Uterotonics
This uterotonic causes direct smooth muscle contractility and thus should be avoided in patients with hypertension or preeclampsia
Methergine (methylergonovine)
This is the dose of TXA given in postpartum hemorrhage
1 g (diluted in 100 cc normal saline)
This can be used as a short acting tocolytic due to its conversion to nitric oxide, leading to smooth muscle relaxation
Nitroglycerin
This is the medication used to treat magnesium toxicity
Calcium (gluconate)
This is the fastest onset local anesthetic due to its high concentration rather than its pKa
Chloroprocaine
Also known as hemabate, this uterotonic is a synthetic prostaglandin which may also cause bronchospasm and thus should be avoided in asthmatics
Carboprost (15-methyl PGF2a)
This is how frequently you can redose hemabate during a postpartum hemorrhage (minimum time between doses)
Every 15 minutes
(Q15-90 min up to 1 mg)
This tocolytic is a calcium channel inhibitor also used for blood pressure management in preeclampsia. Common side effects include headache and flushing
Nifedipine (procardia)
This is a neuromuscular exam finding used to diagnose magnesium toxicity
Loss of deep tendon reflexes
When injected through an epidural, this local anesthetic typically has an onset of 3 to 5 minutes and a duration of about 45 minutes
Lidocaine
In our hospital, this is the starting dose (in mL/hr) of oxytocin when administered prophylactically following delivery in cesarean section assuming the patient has not had previous exposure to oxytocin during labor
300 mL/hr (300 mIU/min)
This is the dose of misoprostol given buccally or rectally in postpartum hemorrhage
600 - 800 mcg
This tocolytic should be used with caution after 32 weeks due to its inhibition of prostaglandins, and therefore risk of early PDA closure in a fetus.
Indomethacin
These are EKG changes seen early in magnesium toxicity
Prolonged PR, widened QRS
This can be added to local anesthetics to speed up onset related to pKa and pH
Sodium bicarbonate
This uterotonic is a prostaglandin E analog
Misoprostol (cytotec)
This is the mechanism of action of tranexamic acid
Inhibits activation of plasminogen to plasmin (thus inhibiting clot breakdown)
This tocolytic is a beta2 agonist that is used for uterine relaxation during obstetric procedures. Side effects include tachycardia
Terbutaline
These are three uses for magnesium in obstetrics:
Fetal neuroprotection (for preemies)
Maternal neuroprotection (seizure prevention in preeclampsia)
Tocolysis
This is the toxic dose of lidocaine if epinephrine is added
7 mg/kg
These 3 uterotonics can be given IM
Hemabate 250 mcg IM
Methergine 0.2 mg IM
Oxytocin 10 IU IM
This is the level of fibrinogen, below which cryoprecipitate should be administered in obstetrics
200 mg/dL
This is the standard dose of terbutaline for uterine relaxation (IV or subQ)
0.25 mg
This is the goal therapeutic level of magnesium
5-9 mg/dL (4-8 mEq/L)
This medication has an onset of around 10 minutes and a duration of about 90 minutes
Mepivacaine