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Pharmacology > Uterus Drugs > Flashcards

Uterus Drugs Flashcards

1
Q

___: goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery

A

Oxytocics: goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in vaginal delivery

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2
Q

Drugs used for cervical ripening and purpose?

A

Dinoprostone, Misoprostol (prostaglandins)

reduces the rate of failed induction, used when induction is indicated but status of cervix is unfavorable

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3
Q
  • *Dinoprostone** ( __ analog)
  • *Misoprostol** ( __ analog)
A
  • Dinoprostone: PGE2
    • vaginal insert, and cervical gel
  • Misoprostol: PGE1
    • intravaginally, orally or sublingually
  • ripens cervix
  • stimulates uterine contractions
  • these alone initiate labor in many women, and obviates need for oxytocin
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4
Q

Prostaglandins AEs

A
  • Tachysystole
  • Fever
  • Chills
  • Vomiting
  • Diarrhea
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5
Q

___ is the preferred drug for inducing labor when the cervix is favorable or ripe

(ripening agent should be used ___ oxytocin in women with unfavorable cervixes)

A

Oxytocin is the preferred drug for inducing labor when the cervix is favorable or ripe

(ripening agent should be used before oxytocin in women with unfavorable cervixes)

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6
Q

Oxytocin

A
  • elicits milk ejection in lactating women
  • 2nd half of pregnancy: uterine smooth muscle becomes increasingly sensitive to stimulant action of endogenous oxytocin
  • exogenously given to induce uterine contractions and maintain labor
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7
Q

Oxytocin signaling pathway

A

GQ → GOAT HAG

GnRH
Oxytocin
ADH (V1-receptor)
TRH

Histamine (H1-receptor)
Angiotensin II
Gastrin

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8
Q

Oxytocin MOA

A
  • Gq - activates voltage-gated Ca2+ channels → myometrial contraction
  • also increases prostaglandin synthesis → further stimulating uterine contractions
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9
Q

oxytocin is most commonly given as ___ for labor induction

A

oxytocin is most commonly given as IV infusion for labor induction

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10
Q

Oxytocin AEs

A
  • Serious toxicity is rare
  • excessive stimulation of uterine contractions before delivery can cause fetal distress, placental abruption, or uterine rupture
  • High concentrations can activate vasopressin receptors → excessive fluid retention → hyponatremia, HF, seizures, death
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11
Q

____ = MC cause of postpartum hemorrhage

Managed with uterine massage and oxytocic drugs (3)

A

Uterine atony = MC cause of postpartum hemorrhage

Managed with uterine massage and oxytocic drugs:

  • *Oxytocin** (first-line, given IV or IM)
  • *Ergot alkaloids**
  • *Prostaglandins**
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12
Q

Methylergonovine

A
  • Ergot Alkaloid
  • Partial agonist at a-adrenergic receptors and some serotonin receptors
  • uterus sensitvity to stimulant effects of ergot alkaloids increase dramatically during pregnancy
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13
Q

Methylergonovine AEs

A
  • HTN
  • headache, nausea, vomiting
  • chest pains
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14
Q

Methylergonovine contraindications

A
  • Angina pectoris
  • Myocardial infarction
  • Pregnancy
  • Cerebrovascular accident
  • Ischemic attack
  • Hypertension
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15
Q

Carboprost Tromethamine

A

PGF2a analog

Given IM

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16
Q

Misoprostol

A

PGE1 analog

Given vaginally or orally

17
Q

Tocolytics: given if going into labor < __ weeks of gestation

A
  • Uterine Relaxants
  • preterm labor <37 weeks of gestation
  • preterm birth = leading cause of neonatal mortality in US
  • Management:
    • Bed rest
    • Tocolytics
      • magnesium sulfate
      • indomethacin
      • nifedipine
    • Glucocorticoids
18
Q

Glucocorticoids can be given if gestational age is < ___ weeks

A

Glucocorticoids can be given if gestational age is < 34 weeks

19
Q

primary purpose of tocolytic therapy is to ____ to allow ____ given to the mother to achieve their maximum effect

A

primary purpose of tocolytic therapy is to delay delivery to allow glucocorticoids given to the mother to achieve their maximum effect

20
Q

Glucocorticoids accelerate ____ and decrease risk of neonatal ____, intracranial bleeding, and mortality

A

Glucocorticoids accelerate maturation of fetal lungs and decrease risk of neonatal respiratory distress syndrome, intracranial bleeding, and mortality

21
Q

MC tocolytic agents used for treating preterm labor

A

magnesium sulfate

indomethacin

nifedipine

(Atosiban and B2-agonists as well)

22
Q

Magnesium Sulfate

A
  • primary tocolytic agent
  • uncouples excitation-contraction in myometrial cells through inhibition of cellular action potentials
  • AEs
    • mother should be monitored for respiratory depression or cardiac arrest
    • crosses placenta and may lead to respiratory and motor depression of the neonate
23
Q

Prostaglandins ___ uterine contractions during normal labor

NSAIDs are used to ___ preterm labor, ___ is the main NSAID for this use

A

Prostaglandins stimulate uterine contractions during normal labor

NSAIDs are used to delay preterm labor, Indomethacin is the main NSAID for this use

24
Q

Indomethacin can cause premature closure of ____

effect is mc after ___ weeks of gestation → not recommended to be given after this time

Can also cross placenta and cause ____ d/t decreased fetal renal blood flow if used >48 hrs

A

Indomethacin can cause premature closure of ductus arteriosus

effect is mc after 32 weeks of gestation → not recommended to be given after this time

Can also cross placenta and cause oligohydraminos d/t decreased fetal renal blood flow if used >48 hrs

25
Q

Nifedipine

A
  • Calcium channel blocker
  • Blocks entry of Ca2+ into myometrial cells inhibiting contractility
  • Effective and safe
  • associated with more frequent successful prolongation of pregnancy compared to other tocolytics
  • AE: maternal tachycardia, palpitations, flushing, headaches, dizziness, nausea
26
Q

___ is a competitive oxytocin antagonist

Not available in the US

A

Atosiban is a competitive oxytocin antagonist

Not available in the US

27
Q

B2 agonists

A
  • ↑ cAMP - activates PKA
  • PKA phosphorylates smooth muscle myosin light chain kinase (MLCK)
  • lower affinity of MLCK for Ca2+-calmodulin complex
  • SmMLCK dose not phosphorylate myosin
  • myometrial smooth muscle relaxes
28
Q

B2 agonist AEs

A
  • palpitations, tremor, nausea, vomiting, nervousness, anxiety, chest pain, shortness of breath, hyperglycemia, hypokalemia, hypotension
  • Serious complications: pulmonary edema, cardiac insufficiency, arrhythmias, myocardial ischemia, maternal death
  • Black Box Warning/Contraindication:deaths and serious adverse reactions withterbutaline given to pregnant women
    • Injectable terbutaline limited to 72 hrs to treat preterm labor
29
Q

Abortifacients

A

Mifepristone (antiprogestin)

Misoprostol (prostaglandin analog)

Methotrexate (folic acid antagonist)

30
Q

First give ___, then give ___ 24-72 hrs later to produce early abortion (< 8 weeks pregnant)

___ is used off-label for early abortion

Major adverse effects: ___

A

First give Mifepristone, then give misoprostol 24-72 hrs later to produce early abortion (< 8 weeks pregnant)

Major AE: Cramping, Diarrhea

Methotrexate is used off-label for early abortion

Major AE: Cramping, Nausea

Pharmacology (19 decks)

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