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oxytocin (Pitocin)
- Action: uterine contraction, decreases bleeding
- SE: Infrequent- water toxication, nausea/vomiting
- Contraindication: none
- Route: IV
-
methylervonovine (Methergine)
- Action: uterine contraction, decreases bleeding
- SE: Hypertension, nausea/vomiting
- Contraindications: hypertension, cardiac disease. Do not give if BP > 140/90
- Route: IM
-
prostaglandin F (Hemabate)
- Action: uterine contraction, decreases bleeding
- SE: Headache, nausea/vomiting, fever, tachycardia, hypertension, diarrhea
- Contraindications: severe asthma
- Route: IM
-
misoprostol (Cytotec)
- Action: uterine contraction, decreases bleeding
- SE: Headache, nausea/vomiting, diarrhea
- Contraindications: allergy to prostaglandins
- Route: Oral
-
terbutaline (Brethine)
- beta2-adrenergic agonist- relaxes uterine smooth muscle
- Oral or subcut
- Adverse effects: tachycardia (should decrease over time), shortness of breath
- Assess vital signs, respiratory effort
- The other beta-adrenergic agonist is ritrodine (Yutopar) and is actually the only one approved as a tocalytic but is used less often.
-
magnesium sulfate
- tocolytic- relaxes uterine smooth muscle, CNS depressant
- IV
- Adverse effects: lethargy and weakness, visual blurring, headache, nausea/vomiting, depression of deep tendon reflexes, decrease in respiratory rate, decrease in urinary output, cardiac arrest
- Assess for: mgso4 toxicity- loss of deep tendon reflexes, urinary output < 25-30 ml, respiratory depression less than 12/min, pulmonary edema, chest pain.
- Antidote: calcium gluconate
-
nifedipine (Procardia)
- calcium channel blocker- blocks ca and reduces uterine contractions.
- Oral
- Adverse effects: maternal transient tachycardia, hypotension, headache, dizziness, peripheral edema, fetal uteroplacental insufficiency related to maternal hypotension.
- Do Not combine with magnesium sulfate-->severe hypotension.
-
indomethacin (Indocin)
- prostaglandin synthetase inhibitors (nsaids)- relaxes uterine smooth muscle by inhibiting prostaglandins.
- Adverse effects: nausea/vomiting, dizziness, oligohydramnios, reduced platelet aggregation (increased risk for hemorrhage). Fetal AE: constriction of ductus arteriosus-->premature closure, decrease in renal fxn due to oligohydramnios. Neonate AE: RDS, intraventricular hemorrhage (IVH)
- Used only when other methods fail and only if < 32 gwks
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