Uterotonics

Uterotonics

Drug monograph · NCLEX study reference
Trade names	Pitocin, Methergine, Hemabate, Cytotec
Therapeutic class	Uterotonic
Pharmacologic class	Posterior pituitary hormone (oxytocin), ergot alkaloid (methylergonovine), prostaglandins (carboprost, misoprostol)
Onset / peak / duration	Oxytocin IV rapid; others by route.
Half-life / level	Oxytocin short; no routine level.
Routes	PO (oral), IV, IM, Sublingual, Rectal, Vaginal
High-alert (ISMP)	Yes (oxytocin)
Black box warning	None
Antidote / reversal	Stop the infusion (oxytocin); supportive care.
Pregnancy / lactation	Used in labor and postpartum care.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Uterotonics (brand names Pitocin, Methergine, Hemabate, Cytotec) — Uterotonic; Posterior pituitary hormone (oxytocin), ergot alkaloid (methylergonovine), prostaglandins (carboprost, misoprostol).

Identification

• Therapeutic class: Uterotonic.
• Pharmacologic class: Posterior pituitary hormone (oxytocin), ergot alkaloid (methylergonovine), prostaglandins (carboprost, misoprostol).

Pharmacology

• Mechanism of action: Stimulate uterine contraction to induce or augment labor and to control postpartum hemorrhage.
• Onset / peak / duration: Oxytocin IV rapid; others by route.
• Half-life / therapeutic level: Oxytocin short; no routine level.

Clinical use

• Indications: Labor induction and augmentation (oxytocin), postpartum hemorrhage (all), cervical ripening (misoprostol).
• Usual dose, route, frequency: Oxytocin IV infusion titrated; methylergonovine IM or PO; carboprost IM; misoprostol oral, vaginal, rectal, or sublingual.
• Maximum dose / adjustments: Titrate oxytocin to contraction pattern with fetal monitoring.

Safety

• Contraindications: Methylergonovine in hypertension or preeclampsia; carboprost in asthma; misoprostol in ongoing pregnancy when not intended.
• Black box warning: None standard for these (oxytocin labeling cautions against elective induction without medical indication).
• Interactions: Vasopressors with methylergonovine (severe hypertension).
• Pregnancy / lactation: Used in labor and postpartum care.
• High-alert: Yes (oxytocin).

Adverse effects

• Common side effects: Cramping, nausea; carboprost causes diarrhea and fever.
• Serious effects to report: Uterine hyperstimulation and rupture, fetal distress, water intoxication (high-dose oxytocin), severe hypertension (methylergonovine), bronchospasm (carboprost).
• Antidote / reversal: Stop the infusion (oxytocin); supportive care.

Nursing process

• Assessment before administration: Contraction pattern, fetal status, blood pressure, asthma history (carboprost).
• Interventions during therapy: Continuous fetal and contraction monitoring with oxytocin; stop oxytocin for hyperstimulation or fetal distress; check blood pressure before methylergonovine.
• Monitor: Contractions, fetal heart rate, blood pressure, bleeding, fluid status.
• Evaluation / expected outcome: Effective labor progression or controlled bleeding.

Patient teaching

• Patient teaching: Expect monitoring during oxytocin; report severe pain.
• Notify provider if: Not applicable (continuous monitoring); team manages.
• Administration tips: Oxytocin titrated with fetal monitoring; verify blood pressure before methylergonovine; high-alert.