gastric ulcers)

19
Q

Misoprostol indication

A

Ripen cervix
Induce labor
Post-partum hemorrhage

20
Q

Tocolytics (uterine relaxants)

A 
Magnesium sulfate
Indometahcin
Nifedipine
Atosiban
Terbutaline (beta 2 agonist)
21
Q

Magnesium sulfate

A

Similar efficacy to terbutaline with better tolerance

Uncouples excitation contraction in myometrium (opposes calcium)**

22
Q

Magnesium sulfate indication

A

Most popular tocolytic

23
Q

Magnesium sulfate PK

A

crosses the placenta

24
Q

Magnesium sulfate adverse

A

Respiratory depression

Cardiac arrest

25
Q

Indomethacin description

A

NSAID

26
Q

Indomethacin Mechanism

A

Inhibit PG synthesis (which stimulates uterine contraction)

27
Q

Indomethacin indication

A

Delay preterm labor

28
Q

Indomethacin PK

A

Crosses placenta

29
Q

Indomethacin adverse

A

Oligohydramnios due to a decreas in fetal renal blood flow (48h)
Premature closure of ductus arteriousus

30
Q

Indomethacin contraindications

A

Not recommended after 32 weeks because AE are more common

31
Q

Nifedipine description

A

Calcium channel blocker

Effective and safe

32
Q

Nifedipine mechanism

A

Inhibits contractility

Decreases calcium -> decreases MLCK

33
Q

Nifedipine indication

A

more successful prolongation of preterm pregnancy

34
Q

Nifedipine adverse

A

Maternal tachycardia
palpitations
flushing, nausea
HA and dizziness

35
Q

Atosiban description

A

Competitive oxytocin receptor antagonist; not available in the U.S.

36
Q

Terbutaline (beta two agonist) description

A

Activates Gs->increases cAMP -> increases PKA -> phosphorylates SM-MLCK -> SM-MLCK has decreased affinity for calcium-calmodulin complex -> myosin is not phosphorylated -> smooth muscle relaxation

Phased out and replaced by magnesium sulfate due to AE

37
Q

Terbutaline (beta two agonist) indication

A

Injectable terbutaline needs to be limited to 72 hrs or less

Oral terbutaline should not be used to treat preterm labor

38
Q

Terbutaline (beta two agonist) adverse

A 
Palpitation, tremor
Nausea, vomiting
Anxiety
Chest pain and dyspnea
Hyperglycemia
Hypokalemia
Hypotension

Pulmonary edema
Cardiac insufficiency
Arrhythmia, MI
Maternal death

39
Q

Terbutaline contraindication

A

Got a black box warning in 2011

Pharmacology (24 decks)

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