Hypertensive Urgency:
Procardia (Nifedipine):
MOA: Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina; also reduces peripheral vascular resistance, producing a reduction in arterial blood pressure.
Onset of action: Immediate release: ~20 minutes
Labetalol:
MOA: Blocks alpha-, beta1-, and beta2-adrenergic receptor sites; elevated renins are reduced. The ratios of alpha- to beta-blockade differ depending on the route of administration: 1:3 (oral) and 1:7 (IV).
Onset of action: Oral: 20 minutes to 2 hours; IV: 2 to 5 minutes
Hydralazine:
MOA: Direct vasodilation of arterioles (with little effect on veins) with decreased systemic resistance
Onset of action: Oral: 20-30 minutes; IV: 5-20 minutes
Postpartum Hemorrhage:
Pitocin: 40 units in 1 L of normal saline intravenously at a rate sufficient to control uterine atony or 10 units intramuscularly (including directly into the myometrium)
MOA: Stimulates uterine contraction by activating G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils. Oxytocin also increases local prostaglandin production, further stimulating uterine contraction.
Onset of action: Uterine contractions: IM: 3 to 5 minutes; IV: ~1 minute
Cytotec (Misoprostol): Sublingual: 800 mcg as a single dose
MOA: Synthetic prostaglandin E1 analog replaces the protective prostaglandins consumed with prostaglandin-inhibiting therapies (eg, NSAIDs); has been shown to induce uterine contractions
Peak: ~30 min for sublingual or oral, 1 hr for rectal administration. (rectal has a longer duration of action, 4 hrs, compared to 2-3 hrs).
Methergine(Methylergonovine): 0.2 mg intramuscularly or directly into the myometrium (never intravenously) q2-4 hours
MOA: Increases the tone, rate and amplitude of contractions on the smooth muscles of the uterus, producing sustained contractions which shortens the third stage of labor and reduces blood loss.
Onset of action: Oxytocic: Oral: 5-10 minutes; IM: 2-5 minutes; IV: Immediately
Time to peak, serum: Oral: 0.3-2 hours; IM: 0.2-0.6 hours
Hemabate(Carboprost tromethamine): 250 mcg intramuscularly every 15 to 90 minutes, as needed, to a total cumulative dose of 2 mg (eight doses)
MOA: Naturally occurring prostaglandin F2 alpha (dinoprost); carboprost stimulates uterine contractility which usually results in expulsion of the products of conception and is used to induce abortion between 13-20 weeks of pregnancy. When used postpartum, hemostasis at the placentation site is achieved through the myometrial contractions produced by carboprost.
Time to peak, serum: IM: 30 minutes
Induction of Labor:
Pitocin:
MOA: Stimulates uterine contraction by activating G-protein-coupled receptors that trigger increases in intracellular calcium levels in uterine myofibrils. Oxytocin also increases local prostaglandin production, further stimulating uterine contraction.
Onset of action: Uterine contractions: IM: 3 to 5 minutes; IV: ~1 minute
Cytotec (Misoprostol): Intravaginal: 25 mcg (1/4 of 100 mcg tablet); q3-4 hours.
MOA: Synthetic prostaglandin E1 analog replaces the protective prostaglandins consumed with prostaglandin-inhibiting therapies (eg, NSAIDs); has been shown to induce uterine contractions
Cervidil (Dinoprostone):Insert 10 mg transversely into the posterior fornix of the vagina (to be removed at the onset of active labor or after 12 hours)
MOA: relaxes cervical smooth muscle, and stimulates uterine contractions