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INTRODUCTION

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dinoprostone (dye-noe-prost-one)

Cervidil Vaginal Insert, Prepidil Endocervical Gel, Prostin E Vaginal Suppository

Classification

Therapeutic: cervical ripening agent

Pharmacologic: oxytocics, prostaglandins

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Indications
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Endocervical Gel, Vaginal Insert: Used to “ripen” the cervix in pregnancy at or near term when induction of labor is indicated. Vaginal Suppository: Induction of midtrimester abortion, Management of missed abortion up to 28 wk, Management of nonmetastatic gestational trophoblastic disease (benign hydatidiform mole).

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Action
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Produces contractions similar to those occurring during labor at term by stimulating the myometrium (oxytocic effect). Initiates softening, effacement, and dilation of the cervix (“ripening”). Also stimulates GI smooth muscle. Therapeutic Effects: Initiation of labor. Expulsion of fetus.

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Adverse Reactions/Side
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Effects Endocervical Gel, Vaginal Insert
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GU: uterine contractile abnormalities, warm feeling in vagina. MS: back pain. Misc: fever.

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Suppository
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CNS: headache, drowsiness, syncope. Resp: coughing, dyspnea, wheezing. CV: hypotension, hypertension. GI: diarrhea, nausea, vomiting. GU: UTERINE RUPTURE, urinary tract infection, uterine hyperstimulation, vaginal/uterine pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, chills, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Be alert for signs of uterine rupture. Signs include increased bleeding, sudden abdominal pain, and changes in fetal heart rate. Notify physician or nursing staff immediately if these signs occur.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension resulting in syncope) or a sustained increase in BP (hypertension).

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Interventions
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  • Provide massage, other manual techniques, or relaxation techniques as needed to relieve back pain and pain associated with childbirth.

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Patient/Client-Related Instruction
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  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, chills, fever, or GI problems (diarrhea, nausea, vomiting).

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Pharmacokinetics
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Absorption: Rapidly absorbed.

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Distribution: Unknown. Action is mostly local.

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Metabolism and Excretion: Metabolized by enzymes in lung, kidneys, spleen, and liver tissue.

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Half-life: Unknown.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
cervical ripening (gel) rapid 30–45 min unknown
cervical ripening (insert) rapid unknown 12 hr
abortion time (suppository) 10 min 12–24 hr 2–3 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to prostaglandins or additives in the gel or suppository; The gel/insert should be avoided in situations in which prolonged uterine contractions should be avoided, including: ...

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