TOCOLYTIC AGENT.pptx

nursing

1. MITTAL COLLEGE OF NURSING AJMER PRESENTATION ON- TOCOLYTIC AGENT SUBMITTED TO: SUBMITTED BY: MISS.SNEHLATA PARASHAR MR.SHIVPAL DHAKAR ASSOCIATE PROFESSER B.SC NURSING 4 TH YEAR (HOD)OBG BATCH 2017-2018

2. INTRODUCTION Tocolytics  (also called  anti-contraction medications  or  labor suppressants ) are medications used to suppress premature labor . Preterm birth accounts for 70% of neonatal deaths.Therefore , tocolytic therapy is provided when delivery would result in premature birth, postponing delivery long enough for the administration of  glucocorticoids , which accelerate fetal lung maturity but may require one to two days to take effect.

3. DEFINITION A medication that can inhibit  labor , slow down or halt the contractions of the uterus. Tocolytic agents are widely used today to treat premature  labor  and permit pregnancy to proceed and so permit the fetus to gain in size and maturity before being born.

4. INDICATION Generally,from 24 gestation week onward. Before 37 gestational week. Sponataneous premature contractions. No evidence of infection. No life threatening

5. CONTRA-INDICATION Several general factors may contraindicate delaying childbirth with the use of tocolytic medications. Pregnant woman has severe pregnancy-induced hypertension. Fetus weighs less than 2.5 kg.  intrauterine infection is present. Lethal congenital or chromosomal abnormalities. Intrauterine fetal demise. Placental insufficiency.

6. Mechanism of action Tocolytic agents are drugs  designed to inhibit contractions of myometrial smooth muscle cells .

7. TOCOLYTICS(UTERINE RELAXANTS

8. CLASSIFICATION OF TOCOLYTICS β 2   adrenergic receptor agonist- - Terbutaline,Isoxsuprine,Retodrine Magnesium sulphate Calcium channel blocker - Nifedipine and Nicardipine Oxytocin receptor antagonist Prostaglandin synthetase inhibitors - Indomethacin,Sulindac Nitric oxide - Nitroglycerine Halothane

9. β 2   adrenergic receptor agonist- Terbutaline Isoxsuprine (DUVADILAN) Retodrine hydrochloride (YUTOPAR) Isoxsuprine (DUVADILAN) Acts directly on vascular smooth muscles, causes stimulation and uterine relaxation.

10. MECHANISM OF ACTION Mechanism of action :- Activation of intracellular enzymes ( adenylate cyclase , cAMP , Protein kinase , decreases intracellular free Ca++ ( Ca++) & inhibits activation of MLCK ( ) Reduced interaction of actin & myosin smooth muscle relaxation.

11. DOSAGE AND ROUTES Initial IV drip 100 mg in 5% dextrose at rate of 0.2 μ g per min Maintainance IM 10mg 6hourly for 24 hours ,tab 10mg 6-8hourly. CONTRA-INDICATION -hypersensitivity -postpartum SIDE EFFECTS -hypotension -nausea -tachycardia

12. Magnesium sulphate Magnesium sulphate (MgSO4) has been successfully used to inhibit premature labor .  Magnesium sulphate is used mainly for patients who have contraindications to beta-adrenergic agents.  Magnesium sulfate used as a second-line tocolysis .

13. Mechanism of action Acts by competitive inhibition of Ca2+ ion either at the motor end place at the cell membrane reducing calcium influx. es acetylcholine release & its sensitivity at motor end plate. Direct depressant action on uterine muscle .

14. DOSAGE AND ROUTES Initial  Loading dose 4-6gm IV (10-20% solution) over 20-30 mins . Maintainance followed by an infusion of 1-2gm/hr to continue tocolysis for 12 hrs after the contractions have stopped  Contraindications Patient with myasthenia gravis , heart block & impaired renal function.

15. Side effects & precautions :- * Common maternal side effects are flushing, perspiration, headache, muscle weakness, rarely pulmonary oedema. * Neonatal side effects are lethargy, hypotonia , rarely respiratory depression.

16. CALCIUM CHANNEL BLOCKER Calcium channel blockers such as nifidipine appear to be powerful uterine relaxant. The mechanism of action appears to be derived from blockade of voltage-dependent calcium channels in myometrial cells.   E.g. - Nifedipine , Nicadipine , Verapamil

17. MECHANISM OF ACTION It blocks the entry of calcium inside the cell. i.e;block the influx of calcium ions , thereby reducing the intra cellular calcium,reduces the tone of myometrium and opposes the contraction. Nifedipine,which has prominent smooth muscle relaxant action is effective, if used early. CONTRA –INDICATION CHF , Hypotension, aortic stenosis

18. DOSAGE AND ROUTES can be given by sublingual and oral route i.e ; a standard dosage regimens of 20 mg every 6 hours till uterine contraction subside. Side effect Hypotension, Headache, Flushing , tachycardia and nausea.  Precautions Combined therapy with Beta mimetic or MgSO4 should be avoided.

19. PROSTAGLANDIN INHIBITORS   Indomethacin  ( Cyclo-oxygenase inhibitor) Suldinac another NSAID is also used as it has less placental transfer. Mechanism of action es synthesis of PGs thereby es intracellular free Ca++, activation of myosin light chain kinase and uterine contractions.

20. CONTRA-INDICATIONS Hepatic diseases, active peptic ulcer ,coagulation disorders. DOSAGE AND ROUTES  Loading dose 50mg PO or PR followed by 25mg every 6 hrs for 48 hrs. SIDE EFFECTS Maternal headache,dizziness,nausea,vomiting,diarrhoea , haematemesis Neonatal-neonatal pulmonary hypertension,oligohydraminos ,

21. Oxytocin Antagonists E.g. – Atosiban is a peptide analogue of oxytocin,acts as an antagonist at oxytocin receptors. Has been licensed in UK for use in pre-term labour. Mechanism of action blocks myometrial oxytocin receptors. It inhibits intracellular Ca++ release, release of PGs & thereby inhibits myometrial contractions

22. CONTRA-INDICATIONS Hepatic and Renal diseases. DOSAGE AND ROUTES Adminstered i.e;6.75mg as a bolus over 1 minute followed by infusion at 18mg/hour for 3 hours and 6mg/hour for upto 45 hours. Total duration of treatment not to exceed 48hours and total dose not to be exceed 330mg. SIDE EFFECTS Nausea, vomiting,dyspnea,chest pain

23.  Nitric Oxide (NO) Donors E.g. – Glyceryl trinitrate (GTN) Mechanism of action :- Smooth muscle relaxant. Doses :- Patches Side effects :- May cause cervical ripening, Headache 

24. Conclusion As I present my topic on tocolytics agent I explain their mechanism of action , indicaion , side effects , complication ,dosage and drugs. I thanks to MRS. SNEHLATA PARASHAR for guiding me and helping me, and also thanks to my classmates for their cooperation.

25. BIBLIOGRAPHY BOOK 1.MATERNAL-FETAL AND NEONATAL MEDICINE (volume 30) AUTHOR-DEV MAULIK 2.MIDWIFERY AND GYNECOLOGICAL NURSING AUTHOR-NEELAM KUMARI,DR.PREETI GUPTA WEB 1. https :// www.slideshare.net/ankita0809/oxytocics-tocolytics 2. https ://www.slideshare.net/SnehlataParashar/diuretics-and-tocolytics

26. MCQ 1.Tocolytic drugs are used for (A)Uterine contraction (B) Bronchodilation (C)Uterine relaxants (D) Brochoconstrictor 2.Select the drug which is used for suppress the labour (A)Atropine (B) Ritrodine (C)Prostaglandin E2 (D)Progesterone