DRUGS ACTING ON UTERUS

DR.ASHOK JAIN
DNB MEDICINE
MD PHARMACOLOGY
EX DNB-SS GENETICS
UTERINE STIMULANTS (OXYTOCICS, ECBOLICS)
OXYTOCIN
 Oxytocin Physiological Actions

High-dose oxytocin

Uterus
 Oxytocin Physiological Actions

3. Kidney: Oxytocin (high doses)

ADH-like action
Decreased urine output.
Water intoxication may occur

4. Cardiovascular system: Oxytocin (high doses) causes vasodilatation and transient hypotension which
leads to reflex tachycardia and flushing.
Oxytocin
 Oxytocin Mechanism Of Action
Oxytocin, interacts with its receptor, a G-protein-coupled receptor (GPCR).

When oxytocin binds to its receptor, it activates a specific G-protein, Gq/11, which in turn activates
phospholipase C (PLC).

PLC then cleaves phosphatidylinositol 4,5-bisphosphate (PIP2) into two second messengers: inositol
trisphosphate (IP3) and diacylglycerol (DAG).

IP3 triggers the release of calcium from intracellular stores, while DAG activates protein kinase C (PKC).

The increased intracellular calcium and PKC activation contribute to the activation of enzymes involved in
prostaglandin synthesis, leading to an increase in prostaglandin production
Oxytocin
Oxytocin
 CARBETOCIN

It is an analogue of oxytocin
longer duration of action.

Uses
prevention of uterine atony following caesarean section.
prevention of PPH.
Ergot Derivatives
Ergot Derivatives Actions
Ergot Derivatives
Ergot Derivatives
Prostaglandins
Prostaglandins
Prostaglandins
Differences Between Oxytocin And Ergometrine

i.m.
 UTERINE RELAXANTS (TOCOLYTICS)
Tocolytics are drugs that inhibit uterine contractions.
β2 Adrenergic Agonists

Headache
Pulmonary edema
Hypokalemia
Calcium Channel Blockers (CCBs)
Atosiban
Prostaglandin synthesis inhibitors
Magnesium Sulfate
Miscellaneous
Uterine Relaxants (Tocolytics)
Q1. Which of the following hormone is responsible for galactokinesis is?
a) - Prolactin
b) - Oxytocin
c) - FSH
d) - Estrogen

Q2. action of oxytocin in small doses, when used as intravenous infusion in a full term uterus?
e) - Relaxes uterus
f) - Induces uterine contractions
g) - Causes cervical dilatation
h) - All

Q3. example of neuroendocrine secretion?

i) - Growth hormone
j) - Cortisol
k) - Oxytocin
l) - Thyroxine
Q4. Lactiferous duct of breast contraction is due to
- a. Progesterone
- b. Estrogen
- c. Oxytocin
- d. Prolactin

Q5. Oxytocin will not do the following action:

- a. Milk production
- b. Milk let down
- c. Contraction of myo-epithelial cells
- d. Vascular contraction

Q6. Oxytocin is mainly secreted by

a) - Preoptic nucleus
b) - Paraventricular nucleus
c) - Midline nucleus
d) - Ventroposterolateral nucleus
Q7. Oxytocin is preferred over ergometrine in:
a) - Induction of labour
b) - Prevention of PPH
c) - Both of the above
d) - None of the above

Q8.Ergometrine is contraindicated in
e) - Eclampsia
f) - Abortion
g) - Induction of labour
h) - Postpartum haemorrhage

Q9. Complication associated with iv bolus oxytocin?

i) - Hypotension
j) - Hypoglycemia
k) - Hyperglycemia
l) - Hypertension
Q10. Sometimes the labor pains are less and uterine contractions have to be induced. What do you think the
doctors inject to facilitate delivery?
a) - FSH and LH
b) - Progesterone and estrogen hormones
c) - Oxytocin
d) - Relaxin

Q11. Oxytocin is preferred over ergometrine for augmenting labour because :

e) - It has brief and titrable action
f) - It is less likely to cause fetal anoxia
g) - It is less likely to impede fetal descent
h) - All of the above

Q12. Tocolytic which is contraindicated in Diabetic patients

i) - Nifedipine
j) - Ritodrine
k) - Atosiban
l) - MgSO4
Q13. All are used in preterm labour to decrease uterine contractility except?
a) - Methyl alcohol
b) - Ritodrine
c) - Magnesium sulphate
d) - Dexamethasone

Q14. Which of the following drugs may be used to arrest premature labour?
e) - Aspirin
f) - α-Methyl dopa
g) - Magnesium sulphate
h) - Diazoxide

Q15. All of the following drugs have been used for medical abortion except?
i) - Mifepristone
j) - Misoprostol
k) - Methotrexate
l) - Atosiban
Q16. Which uterine relaxant act as Oxytocin antagonist
a) - Atosiban
b) - Terbutaline
c) - Nifedipine
d) - All

Q17. Tocolytic of choice in pregnancy complicated with heart disease

e) - Nifedipine
f) - Terbutaline
g) - Atosiban
h) - Ritodrine

Q18. Which of the following is a synthetic PFG2 alpha derivative used as an abortifacient?
i) - Dinoprost
j) - Dinoprostone
k) - Misoprostol
l) - Carboprost
Q19. All of the following drugs are used for the treatment of post-partum hemorrhage except:
- (a) Misoprostol
- (b) Dinoprostone
- (c) Prostaglandin F2 alpha
- (d) Oxytocin

- Q20. Which drug is given only intramuscular.

a) - CARBOPROST
b) - MISOPROST
c) - MISOPROSTOL
d) - OXYTOCIN

Q21. All drug useful in treatment of PPH in women with rheumatic heart disease except
e) - Oxytocin
f) - Misoprostol
g) - Methylergometrine
h) - Carboprost
Q22. Tocolytic with more fetal complications are
a) - Ritodrine
b) - Isoxisuprine
c) - Indomethacin
d) - Nifedipine

Q23. Which of the following tocolytic causes fracture in fetus

e) - Nifedipine
f) - Atosiban
g) - Mgso4
h) - Ritodrine

Q24. A 30-year-old woman develops generalized tonic-clonic seizures about 27 hours after
spontaneous vaginal delivery augmented by oxytocin. Uterine massage and an oxytocin bolus
controlled postpartum bleeding.. Laboratory test results are hemoglobin 9.9 g/dL, platelet count
250000 /µL, sodium 114 mEq/L, potassium 3.7 mEq/L, chloride 102 mEq/L, glucose 120 mg/dL,
calcium 10 mg/dL, and magnesium 6.1 mg/dL. Which of the following infusions is the most effective
treatment?
A.Hypertonic saline
B.Calcium gluconate
C.Normal saline
D.5% dextrose
Q25. A 35-year-old woman gives birth at 38 weeks of gestation. During the third stage of labor, a drug is administered to
aid the delivery of the placenta and control postpartum bleeding. Which structure of the brain is responsible for the
synthesis of an endogenous hormone similar to this drug?
A.Anterior pituitary
B.Posterior pituitary
C.Hypothalamus
D.Hippocampus

Q26. Where are arginine vasopressin (AVP) and oxytocin stored?

A. - Anterior pituitary
B. - Supraoptic nucleus
C. - Paraventricular nucleus
D. - Herring bodies

Q27.Drug preventing contraction of uterus

E. Carbaprost
F. Antiprogestin
G. Atosiban
H. Methyl ergomatrine
Q28. DOC TO PREVENT NEUROLOGICAL COMPLICATIONS IN PRETERM LABOUR IS
A. - NIFEDIPINE
B. - ATOSIBAN
C. - MgSO4
D. - LABETALOL

Q29. The drug that inhibits uterine contractility and cause pulmonary edema is
E. - Ritodrine
F. - Nifedipine
G. - Indomethacin
H. - Atosiban

Q30. All of the following drugs have been used for medical abortion except?
I. - Mifepristone
J. - Misoprostol
K. - Methotrexate
L. - Atosiban
Q31. Safest Tocolytics for management of Pre-term labor
A. - Nifedipine
B. - Atosiban
C. - MgSO4
D. - Progesterone

Q32. Which antiasthmatic drug should not be used in pregnancy?

A. Salbutamol B. Prednisolone
C. Theophyline D. Ipratropium bromide

Q33. Which is not a tocolytic agent

a. MgSO4
b. Nifedipine
c. Atosiban
d. Dinoprostone
Q34.Best tocolytic , best Tocolytic in heart disease and best tocolytic in diabetes respectively are
- 1) Nifidipine
- 2) Atosiban
- 3) Beta agonist s
A. - 1,2,3
B. 3,1,2
C. 1,3,2
D. 2.1.3

Q35. Most effective tocolytics for management of Pre-term labor

E. - Nifedipine
F. - Atosiban
G. - MgSO4
H. - Progesterone

Q36. A 32-week-pregnant woman with a history of two previous mid trimester abortions presents with regular contraction of the
uterus. The cervix is 2 cm dilated. All the following are done EXCEPT:
- (A) Tocolytics
- (B) Dexamethasone
- (C) Antibiotics
- (D) Emergency encirclage
Q37. All of the following statements about peripartum cardiomyopathy are true except?
- A. Use of tocolytic therapy for premature labor is a risk factor
- B. Presents early in pregnancy
- C. Decreased angiogenic reserve
- D. None of the above

Q38. Best tocolytic in diabetes

A. - Terbutaline
B. - Isoxsuprine
C. - MgSO4
D. - Nifedipine

Q39. 28 years old female admitted for preterm labor. Which of the following tocolytic is most commonly used ?
E. - Ritodrine
F. - Metoprolol
G. - Terbutaline
H. - Ritoxine
Q40. Most potent drug to control PPH
A. Methergin
B. Oxytocin
C. Misoprostol
D. Carboprost

Q41. A woman presented in her 8th week of pregnancy seeking MTP. The appropriate dosage of Misoprostol (administered by
mucosal route) would be
E. - 200 mcg
F. - 600 mcg
G. - 400 mcg
H. - 800 mcg

Q42. What is the Maternal Risk of Using Misoprostol For Ripening of Cervix During Induction of Labor ?
I. - Tachycardia
J. - Tachysystole
K. - Hypotension
L. - Bradycardia
Q43. Which Drug is Contraindicated in Patient With atonic PPH With History Of Hypertension ?
A. - Oxytocin
B. - Misoprostol
C. - PGF2 Alpha
D. - Ergotamine

Q44. A Woman Post Term Pregnancy With Unripe Cervix Should Not be Induced With Misoprostol if she has ?
E. - Asthma
F. - Diabetes
G. - Decompensated Heart Failure
H. - Hep B Antigen Positive

Q45. Misoprostol Can be Used During Pregnancy by the Following Route Except ?
I. - Intravenous
J. - Oral
K. - Vaginal
L. - Sublingual
Q46.All of the following reduces gastric acid secretion except
A. Misoprostol
B. Pantoprazole
C. Sucralfate
D. Ranitidine

Q47. A Pregnant lady with 30weeks gestation has peptic ulcer diseases. All the following drugs can be used except:
E. - ⦁ Rabeprazole
F. - ⦁ Ranitidine
G. - ⦁ Antacids
H. - ⦁ Misoprostol

Q48. What dose of misoprostol is used orally to control bleeding in post partum hemorrhage?
- a) 400 micrograms
- b) 600 micrograms
- c) 800 micrograms
- d) 1000 micrograms
Q49. Misoprostol is effective in all of the following condition except
A. PPH
B. Missed abortion
C. Induction of labour
D. Menorrhagia

Q50. Identify the INCORRECT Teratogen and Effect on fetus match:

E. - Phenytoin -Neuroblastoma
F. - Misoprostol-Mobius syndrome
G. - Statin -Ebstein anomaly
H. - Vitamin D-hypercalcemia

Q51. All of the following drugs act via G protein coupled receptors except:
I. - Nicotine
J. - Atropine
K. - Misoprostol
L. - Dobutamine
Q52. Drug combination which is preferred for MTP ?
A. - Lupiprostone + Mifepristone
B. - Alprostadil Misoprostol
C. - Lubiprostone + Misoprostol
D. - Mifepristone + Misoprostol

Q53. Misoprostol used in the induction of labour is an analogue of which of the following type of prostaglandin?
- A.PGE1
- B.PGE2
- C.PGF2alfa
- D.PGI2

Q54. Drug which is contraindicated before 2nd stage of labor is:

- a) Mifepristone
- b) Oxytocin
- c) Misoprostol
- d) Ergometrine
Q55.Uterotonic drugs
A. Oxytocin
B. Misoprostol
C. PGF2 alpha
D. All of the above

Q56. In MTP ,according to FDA, Misoprostol is given after how many hours of Mifepristone?
- A. 24 hours
- B. 48 hours
- C. 72 hours
- D. 96 hours

Q57. A 8 weeks pregnant lady came for medical termination of pregnancy what is the dose of misoprostol to be given with
mifepristone
A. - 200 mcg vaginally
B. - 400 mcg vaginally
C. - 800 mcg orally
D. - 800 mcg vaginally
Q58. All of the following statements are correct regarding misoprostol except
A. - Can cause abortion in first trimester
B. - Can cause moebius syndrome in second and third trimester
C. - Cause uterine contractions and cervical ripening
D. - Drug of choice to treat postpartum haemorrhage

Q59. Best medical abortion regime for 8 weeks pregnancy would be

E. - Mifepristone 200 mg orally and misoprostol 400 mcg orally
F. - Mifepristone 200 mg orally and misoprostol 400 mcg vaginally
G. - Mifepristone 200 mg orally and misoprostol 800 mcg orally
H. - Mifepristone 200 mg orally and misoprostol 800 mcg vaginally

Q60. DOC to treat Postpartum haemorrhage is?

I. - Oxytocin 10 IU I/M Injection
J. - Carboprost
K. - Oxytocin 40 IU slow IV infusion
L. - Misoprostol
Q61. The approved indication for misoprostol:
- A. Reflux esophagitis.
- B. Regional ileitis.
- C. Ulcerative colitis.
- D. Prevention gastric ulceration in patients using large doses of aspirin like drugs.

Q62. The uterotonic which needs does not require refrigeration is

A. - Misoprostol
B. - Oxytocin
C. - Dinoprostone
D. - B & c are correct

Q63. mifepristone and misoprostol can be used for induction of abortion for a maximum of upto :
- a. 6 weeks of amenorrhea
- b. 8 weeks of amenorrhea
- c. 7 weeks of amenorrhea
- d. 9 weeks of amenorrhea
Q64. All of the following drug are used for medical management of ectopic pregnancy except:
1. Potassium Chloride 2. Methotrexate 3. Misoprostol 4. Mifepristone
A. -1
B. -2
C. -3
D. -4

Q65. All the following statements are correct regarding medical abortion, except?
E. - Mifepristone and misoprostol should be taken on the same day to increase efficacy.
F. - One mifepristone table should be taken orally.
G. - Four misoprostol tablets should be used in a for of sublingual, buccal or vaginal tablets.
H. - Medical abortion is only approved in the first 63 days of gestation

Q66. long-acting analog of oxytocin.

I. - Desamino-oxytocin
J. - Carbetocin
K. - Solifenacin
L. - Darifenacin
Q67. Buccal formulationof oxytocin.
A. - Desamino-oxytocin
B. - Carbetocin
C. - Solifenacin
D. - Darifenacin