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Uterine Relaxants (Tocolytics)
For BNS Ist Year
Dr. Pravin Prasad
Ist Year Resident, MD Clinical Pharmacology
Maharajgunj Medical Campus
2nd October, 2015(Asoj 15, 2072); Friday
Drugs used as Tocolytics
• Adrenergic agonist: Ritoridine
• Calcium channel blockers: Nifedipine
• Oxytocin Antagonist: Atosiban
• Magnesium sulfate
• Miscellaneous: Ethyl alcohol, nitrates, progesterone, general
anaesthetics, indomethacin, Halothane
Ritoridine
• Mechanism of action:
– β2 selective agonist
• Use:
— Supress premature labour
— Delay delivery
— Treatment beyond 48 hrs not
recommended
• Side Effects:
‒ CVS – hypotension, tachycardia,
arrhythmia, pulmonary edema
‒ Metabolic – hyperglycaemia,
hyperinsulinemia, hypokalemia
‒ Anexity, restlessness, headache
‒ Neonate – foetal pulmonary
edema, hypoglycaemia, ileus
• Contraindication:
– Mother having diabetes or heart
disease, or receiving β blockers or
steroids
Nifedipine
• Mechanism of Action:
• Reduces the tone of myometrium and opposes contraction
• Prominent smooth muscle relaxant action
• Side Effects:
• Maternal - Tachycardia, Hypotension
• Foetal – Foetal Hypoxia due to placental perfusion
Other Tocolytics
• Atosiban
• Mechanism of Action: Antagonist at the oxytocin receptors
• Availability in Nepal (??)
• Magnesium sulfate
• Mechanism of Action: Acts as tocolytics by competiting with Ca++ ions for
entry into myocardium through both voltage gated and ligand gated Ca++
channels
• Higher risk to be used as tocolytics – increases perinatal mortality
• Not recommended
• Halothane
• Used as relaxant when external or internal version is attempted
Thank You!!

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Uterine relaxants (tocolytics)

  • 1. Uterine Relaxants (Tocolytics) For BNS Ist Year Dr. Pravin Prasad Ist Year Resident, MD Clinical Pharmacology Maharajgunj Medical Campus 2nd October, 2015(Asoj 15, 2072); Friday
  • 2. Drugs used as Tocolytics • Adrenergic agonist: Ritoridine • Calcium channel blockers: Nifedipine • Oxytocin Antagonist: Atosiban • Magnesium sulfate • Miscellaneous: Ethyl alcohol, nitrates, progesterone, general anaesthetics, indomethacin, Halothane
  • 3. Ritoridine • Mechanism of action: – β2 selective agonist • Use: — Supress premature labour — Delay delivery — Treatment beyond 48 hrs not recommended • Side Effects: ‒ CVS – hypotension, tachycardia, arrhythmia, pulmonary edema ‒ Metabolic – hyperglycaemia, hyperinsulinemia, hypokalemia ‒ Anexity, restlessness, headache ‒ Neonate – foetal pulmonary edema, hypoglycaemia, ileus • Contraindication: – Mother having diabetes or heart disease, or receiving β blockers or steroids
  • 4. Nifedipine • Mechanism of Action: • Reduces the tone of myometrium and opposes contraction • Prominent smooth muscle relaxant action • Side Effects: • Maternal - Tachycardia, Hypotension • Foetal – Foetal Hypoxia due to placental perfusion
  • 5. Other Tocolytics • Atosiban • Mechanism of Action: Antagonist at the oxytocin receptors • Availability in Nepal (??) • Magnesium sulfate • Mechanism of Action: Acts as tocolytics by competiting with Ca++ ions for entry into myocardium through both voltage gated and ligand gated Ca++ channels • Higher risk to be used as tocolytics – increases perinatal mortality • Not recommended • Halothane • Used as relaxant when external or internal version is attempted