Misoprostol

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misoprostol pharmacokinetics and different methods of use

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  • http://obataborsicytotectuntas.com/ JUAL OBAT ABORSI
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Misoprostol

  1. 1. Misoprostol<br />Theory & Practice<br />In Obstetrics<br />
  2. 2.
  3. 3. Objectives<br /><ul><li>Be familiar with the nature and pharmacokinetics of misoprostol.
  4. 4. Establish the difference between different routes of drug adminstration.
  5. 5. Strengthen the self-confidence with erasing the internal worries about the use of misoprostol. </li></li></ul><li>Subjects<br /><ul><li>Nature & pharmacokinetics of misoprostol.
  6. 6. Adverse reactions.
  7. 7. Uses of misoprostol.</li></li></ul><li>Nature<br />Synthetic PGE1 analog<br />Why?<br />
  8. 8. Pharmacokinetics<br />Routes of adminstration & absorption:<br /><ul><li>Oral…..affected by food & antacids
  9. 9. Sublingual
  10. 10. Vaginal
  11. 11. Rectal
  12. 12. Parentral……NO</li></li></ul><li>ORAL <br />VAGINAL<br />
  13. 13. ORAL<br />RECTAL<br />
  14. 14. Metabolism<br /><ul><li>Mainly in the liver……</li></ul>So take care in hepatic patient<br />not renal one.<br /><ul><li>No accumulation.</li></li></ul><li>Adversereactions<br /><ul><li>Diarrhea
  15. 15. Abdominal pain
  16. 16. Headache
  17. 17. Nausea
  18. 18. Vomiting
  19. 19. Flatulence
  20. 20. Chills
  21. 21. Shivering
  22. 22. fever
  23. 23. Less common adverse reactions
  24. 24. Dose-dependent</li></li></ul><li>Toxicity<br />No serious side effects<br />2200 g (11 tablets)<br />Serious side effects:<br />Hyperthermia<br />Rhabdomyolysis<br />Hypoxemia<br />Acid-base balance disorder<br />6000 g (30 tablets)<br />
  25. 25. Teratogenicity:<br /><ul><li>Mobiussyndrome
  26. 26. Category “X”</li></li></ul><li>Uses of misoprostol<br /><ul><li>Obstetric uses:
  27. 27. Termination of pregnancy
  28. 28. 1st trimester
  29. 29. 2nd trimester
  30. 30. 3rd trimester
  31. 31. Postpartum hemorrhage
  32. 32. Prevention
  33. 33. Treatment
  34. 34. Gynecological uses
  35. 35. Pre-hysteroscopy
  36. 36. Intauterine Insemination (IUI)
  37. 37. Cervical pregnancy
  38. 38. GIT
  39. 39. Prevention & treatment of peptic ulcer induced by NSAIDs</li></li></ul><li>Misoprostol in 1st trimester<br />Gestational age not more than 49 days (completed 7 weeks)<br />3 different regimens<br />mifepristone<br />methotrexate<br />misoprostol<br />5-7 days<br />6 hr<br />36-48hr<br />misoprostol<br />misoprostol<br />success<br />47% ????<br />91-97%<br />88-100%<br />
  40. 40. Gestational age more than 56 days (completed 9 weeks)<br />Misoprostol as cervical –priming agent before vaccum-aspiration of the products of conception<br />400 g vaginal 3 hours before procedure<br />Misoprostol PGE2<br />
  41. 41.
  42. 42. Misoprostolin 2nd trimester<br />Misoprostol 400 g vaginal every 3 hours<br />Misoprostol = PGE2 = extraamniotic PGs<br />
  43. 43. Misoprostol in 3rd trimester<br />Induction of labor<br />Living fetus at term<br />Dead fetus at term<br />Misoprostol25 g<br />every 6 hours<br />Misoprostol50 g<br />every 12 hours<br />why?<br />
  44. 44. Concerns about misoprostol<br />in induction of labor !!!!!<br /><ul><li>Uterine tachysystole
  45. 45. Uterine hyperstimulation
  46. 46. Uterine rupture</li></li></ul><li>Misoprostol in postpartum hemorrhage<br />(PPH)<br />Prevention of PPH<br />Treatment of PPH <br />Insufficient evidence to <br />support its routine use <br />when oxytocin or<br /> methyl-ergometrine<br />is available <br />Rectal misoprostol<br /> 800 g <br />Useful 1st line drug for ttt PPH<br />Why ?<br />
  47. 47. WHO misoprostol multicenter Trial concluded <br />that oral tablets of 600 g was associated with <br />a higher risk of:<br /><ul><li>Severe postpartum hemorrhage
  48. 48. Need for additional uterotonics
  49. 49. Shivering
  50. 50. Pyrexia</li></ul>This is in comparison to intramuscular <br /> or intravenous oxytocin<br />
  51. 51. But <br />Why misoprostol is still evaluated as uterotonic<br />agent despite its side-effects<br />Ease of use<br />Stability in field conditions<br />Longer shelf-life<br />Less expense<br />
  52. 52.
  53. 53.
  54. 54.
  55. 55.
  56. 56.
  57. 57. Thank you for your attention!<br />Any Questions?<br />
  58. 58. Mohamed GamalSaleh Ibrahim<br /> <br />e-mail:mgs_medicine@hotmail.com<br />mobile:002 012 630 1515<br />

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