—posting due by July 15
How do the following drugs actually cause pregnancy loss? If and when do you feel they should be used?
Kevin— Levonorgestrel
Mike—Preven
Krista—Ethinyl estradiol alone
Faith—Mifepristone (RU 486)
Neil—Dinoprostone
Sarah—Methotrexate
Eli—Carboprost
8 comments:
Dinoprostone (PGE 2 ) is a naturally-occurring biomolecule. It is found in low concentrations in most tissues of the body and functions as a local hormone (1-3). As with any local hormone, it is very rapidly metabolized in the tissues of synthesis (the half-life estimated to be 2.5-5 minutes). The rate limiting step for inactivation is regulated by the enzyme 15-hydroxyprostaglandin dehydrogenase (PGDH) (1,4). Any PGE 2 that escapes local inactivatio is rapidly cleared to the extent of 95% on the first pass through the pulmonary circulation (1,2).
In pregnancy, PGE 2 is secreted continuously by the fetal membranes and placenta and plays an important role in the final events leading to the initiation of labor (1,2).
Thus the medicine induces labor and should only be use when labor is required at the end of pregnancy.
http://www.rxlist.com/cgi/generic/dinoprostonevag_wcp.htm
Levonorgestrel is a form of progesterone, which is a female hormone involved in conception. Levonorgestrel is used to prevent pregnancy by inhibiting ovulation and by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus.Levonorgestrel is in the FDA pregnancy category X. This means that levonorgestrel is known cause birth defects in an unborn baby. Hormonal changes during pregnancy can have very serious negative effects on a developing baby.
http://www.drugs.com/MTM/levonorgestrel.html
http://en.wikipedia.org/wiki/Levonorgestrel
Ethinyl estradiol- alone
-While estradiol is readily absorbed when taken orally, it is also quickly inactivated by the liver. Substitution at C17 of the estrane steroid with an ethinyl group proved to provide an estrogen that is much more resistant to degradation and paved the way for the development of oral contraceptives.
http://en.wikipedia.org/wiki/Ethinylestradiol
-The effects of large doses of ethinyl estradiol on implantation and early gestation in women were evaluated. 32 women exhibiting early amenorrhea were treated with a daily dose of 1 mg of ethinyl estradiol for 7 consecutive days. It was determined through testing that 12 of the women were not pregnant. In 14 of the 20 pregnant women, side effects were noted in the form of nausea and vomiting. Histologic examination of the endometrial specimens indicated the presence of placental tissue in all subjects. It was considered possible that the dose of ethinyl estradiol administered might be insufficient to induce abortion. In a second study, a dose of 5 mg was administered daily for 7 days to a group of 6 women. The beginning of estrogen treatment varied between 36 and 46 days. Nausea was milder in this group than in the subjects treated with only 1 mg of ethinyl estradiol. Abortion did not occur. In a third study, 4 fertile women with approximately normal cycles were given daily doses of 5 mg of ethinyl estradiol from the twenty-first to the twenty-eighth day of the cycle during 2 cycles. 3 of the 4 subjects became pregnant. It was concluded that ethinyl estradiol is not a reliable abortifacient in women and that its efficiency as a postcoital contraceptive may be limited to a relatively short period following ovulation and prior to implantation.
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=5423572&dopt=Abstract
-I do not believe in abortion what so ever! So IF the drug was going to be used to induce pregnancy loss then I do not feel it is the moral thing to do. IF the drug is going to be combined to be used as a contraceptive pill (Nuvaring) then that is acceptable.
Each dose of Preven contains contains 0.5 mg of levonorgestrel and 100 µg of ethinyl estradiol. Preven is a female hormone that prevents ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucous and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. This drug will not cause pregnancy loss but it will help prevent the patient from becoming pregnant.
This drug should not be used as a regular form of contraception and should only be used in an emergency situation.
https://online.epocrates.com/u/10a2473/levonorgestrel?mode=SingleMatch&src=PK
http://ec.princeton.edu/pills/prevenpic.html
Mifeoristone has an affinity at progesterone receptors. The drug blocks the action of progesterone receptors which causes “endometrial decidual degeneration”. It also causes cervical softening and dialation. Overall, it reduces the amount of progesterone produced in the body and since pregnancy is dependent upon the production of progesterone the pregnancy is terminated. It is given orally within the first seven to nine weeks of pregnancy and causing the fetus to die will cause contractions so that the fetus can be expelled.
If when do you feel they should be used?
I don't advocate abortion, and I know that I would never use one of these to terminate a pregnancy but I cannot speak for other people. They'll have to make up their own minds and decide what the right thing to do is.
http://www.americanpregnancy.org/unplannedpregnancy/medicalabortions.html
http://en.wikipedia.org/wiki/Mifepristone
Carboprost causes pregnancy loss by stimulating uterine contractions, and causing complete abortion in 16 hours. Carboprost is indicated for abortion at 13-20 weeks gestation, and also for postpartum haemorrhaging. Carboprost is classified as and oxytocic, which means it acts by causing the uterus to contract the way it does during labor, and also helps the cervix dilate.
I don't feel that Carboprost should be used for abortion except in very rare emergency situations.
www.rxlist.com
www.drugs.com
Dinoprostone: indicated in inducing labor, ripening of an unfavorable cervix, and an abortant. It works by its sedative, anticholinergic, and antiemetic effects.
For use as an abortant or to induce labor, Dinoprostone comes as a vaginal insert and as a gel that is inserted high into the vagina. A second dose of the gel may be administered in 6 hours if the first dose does not produce the desired response.
Although this drug may be used as an abortion drug, it's also used just to help induce labor during the end of pregnancy. For its use as an abortion drug I am generally against abortion in most cases. Exceptions (to me) would include a fatus that would have mental or physical problems, a mother at high risk of injury/death during pregnancy/labor, a rape victim.
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682512.html
http://www.drugs.com/cons/dinoprostone-cervical-vaginal.html
http://en.wikipedia.org/wiki/Dinoprostone
'99 edition PDR Nurse's Handbook
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