1. Bill Wightkin, PharmD, MS 480.219.6167 wwightkin@atsu.edu
Abortifacients
Bill Wightkin, PharmD, MS
Reviewed

2. Learning Objectives
Describe the mechanisms of action of mifepristone, misoprostol, dinoprostone and carboprost when used for elective and therapeutic abortions (slides 6, 9, 10, 12)
Explain the various indications for the obstetrical use of misoprostol (slide 11)

3. A Pregnancy Loss B Spontaneous C Recurrent D Uterine Factors E
Medical Conditions F
Endocrine G
Autoimmune H
Chronic Illness I
Genetic /
Environmental J
Psychological K
Therapeutic Abortion

4. © World Health Organization 2012.

6. Mifepristone (RU-486): A progesterone receptor antagonist
Progesterone is crucial for maintenance of
the endometrium during pregnancy.
Blockade of progesterone action by mifepristone results
in decay and death of the decidua. Lack of nourishment from the decidua causes the blastocyst to die and detach from the uterus.
Usually combined w/ misoprostol which stimulates uterine contraction. Combination >= 95% effective in term 1st trimester pregnancies. In fact, mifepristone increases uterine sensitivity to prostaglandins.
Major adverse effect not from drug but from excessive vaginal
bleeding that can occur from subsequent abortion

7. MISOPROSTOL Information from Last Year’s GI Course

8. Misoprostol (CYTOTEC) Pharmacology
MISOPROSTOL Information from Last Year’s GI Course
Misoprostol (CYTOTEC) Pharmacology
Synthetic analog of PGE1
Promotes gastric mucus and mucosal bicarbonate secretion
Inhibits basal and nocturnal gastric acid secretion from parietal cells
Misoprostol Adverse Effects
Diarrhea (dose dependent)
Abdominal cramping, flatulence

9. N Engl J Med 2007;357:

10. Prostaglandins (E1, E2, F2 α ): stimulate uterine contraction
MISOPROSTOL: analog of PG E1

11. Obstetrical Uses of Misoprostol
Available ONLY as a tablet originally intended just for oral use: given orally, vaginally or rectally (doses differ based on route and reason for use)
Uses
Abortifacient
“Ripen” cervix prior to labor
Induce labor
Treat postpartum hemorrhage

12. Other Prostaglandin Abortifacients
Carboprost: analog of naturally occurring prostaglandin F2α
OTHER USE: Treatment of postpartum hemorrhage due to uterine atony
OTHER USE: Dinoprostone vaginal suppository (prostaglandin E2) (Prostin E2) is indicated for evacuation of the uterine contents in the management of missed abortion or intrauterine fetal death.

13. THE COPYRIGHTED MATERIALS AVAILABLE IN THIS PRESENTATION ARE FOR EDUCATIONAL USE ONLY. ONE COPY PER STUDENT IS PERMITTED FOR EDUCATIONAL PURPOSES. REDISTRIBUTION IS NOT PERMITTED

14. The End

15. Extra Reading