Oxytocics & Tocolytics: Uterine Drugs – Flashcards
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Uterine stimulants are called
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oxytocics
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The goal of cervical ripening
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reduce rate of failed induction
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2 Drugs used for cervical ripening
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-Prostaglandins 1. dinoprostone 2. misoprosol (Mnemonic: in the Service, Al Ripen had his stuffed Dinosaur that spoke in Prose and in a monoTone voice whenever they had Miso soup)
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Dinoprostone and misoprostol are administered to promote _____________ and additionally stimulate ____________.
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1. cervical ripening 2. uterine contractions
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Dinoprostone is synthetic
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PGE2
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Misoprostol is analoge of
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PGE1
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Misoprostol is FDA approved for
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high risk gastric ulcer patients
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Adverse effects of prostaglandins
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1. tachysystole 2. fever 3. chills 4. vomiting 5. diarrhea
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The drug of choice for inducing labor in a patient with a favorable or ripe cervix
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oxytocin
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Oxytocin is a __________ hormone produced in the ___________ and secreted by the ____________.
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1. peptide 2. hypothalamus 3. posterior pituitary
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The physiological action of oxytocin
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elicit milk ejection in lactating women
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The pharmacologic action of oxytocin
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induce uterine contractions and maintain labor
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Oxytocin MOA review (start with receptor type)
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starts with Gq
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Oxytocin is most commonly administered via
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IV infusion
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High concentrations of oxytocin can activate
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vasopressin receptors (similar structure)
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High concentrations of oxytocin can lead to
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1. excessive fluid retention or water intoxication -> 2. hyponatremia 3. heart failure 4. seizures 5. death
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A secondary use of oxytocin
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postpartum hemorrhage d/t uterine atony
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Methylergonovine is this class of drug
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ergot alkaloid
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Methylergonovine acts as a
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partial agonist at alpha-adrenergic receptors and some serotonin receptors
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Activation of alpha-adrenergic receptors during pregnancy leads to
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contraction
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Uterine sensitivity to stimulant effects of ergot alkaloids increases during pregnancy due to
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upregulation of alpha receptors
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Adverse effects of Methylergonovine may include
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1. hypertension 2. headache 3. nausea 4. vomiting 5. chest pains *severe are minimal
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Contraindications of Methylergonovine include
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1. angina pectoris 2. MI 3. pregnancy 4. cerebrovascular accident 5. ischemic attack 6. HTN
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2 examples of prostaglandin oxytocics
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1. Carboprost tromethamine (PGF2a analogue) 2. misoprostol (PGE1 analogue)
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Tocolytics are
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uterine relaxants
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Labor is considered preterm if it begins
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before 37 weeks gestation
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3-fold management of preterm labor includes
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1. bed rest 2. tocolytics 3. glucocorticoids (if < 34 wks)
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The 3 most common tocolytic agents for treatment of preterm labor
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1. magnesium sulfate 2. indomethacin 3. nifedipine *no first choice
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A general way to think about the effect/MOA of magnesium sulfate ("not a test question" -LC)
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as a calcium antagonist
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Indomethacin is an
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NSAID
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Since prostaglandins stimulate uterine contractions during normal labor, inhibition of prostaglandins with this NSAID should delay preterm labor
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Indomethacin
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If used for more than 48 hours, indomethacin can cross the placenta and cause
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oligohydraminos due to decrease in renal blood flow
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As it inhibits prostaglandins, indomethacin can close this important structure necessary for proper fetal circulation
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ductus arteriosus (more common after 32 weeks)
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Nifedipine is a
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calcium channel blocker
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A competitive antagonist at oxytocin receptors that is not available in the U.S.
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Atosiban
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The main reason why B2-agonist are not used as tocolytics
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side-effect profile is not favorable; Black Box warning and contraindicated
