Pharmacy & Chemistry of Organic Medicinals | Prepared by: Aldrex B.
Dacawe, RPh
Eicosanoids
Structure Indication
Epoprostenol
For the long-term intravenous treatment of
primary pulmonary hypertension and
pulmonary hypertension associated with the
scleroderma spectrum of disease in NYHA
Class III and Class IV patients who do not
respond adequately to conventional therapy.
Alprostadil
For palliative, not definitive, therapy to
temporarily maintain the patency of the
ductus arteriosus until corrective or palliative
surgery can be performed in neonates who
have congenital heart defects and who
depend upon the patent ductus for survival.
Also for the treatment of erectile dysfunction
due to neurogenic, vasculogenic, psychogenic,
or mixed etiology.
Indicated for the treatment of ulceration
Misoprostol
(duodenal, gastric and NSAID induced) and
prophylaxis for NSAID induced ulceration.
Misoprostol is also indicated for other uses
that are not approved in Canada, including
the medical termination of an intrauterine
pregnancy used alone or in combination with
methotrexate,as well as the induction of
labour in a selected population of pregnant
women with unfavourable cervices. This
indication is avoided in women with prior
uterine surgery or cesarean surgery due to an
increased risk of possible uterine rupture.
Misoprostol is also used for the prevention or
treatment of serious postpartum
hemorrhage.
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Eicosanoids
Mechanism of Action
Epoprostenol has two major
pharmacological actions: (1) direct
vasodilation of pulmonary and
systemic arterial vascular beds, and (2)
inhibition of platelet aggregation.
Alprostadil (prostaglandin E1) is
produced endogenously to relax
vascular smooth muscle and cause
vasodilation. Alprostadil causes
vasodilation by means of a direct effect
on vascular and ductus arteriosus (DA)
smooth muscle, preventing or
reversing the functional closure of the
DA that occurs shortly after birth. This
is because, as a form of
prostaglandinE1 (PGE1) it has multiple
effects on blood flow.
Misoprostol is a prostaglandin E1
(PGE1) analogue used for the
treatment and prevention of stomach
ulcers. When administered,
misoprostol stimulates increased
secretion of the protective mucus that
lines the gastrointestinal tract and
increases mucosal blood flow, thereby
increasing mucosal integrity. It is
sometimes co-prescribed with non-
steroidal anti-inflammatory drugs
(NSAIDs) to prevent the occurrence of
gastric ulceration, a common adverse
effect of the NSAIDs.
 Pharmacy & Chemistry of Organic Medicinals | Prepared by: Aldrex B. Dacawe, RPh
For the termination of pregnancy during the
Dinoprostone
second trimester (from the 12th through the
20th gestational week as calculated from the
first day of the last normal menstrual period),
as well as for evacuation of the uterine
contents in the management of missed
abortion or intrauterine fetal death up to 28
weeks of gestational age as calculated from
the first day of the last normal menstrual
period. Also used in the management of
nonmetastatic gestational trophoblastic
disease (benign hydatidiform mole). Other
indications include improving the cervical
inducibility (cervical "ripening") in pregnant
women at or near term with a medical or
obstetrical need for labor induction, and the
management of postpartum hemorrhage.
For the reduction of elevated intraocular
Latanoprost
pressure in patients with open-angle
glaucoma or ocular hypertension.
For aborting pregnancy between the 13th and
Carboprost
20th weeks of gestation as calculated from
the first day of the last normal menstrual
period and in the following conditions related
to second trimester abortion: 1. Failure of
expulsion of the fetus during the course of
treatment by another method; 2. Premature
rupture of membranes in intrauterine
methods with loss of drug and insufficient or
absent uterine activity; 3. Requirement of a
repeat intrauterine instillation of drug for
expulsion of the fetus; 4. Inadvertent or
spontaneous rupture of membranes in the
presence of a previable fetus and absence of
adequate activity for expulsion. Also for the
treatment of postpartum hemorrhage due to
uterine atony which has not responded to
conventional methods of management.
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Eicosanoids
Dinoprostone is equivalent to
prostaglandin E2 (PGE2). It stimulates
labor and delivery by stimulating the
uterine, and thus terminates
pregnancy. Dinoprostone is also
capable of stimulating the smooth
muscle of the gastrointestinal tract of
man.
Dinoprostone administered
intravaginally stimulates the
myometrium of the gravid uterus to
contract in a manner that is similar to
the contractions seen in the term
uterus during labor, resulting in the
evacuation of the products of
conception from the uterus.
Latanoprost is a prostaglandin F2a
analogue. Specifically, Latanoprost is a
prostanoid selective FP receptor
agonist that is believed to reduce the
intraocular pressure (IOP) by increasing
the outflow of aqueous humor.
Carboprost is a synthetic
prostaglandin. It binds the
prostaglandin E2 receptor, causing
myometrial contractions, casuing the
induction of labour or the expulsion of
the placenta. Prostaglandins occur
naturally in the body and act at several
sites in the body including the womb
(uterus). They act on the muscles of
the womb, causing them to contract.