Narrated Uterine meds (Ch. 63)

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Pharmacology

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Chapter 63: 

Chapter 63 Drugs That Affect Uterine Function

Drugs That Affect Uterine Function: 

Drugs That Affect Uterine Function Three main categories Uterine relaxants (tocolytics) Suppression of preterm labor Uterine stimulants (oxytocics) Induction/augmentation of labor Control of postpartum bleeding Induction of abortion Drugs used to promote cervical ripening

Preterm Birth: 

Preterm Birth Before 37 weeks gestation Leading cause of infant morbidity and neonatal mortality U.S. – 12.5% of all live births Premature births account for 75% of all neonatal mortality 50% of congenital neurologic deficits Most common neonatal respiratory distress syndrome

Uterine Relaxants (Tocolytics): 

Uterine Relaxants (Tocolytics) Used to delay delivery Average delay – only 48 hours If used with glucocorticoids, the glucocorticoids can accelerate lung development Also used to buy time to treat infection See Box 63-1

Uterine Relaxants (Tocolytics): 

Uterine Relaxants (Tocolytics) Beta 2 -selective adrenergic agonists Terbutaline ( Brethine ) Beta 2 -selective adrenergic agonist Not approved by FDA for this use

Uterine Stimulants (Oxytocics): 

Uterine Stimulants (Oxytocics) Three groups of uterine stimulants Oxytocin Ergot alkaloids Prostaglandins

Uterine Stimulants (Oxytocics): 

Uterine Stimulants (Oxytocics) Oxytocin (Pitocin) Peptide hormone produced by the posterior pituitary Increases the force, frequency, and duration of uterine contractions Uterus becomes progressively more responsive to oxytocin throughout pregnancy Facilitates labor, but unclear if it can initiate labor

Uterine Stimulants (Oxytocics): 

Uterine Stimulants (Oxytocics) Oxytocin (Pitocin) (cont ’ d) Physiologic and pharmacologic effects Uterine stimulation Milk ejection Water retention Precautions and contraindications Uterine rupture may occur Women with active genital herpes Adverse effect – water retention/intoxication

Uterine Stimulants (Oxytocics): 

Uterine Stimulants (Oxytocics) Carboprost tromethamine (Hemabate) Preferred agent for controlling postpartum hemorrhage Causes intense uterine contractions Adverse effects GI reactions Vomiting and diarrhea Fever Vasoconstriction Constriction of the bronchi

Drugs Used to Promote Cervical Ripening: 

Drugs Used to Promote Cervical Ripening Dinoprostone (Prepidil, Cervidil) Dinoprostone gel Dinoprostone vaginal inserts (Cervidil) Misoprostol (Cytotec) Not approved for this use