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ER Week 4 > Uterine Drugs > Flashcards

Uterine Drugs Flashcards

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1
Q

What are the two groups of drugs that affect uterine motility and uterine smooth muscle control?

A

osytocics
tocolytics

(tokos means childbirth)

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2
Q

What are the three classes of oxytocics?

A

oxytocin
prostaglandins
ergots

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3
Q

What are the 4 classes ot tocolytics?

A

beta agonists
magnesium sulfate
oxytocin receptor angatonist
NSAIDs

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4
Q

What do oxytocics do?

A

stimulate uterine smooth muscle to contract

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5
Q

What do we use them for?

A
  1. induce/augment labor
  2. control postpartum heorrhage
  3. correct postpartum uterine atony
  4. produce uterine contractions after c section or other uterine surgery
  5. expel conceptus
  6. can initiate and enhanc erhythmic uterine contraction at any time, but relatively high doses are required for such responses in early pregnancy
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6
Q

What do tocolytics do?

A

suppress uterine smooth muscle and thereby suppress premature labor

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7
Q

Oxtocin is very similar to what other hormone?

A

ADH - it’s only two amino acids different

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8
Q

Where is Oxytocin made?

A

paraventricular and supraoprtic nuclei of hypothalamus

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9
Q

What will it be release in response to?

A

cervical dilation
mechanical stimulation of vagina and uterus
suckling reflex

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10
Q

Describe the oxytocin receptor?

A

G protein coupled to phosphpolipiase C

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11
Q

Where in the body is the OT receptor?

A

myoepithelial cells of mammary gland
pregnant myometrium
CNS

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12
Q

What does ethanol do to oxytocin?

A

inhibits it

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13
Q

What does oxytocin promote?

A

uterine contraction
milk let-down
antidiuretic and vasoactive at high concentrations

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14
Q

How can we give oxytocin?

A

parenteral, sublingual or nasal (it’s a peptide)

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15
Q

When in pregnancy is oxytocin degraded more readily?

A

term

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16
Q

Where in the body os oxytocinase located?

A

uterus and placenta

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17
Q

What is the synthetic oxytocin?

A

pitocin

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18
Q

When might you want to speed up labor with pitocin?

A

chrnic hypertension or preeclampsia

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19
Q

Besides starting and speeding up labor, why do we use it in parturition?

A

mild let down

stimulation of uterine motility postpartum to reduce bleeding (get uterus to contract back down)

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20
Q

WHat are the contraindications for pitocins?

A

if baby is too big to pit or presenting breech

also if you have hyperotnic uterine contractions

also in women who ahve had lots of previous c sections - increased risk of uterine rupture

21
Q

What does PGE2 do?

A

contracts the uterus and produces hyperalgesia

promotes softening of the cervix

22
Q

What type of receptor is PGER?

A

Gs coupled

23
Q

What does PGF2 do in this regard?

A

uterine contractions

24
Q

What type of receptor is the PGFR?

A

Gq stimulating IP3

25
Q

What happens to levels of prostaglandins during parturition?

A

increase in amniotic fluid

26
Q

What drug will reduce the oxytocin-induced uterine contractions through it’s action on reducing PG production?

A

indomethacin - an NSAID that blocks COX, so no prostaglandin synthesis

27
Q

What is the natural PGE we use?

A

Dinoprostone

28
Q

What is the synthetic PGE we use?

A

Misoprostol

29
Q

Which one can be used as an abortifacient?

A

Misoprostol

30
Q

What is the natural PGF2alpha?

A

Dinoprost

31
Q

What is the synthetic PGF2alpha used IM

A

Carboprost

32
Q

Which trimester can Carboprost be used as an abortifacient or to induce labor?

A

can be used in any trimester

33
Q

Which analog is also used to treat hydatidiform mole?

A

dinoprostone

34
Q

What are the side effects of these prostaglandin analogs?

A

basically flu-like symptoms

35
Q

What are ergots?

A

alkaloids identified from a fungus that grows on cereal grasses

36
Q

What will poisoning with ergot cause?

A

vascular constriction with gangrene in periphery

convulsions

37
Q

In general, what do the ergots do to smooth muscle?

A

smooth muscle constriction

38
Q

Why do we use ergots in this setting?

A

contraction of the uterus to control postpartum bleeding

39
Q

Which ergot is largely used for this purpose?

A

ergonovine = ergometrine

40
Q

Which ergot is used to contract blood vessels and treat migraine headache?

A

ergotamine

41
Q

Which beta2 agonist do we use to slow down uterine contractions?

A

terbutaline

42
Q

How does terbulatine work here?

A

activates the Gs receptor, which activates AC and increases cAMP to turn on PKA.

PKA will turn off myosin light chain kinase, which will decrease muscle contraction

43
Q

When can terbutaline be used in pregnancy?

A

after the 2oth week

44
Q

What are the side effects of tocolytics?

A

tachycardia and pulmonary edema

also hyperglycemia

can precipitate myocardial infarction by increasing oxygen demand (through increased heart rate)

45
Q

How is magnesium sulfate given?

A

IV

46
Q

What does magnesium sulfate do here?

A

it competes with calcium and relaxes smooth muscle

47
Q

Why do we give magnesium in eclampsia?

A

prevents the seizures

48
Q

What is the oxytocin receptor antagonist?

A

Atosiban (Tractocile)

49
Q

Which has more maternal side effects - atosiban or terbutaline?

A

terbutaline

but atosiban might not be as effective

ER Week 4 (15 decks)

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