SlideShare uma empresa Scribd logo
1 de 28
Drugs acting on Uterus
Dr. D. K. Brahma
Department of Pharmacology
NEIGRIHMS, Shillong
Uterine stimulants (oxytotics or
abortifacients)
 Posterior Pituitary hormones: Oxytocin,
Desamino oxytocin
 Ergot alkaloids: Ergometrine,
methylergometrine
 Prostaglandins: PGE2, PGF2α,
misoprostol
 Miscellaneous: ethacridine and quinine
Oxytocin
 Hormone of Posterior pituitary. The
other hormone is vasopressin
Biosynthesis - Physiology
 Synthesized as cell bodies of
praventricular nucleus and
supraoptic nucleus of
hypothalumus as prohormone
 Precursor broken down to
active hormone and
neurophysin complex
 Packaged into the secretor
granules by oxytocin-
neurophysin complex
 Secreted from nerve endings
in posterior pituitary gland
(neurohypophysis)
Oxytocin - Physiological Role
1. Labour
2. Milk ejection reflex
3. Neurotransmission
Oxytocin secretion
 Sensory stimuli from cervix, vagina and
breast suckling
 Expulsive phase is triggered by sustained
distension of uterine cervix and vagina
 Oestrogen increases its secretion
 Ovarian polypeptide relaxin inhibits its
release
 ADH: Pain, haemorrhage and dehydration
increases secretion
Actions of Oxytocin –
Uterus
 Increase in force and frequency of contractions
 Low doses: Full relaxation occurs between the contractions, but
high doses – basal tone increases
 Mechanism - High electrical activity of myometrium cell
membrane – burst of discharges
 Very low level of motor activity in the first two trimesters - 3rd
trimester onwards – spontaneous motor activity progressively
increases and sharp rise initiates labor
 Uterine sensitivity - 8 fold increase in in last 9 weeks and 30 fold increase
in number of oxytocin receptors between early pregnancy and early labour –
estrogen
 No. of receptors and myometrium sensitivity increases late in pregnancy –
labour initiation and postpartum involution
 Increase in contraction is restricted to fundus and the body
 Non pregnant uterus are resistant to its action
 Oxytocin antagonist ATOSIBAN suppresses preterm labor
… Actions – contd.
Breast
 Role in milk ejection
 Breast suckling and manipulation induces oxytocin release
 Mechanism: Contractions of myoepithelial surrounding alveolar
channels in mammary gland forces milk into large collecting
sinuses – milk ejection reflex
Oxytocin – other effects
CVS
 No effect in low dose but at higher doses
fall in BP, reflex tachycardia and flushing
Kidney
 ADH like effect in high doses – decreased
urine output, pulmonary oedema etc.
Oxytocin – Mechanism of
action (OXTR)
 Specific G protein-coupled membrane receptors
related to Vasopressin (V1 and V2) receptors
 Depolarization of muscle fibres and Ca++ influx
 Human myometrium – receptors coupled to Gq
activation leads to generation of IP3 – release of Ca+
+ ions
 Increase in local prostaglandin concentration –
uterine contraction
 Kinetics:
 Being a peptide not effective orally
 Short half life – 3 to 6 minutes
 Available as injections for IM and IV use – 0.5 ml, 1 ml and 5
ml etc.
Clinical uses of
oxytocin
1. Induction of labour To induce or augment labor in
pregnant women
 Indications:

Premature rupture of membranes

Pre and post maturity

Intra uterine growth retardation (IUGR)

Placental insufficiency – diabetes, preeclampsia or eclampsia
 Before induction, rule out:

Abnormal fetal position

Cephalopelvic disproportion

Evidence of fetal distress

Placental abnormalities

Previous uterine surgery
Oxytocin is the drug of choice for induction of labor
Clinical uses of oxytocin (Pitocin
or syntocinon) – contd.
 5 IU is diluted in 500 ml of
5% glucose or 0.9% saline
– 5 milli IU/ml
 Start at low dose
progressively increase
0.2 – 2 ml/min
 Induces labour within 2 – 4
IU
 If no induction after giving
upto 30 – 40 mU/min –
higher doses are
unsuccessful
 If labour – reduce the dose
progressively
 Unitage: 1 IU of Oxytocin
= 2 mcg of pure hormone
Oxytocin infusion Monitoring
 Presence of Physician
 Mother and fetus monitoring – fetal and
maternal heart rate, maternal BP and strength
of contractions
 If uterine hyper stimulation – discontinue
infusion
 Higher dose (more than 20 mu/min) may
reduce water clearance – leading to water
intoxication, coma and death
Clinical uses of oxytocin – contd.
2. Augmentation of labour
 In hypotonic contractions in dysfunctional labour
(nulliparous) – administer as above
 But be careful, normal progression of labor should
never be tried to hasten, because over stimulation
may cause
 Uterine rupture
 Trauma of mother
 Trauma of fetus
 Compromised fetal oxygenation
 Useful in prolong latent phase of cervical dilation or arrest of
dilation
Clinical uses of oxytocin –
contd
3. Post partum haemorrhage, cesarean section:
 5 IU IM or slow IV for immediate response
 Especially useful in hypertensive women where
ergometrine cannot be used
 Also to maintain normal tone of uterine muscle
4. Breast engorgement:
 Inefficient milk ejection reflex
 Intranasal spray before suckling
Ergometrine
 Natural ergot alkaloid also
called ergonovine and
methylergometrine is its
derivative - an amine
alkaloid
 Recall ergots: amino acid,
amine and semisynthetic
derivatives
 Amino acid alkaloids –
ergotamine, ergotoxin etc.
 Amines – ergometrine
 Semisynthetic derivatives -
DHE
 Claviceps purpurea
Pharmacological Actions -
ergometrine
 Uterus:
 Increases force, frequency and duration of contractions
 At low dose contraction is phasic in nature with normal relaxation in
between
 But moderate increase in dose – sustained contraction occurs
 More sensitive - Gravid uterus and at puerperium
 Contractions involve lower segment also
 CVS:
 Weaker vasoconstrictors than their amino acid counterparts - less chance of
developing endothelial damage
 No significant rise in BP
 CNS:
 Interacts partially with dopaminergic, adrenergic and serotonergic receptors
 No significant effect in usual doses
 GIT: High doses cause increased peristalsis
Ergometrine – contd.
 Methylergometrine is preferred over ergometrine - higher
potency and less marked other effects
 Pharmacokinetics:
 Near complete absorption form GIT
 Immediate onset of action with IV route
 Metabolized in liver and excreted in urine
 Half life – 1 to 2 hrs
 Adverse effects:
 No complication in usual doses - Nausea, vomiting and rise in BP
may occur
 Decrease in milk secretion (dopaminergic)
 Contraindications: Pregnancy before 3rd
stage of labour, vascular
disease, hypertension, liver and kidney diseases
Ergometrine - Uses
 Postpartum haemorrhage: to prevent
 Used the dose of 0.2 to 0.3 mg IM immediately
after delivery
 Continued for 4 - 7 days post partum
 If already PPH, use higher dose 0.5 mg IV
 Cesarean section and instrumental delivery –
to prevent uterine atony
 For normal involution: 0.125 mg orally tds for
4 – 7 days postpartum
Prostaglandins
 PGE2 and PGF2α – tocolytics
 Uses:
 Abortion

In early termination with antiprogesterone (Mifepristone)

Midtrimester abortion – extra-amniotic injection followed by
oxytocin (1o mg/ml available)
 Induction/augmentation of labour – intravaginal
route is preferred
 Cervical priming – intravaginal gel (cerviprime)
 Post-partum haemorrhage
Uterine relaxants
Tocolytics
Tocolytics - drugs
 These are drugs that inhibit uterine
contractions
 Beta-sympathomimetics (beta-2)

Ritodrine, isoxsuprine, terbutaline and salbutamol
 Calcium channel blockers: Nifedepine
 Magnesium sulfate
 Prostaglandin inhibiting agents: Indomethacin
 Oxytocin antagonist: Atosiban
 Ethyl alcohol
Tocolytics
 Therapeutic uses:
 Delay or postpone labor – to allow fetus to
mature and transfer of mother to a
healthcare centre
 Threatened abortion
 Dysmenorrhoea
Ritodrine
 MOA: Relaxation of uterine smooth muscle by
stimulation of beta-2 receptors
 Doses: 50 mg of ritodrine in 500 ml of 5% glucose
solution. Start by 10 drops per minute and increase
by 5 drops every 10 minutes until uterine contractions
cease
 Infusion should be continued for 12-48 Hrs after cessation of
contractions
 Oral therapy should be continued every 8 Hrs after food
 Monitor maternal pulse, BP and FHS
 Adverse effects: CVS effects like hypertension, tachycardia,
arrhythmia etc. & metabolic effects like hyperglycemia,
hyperinsulinemia and hypokalaemia – also foetal
hypoglycaemia and paralytic ileus
Ritodrine – contd.
 Contraindications:
 Heart disease - Hypertension or hypotension  
 Hyperthyroidism and diabetes
 Antepartum haemorrhage (dilatation of the uterine
arteries may increase the bleeding)
 Rupture of membrane
 Preparations: available as Ritodie/yutopar
 Tablet 10 mg / tablet or injections 10 mg/ml – 1ml
or 5 ml
 Isoxsuprine (duvadilan) is available as
oral and injections (10, 20, 40 mg tablets) 
Magnesium sulfate and
Calcium channel blockers
 Magsulf:
 Action: The intracellular calcium is displaced by magnesium
ion leading to inhibition of the uterine activity
 Dosage: The initial dose is 40 cc of 10% solution given
slowly IV. The subsequent doses depend upon the response
and the development of MgSO4 toxicity so reflexes and
respiratory rate should be observed
 Uses: Used for prevention of seizures in eclampsia, not
used for arrest of preterm labor for its toxicites
 Nifedepine: equal efficacy with beta-2 agonists
 Dose: 10 mg every 30 minutes and followed by 10 mg every
6 hrly
 Problems: tachycardia, hypotension and foetal hypoxia
Summary – must know
 Drugs used as uterine stimulants -
Classification
 Oxytocin – Mechanism of action o uterus and
its therapeutic uses
 Ergometrine – Pharmacological actions in
uterus and therapeutic uses
 Drugs used as Tocolytics – role of ritodrine
(beta-2 agonists) in arrest of labor
Thank you

Mais conteúdo relacionado

Mais procurados (20)

Uterine stimulants & relaxants
Uterine stimulants & relaxantsUterine stimulants & relaxants
Uterine stimulants & relaxants
 
Pharmacology of Prostaglandins
Pharmacology of ProstaglandinsPharmacology of Prostaglandins
Pharmacology of Prostaglandins
 
Anti-Rheumatic drugs
Anti-Rheumatic drugsAnti-Rheumatic drugs
Anti-Rheumatic drugs
 
Diuretics...
Diuretics...Diuretics...
Diuretics...
 
Diuretics
DiureticsDiuretics
Diuretics
 
Anti thyroid drugs
Anti thyroid drugsAnti thyroid drugs
Anti thyroid drugs
 
Drugs Acting on Uterus.pptx
Drugs Acting on Uterus.pptxDrugs Acting on Uterus.pptx
Drugs Acting on Uterus.pptx
 
Insulin preparations
Insulin preparationsInsulin preparations
Insulin preparations
 
Drugs for treating shock
Drugs for treating shockDrugs for treating shock
Drugs for treating shock
 
Class drug therapy of shock
Class drug therapy of shockClass drug therapy of shock
Class drug therapy of shock
 
Antihyperlipidemic agents
Antihyperlipidemic agentsAntihyperlipidemic agents
Antihyperlipidemic agents
 
INSULIN & ITS PREPARATIONS
INSULIN & ITS PREPARATIONSINSULIN & ITS PREPARATIONS
INSULIN & ITS PREPARATIONS
 
Antirheumatoid drugs
Antirheumatoid drugsAntirheumatoid drugs
Antirheumatoid drugs
 
Anti diuretics drugs
Anti diuretics drugsAnti diuretics drugs
Anti diuretics drugs
 
Antigout drugs
Antigout drugsAntigout drugs
Antigout drugs
 
Anti gout
Anti goutAnti gout
Anti gout
 
ORAL HYPOGLYCEMIC AGENTS
ORAL HYPOGLYCEMIC AGENTS ORAL HYPOGLYCEMIC AGENTS
ORAL HYPOGLYCEMIC AGENTS
 
Hematinics
HematinicsHematinics
Hematinics
 
physiological role of prostaglandin
physiological role of prostaglandinphysiological role of prostaglandin
physiological role of prostaglandin
 
PROGETINS
PROGETINSPROGETINS
PROGETINS
 

Destaque

Prostate Cancer: Keep Takling The Androgenic Nature
Prostate Cancer: Keep Takling The Androgenic NatureProstate Cancer: Keep Takling The Androgenic Nature
Prostate Cancer: Keep Takling The Androgenic NatureMohamed Abdulla
 
Gonadal hormones and inhibitors
Gonadal hormones and inhibitorsGonadal hormones and inhibitors
Gonadal hormones and inhibitorsMD Specialclass
 
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...Tural Abdullayev
 
Estrogens and androgens - Pharmacology
Estrogens and androgens - PharmacologyEstrogens and androgens - Pharmacology
Estrogens and androgens - PharmacologyAreej Abu Hanieh
 
National drug policy for BPH
National drug policy for BPHNational drug policy for BPH
National drug policy for BPHPravin Prasad
 
Pharmacodynamics for BPH
Pharmacodynamics for BPHPharmacodynamics for BPH
Pharmacodynamics for BPHPravin Prasad
 
Essential medicine list concept for BPH
Essential medicine list concept for BPHEssential medicine list concept for BPH
Essential medicine list concept for BPHPravin Prasad
 
Clinical trial for BPH
Clinical trial for BPHClinical trial for BPH
Clinical trial for BPHPravin Prasad
 
Hormonal contraceptives
Hormonal contraceptivesHormonal contraceptives
Hormonal contraceptivespctebpharm
 
Respiratory physiology
Respiratory physiologyRespiratory physiology
Respiratory physiologyPravin Prasad
 
Routes of drug administration for bns 1st year
Routes of drug administration for bns 1st yearRoutes of drug administration for bns 1st year
Routes of drug administration for bns 1st yearPravin Prasad
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunctionfhammoud
 
Androgens, Oestrogens, Progestins and Contraceptives - drdhriti
Androgens, Oestrogens, Progestins and Contraceptives - drdhritiAndrogens, Oestrogens, Progestins and Contraceptives - drdhriti
Androgens, Oestrogens, Progestins and Contraceptives - drdhritihttp://neigrihms.gov.in/
 

Destaque (20)

Prostate Cancer: Keep Takling The Androgenic Nature
Prostate Cancer: Keep Takling The Androgenic NatureProstate Cancer: Keep Takling The Androgenic Nature
Prostate Cancer: Keep Takling The Androgenic Nature
 
Gonadal hormones and inhibitors
Gonadal hormones and inhibitorsGonadal hormones and inhibitors
Gonadal hormones and inhibitors
 
Class androgens
Class androgensClass androgens
Class androgens
 
Androgens
AndrogensAndrogens
Androgens
 
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...
Estrogens ( Mechanism of action, adverse effects, pharmacokinetics and metabo...
 
Androgens - drdhriti
Androgens - drdhritiAndrogens - drdhriti
Androgens - drdhriti
 
estrogen
estrogenestrogen
estrogen
 
Estrogens and androgens - Pharmacology
Estrogens and androgens - PharmacologyEstrogens and androgens - Pharmacology
Estrogens and androgens - Pharmacology
 
National drug policy for BPH
National drug policy for BPHNational drug policy for BPH
National drug policy for BPH
 
Pharmacodynamics for BPH
Pharmacodynamics for BPHPharmacodynamics for BPH
Pharmacodynamics for BPH
 
Pneumonia
PneumoniaPneumonia
Pneumonia
 
Essential medicine list concept for BPH
Essential medicine list concept for BPHEssential medicine list concept for BPH
Essential medicine list concept for BPH
 
Clinical trial for BPH
Clinical trial for BPHClinical trial for BPH
Clinical trial for BPH
 
Hormonal contraceptives
Hormonal contraceptivesHormonal contraceptives
Hormonal contraceptives
 
Respiratory physiology
Respiratory physiologyRespiratory physiology
Respiratory physiology
 
Routes of drug administration for bns 1st year
Routes of drug administration for bns 1st yearRoutes of drug administration for bns 1st year
Routes of drug administration for bns 1st year
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunction
 
Sex hormones
Sex hormonesSex hormones
Sex hormones
 
Estrogens and antiestrogens
Estrogens and antiestrogensEstrogens and antiestrogens
Estrogens and antiestrogens
 
Androgens, Oestrogens, Progestins and Contraceptives - drdhriti
Androgens, Oestrogens, Progestins and Contraceptives - drdhritiAndrogens, Oestrogens, Progestins and Contraceptives - drdhriti
Androgens, Oestrogens, Progestins and Contraceptives - drdhriti
 

Semelhante a Drugs acting on uterus - drdhriti

Oxytocin, Uterine Stimulant , Tocolytic drugs.pdf
Oxytocin, Uterine Stimulant , Tocolytic drugs.pdfOxytocin, Uterine Stimulant , Tocolytic drugs.pdf
Oxytocin, Uterine Stimulant , Tocolytic drugs.pdf7ShivamDhumal
 
Pharmaco therapeutics in obstetrics
Pharmaco therapeutics in obstetricsPharmaco therapeutics in obstetrics
Pharmaco therapeutics in obstetrics123shital
 
Oxytocics and tocolytics
Oxytocics and tocolyticsOxytocics and tocolytics
Oxytocics and tocolyticsPriyanka Gohil
 
Drugs in obstetrics
Drugs in obstetricsDrugs in obstetrics
Drugs in obstetricsSami Sambyal
 
Drugs acting on genitourinary system
Drugs acting on genitourinary systemDrugs acting on genitourinary system
Drugs acting on genitourinary systemJaveria Fateh
 
Pharmacology of obstretic drugs
Pharmacology of obstretic drugsPharmacology of obstretic drugs
Pharmacology of obstretic drugsSREEJITH HARIHARAN
 
Oxytocics & Tocolytics
Oxytocics & TocolyticsOxytocics & Tocolytics
Oxytocics & Tocolyticsankita0809
 
Drug acting on uterus
Drug acting on uterusDrug acting on uterus
Drug acting on uterusChintan Doshi
 
GENITOURINARY SYSTEM
GENITOURINARY SYSTEMGENITOURINARY SYSTEM
GENITOURINARY SYSTEMAsra Hameed
 
DRUGS USED IN GYNAECOLOGY BY COSS B.pptx
DRUGS USED IN GYNAECOLOGY BY COSS B.pptxDRUGS USED IN GYNAECOLOGY BY COSS B.pptx
DRUGS USED IN GYNAECOLOGY BY COSS B.pptxTendaiSiku
 
Drugs in obstetrics.pdf ‘’………………………………..
Drugs in obstetrics.pdf ‘’………………………………..Drugs in obstetrics.pdf ‘’………………………………..
Drugs in obstetrics.pdf ‘’………………………………..Montdherhadi3
 
mtp-170513153856 (1) (1).pptx
mtp-170513153856 (1) (1).pptxmtp-170513153856 (1) (1).pptx
mtp-170513153856 (1) (1).pptxSachinSingh215159
 
progesterone receptor.pptx
progesterone receptor.pptxprogesterone receptor.pptx
progesterone receptor.pptxashharnomani
 
drugs used to treat hypothalamus and anterior pituitary hormones
drugs used to treat hypothalamus and anterior pituitary hormonesdrugs used to treat hypothalamus and anterior pituitary hormones
drugs used to treat hypothalamus and anterior pituitary hormonesAbdul Rehman (R)(CT)(MR)
 
24.复件 Family Panning2008
24.复件 Family Panning200824.复件 Family Panning2008
24.复件 Family Panning2008Deep Deep
 
Drugs used in maternal health 2017
Drugs used in maternal health 2017Drugs used in maternal health 2017
Drugs used in maternal health 2017Pravin Prasad
 

Semelhante a Drugs acting on uterus - drdhriti (20)

Oxytocin, Uterine Stimulant , Tocolytic drugs.pdf
Oxytocin, Uterine Stimulant , Tocolytic drugs.pdfOxytocin, Uterine Stimulant , Tocolytic drugs.pdf
Oxytocin, Uterine Stimulant , Tocolytic drugs.pdf
 
Pharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetricsPharmacotherapeutics in obstetrics
Pharmacotherapeutics in obstetrics
 
Pharmaco therapeutics in obstetrics
Pharmaco therapeutics in obstetricsPharmaco therapeutics in obstetrics
Pharmaco therapeutics in obstetrics
 
Oxytocics and tocolytics
Oxytocics and tocolyticsOxytocics and tocolytics
Oxytocics and tocolytics
 
Drugs in obstetrics
Drugs in obstetricsDrugs in obstetrics
Drugs in obstetrics
 
Drugs acting on genitourinary system
Drugs acting on genitourinary systemDrugs acting on genitourinary system
Drugs acting on genitourinary system
 
Pharmacology of obstretic drugs
Pharmacology of obstretic drugsPharmacology of obstretic drugs
Pharmacology of obstretic drugs
 
Oxytocics & Tocolytics
Oxytocics & TocolyticsOxytocics & Tocolytics
Oxytocics & Tocolytics
 
Drug acting on uterus
Drug acting on uterusDrug acting on uterus
Drug acting on uterus
 
GENITOURINARY SYSTEM
GENITOURINARY SYSTEMGENITOURINARY SYSTEM
GENITOURINARY SYSTEM
 
DRUGS USED IN GYNAECOLOGY BY COSS B.pptx
DRUGS USED IN GYNAECOLOGY BY COSS B.pptxDRUGS USED IN GYNAECOLOGY BY COSS B.pptx
DRUGS USED IN GYNAECOLOGY BY COSS B.pptx
 
Drugs in obstetrics.pdf ‘’………………………………..
Drugs in obstetrics.pdf ‘’………………………………..Drugs in obstetrics.pdf ‘’………………………………..
Drugs in obstetrics.pdf ‘’………………………………..
 
MTP
MTPMTP
MTP
 
mtp-170513153856 (1) (1).pptx
mtp-170513153856 (1) (1).pptxmtp-170513153856 (1) (1).pptx
mtp-170513153856 (1) (1).pptx
 
Oxytocics
OxytocicsOxytocics
Oxytocics
 
progesterone receptor.pptx
progesterone receptor.pptxprogesterone receptor.pptx
progesterone receptor.pptx
 
drugs used to treat hypothalamus and anterior pituitary hormones
drugs used to treat hypothalamus and anterior pituitary hormonesdrugs used to treat hypothalamus and anterior pituitary hormones
drugs used to treat hypothalamus and anterior pituitary hormones
 
24.复件 Family Panning2008
24.复件 Family Panning200824.复件 Family Panning2008
24.复件 Family Panning2008
 
Drugs used in maternal health 2017
Drugs used in maternal health 2017Drugs used in maternal health 2017
Drugs used in maternal health 2017
 
methergin and clomiphene citrate
methergin and clomiphene citrate methergin and clomiphene citrate
methergin and clomiphene citrate
 

Mais de http://neigrihms.gov.in/

Excretion of drugs and kinetics of elimination
Excretion of drugs and kinetics of eliminationExcretion of drugs and kinetics of elimination
Excretion of drugs and kinetics of eliminationhttp://neigrihms.gov.in/
 
Antimanic drugs and mood stabilizing agents
Antimanic drugs and mood stabilizing agentsAntimanic drugs and mood stabilizing agents
Antimanic drugs and mood stabilizing agentshttp://neigrihms.gov.in/
 
Cholinergic Pharmacology and Cholinergic Drugs 2017
Cholinergic Pharmacology and Cholinergic Drugs 2017Cholinergic Pharmacology and Cholinergic Drugs 2017
Cholinergic Pharmacology and Cholinergic Drugs 2017http://neigrihms.gov.in/
 

Mais de http://neigrihms.gov.in/ (20)

Ectoparasiticides
EctoparasiticidesEctoparasiticides
Ectoparasiticides
 
Antimalarial Drugs Pharmacology
Antimalarial Drugs PharmacologyAntimalarial Drugs Pharmacology
Antimalarial Drugs Pharmacology
 
Fluoroquinolones
Fluoroquinolones Fluoroquinolones
Fluoroquinolones
 
Betalactum antibiotics
Betalactum antibioticsBetalactum antibiotics
Betalactum antibiotics
 
Excretion of drugs and kinetics of elimination
Excretion of drugs and kinetics of eliminationExcretion of drugs and kinetics of elimination
Excretion of drugs and kinetics of elimination
 
Pharmacology of Antitubercular Drugs
 Pharmacology of Antitubercular Drugs  Pharmacology of Antitubercular Drugs
Pharmacology of Antitubercular Drugs
 
Drugs used in glaucoma
Drugs used in glaucomaDrugs used in glaucoma
Drugs used in glaucoma
 
NSAIDS
NSAIDSNSAIDS
NSAIDS
 
Antimanic drugs and mood stabilizing agents
Antimanic drugs and mood stabilizing agentsAntimanic drugs and mood stabilizing agents
Antimanic drugs and mood stabilizing agents
 
Polypeptide antibiotics
Polypeptide antibioticsPolypeptide antibiotics
Polypeptide antibiotics
 
Medications in the elderly
Medications in the elderlyMedications in the elderly
Medications in the elderly
 
Pharmacotherapy of shock
Pharmacotherapy of shockPharmacotherapy of shock
Pharmacotherapy of shock
 
Factors modifying drug action
Factors modifying drug actionFactors modifying drug action
Factors modifying drug action
 
Oral hypoglycaemic drugs
Oral hypoglycaemic drugsOral hypoglycaemic drugs
Oral hypoglycaemic drugs
 
Insulin pharmacology
Insulin pharmacologyInsulin pharmacology
Insulin pharmacology
 
CNS stimulants and cognition enhancers
CNS stimulants and cognition enhancersCNS stimulants and cognition enhancers
CNS stimulants and cognition enhancers
 
Sedative hypnotics.ppt - dr dhriti
Sedative hypnotics.ppt - dr dhriti Sedative hypnotics.ppt - dr dhriti
Sedative hypnotics.ppt - dr dhriti
 
Antiplatelet drugs (antithrombotics)
Antiplatelet drugs (antithrombotics)Antiplatelet drugs (antithrombotics)
Antiplatelet drugs (antithrombotics)
 
Drugs affecting renin-angiotensin system
Drugs affecting renin-angiotensin systemDrugs affecting renin-angiotensin system
Drugs affecting renin-angiotensin system
 
Cholinergic Pharmacology and Cholinergic Drugs 2017
Cholinergic Pharmacology and Cholinergic Drugs 2017Cholinergic Pharmacology and Cholinergic Drugs 2017
Cholinergic Pharmacology and Cholinergic Drugs 2017
 

Último

Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available
Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service AvailableCall Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available
Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service AvailableJanvi Singh
 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...karishmasinghjnh
 
Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Vipesco
 
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...chandars293
 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...khalifaescort01
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...chetankumar9855
 
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...Sheetaleventcompany
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...chennailover
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...tanya dube
 
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...parulsinha
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Anamika Rawat
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...mahaiklolahd
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Availableperfect solution
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...parulsinha
 
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...Sheetaleventcompany
 
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...BhumiSaxena1
 

Último (20)

Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available
Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service AvailableCall Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available
Call Girls Jaipur Just Call 9521753030 Top Class Call Girl Service Available
 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
 
Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510Kollam call girls Mallu aunty service 7877702510
Kollam call girls Mallu aunty service 7877702510
 
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 8250077686 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
 
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
Call Girls Service Jaipur {8445551418} ❤️VVIP BHAWNA Call Girl in Jaipur Raja...
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...
💚Call Girls In Amritsar 💯Anvi 📲🔝8725944379🔝Amritsar Call Girl No💰Advance Cash...
 
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
Saket * Call Girls in Delhi - Phone 9711199012 Escorts Service at 6k to 50k a...
 

Drugs acting on uterus - drdhriti

  • 1. Drugs acting on Uterus Dr. D. K. Brahma Department of Pharmacology NEIGRIHMS, Shillong
  • 2. Uterine stimulants (oxytotics or abortifacients)  Posterior Pituitary hormones: Oxytocin, Desamino oxytocin  Ergot alkaloids: Ergometrine, methylergometrine  Prostaglandins: PGE2, PGF2α, misoprostol  Miscellaneous: ethacridine and quinine
  • 3. Oxytocin  Hormone of Posterior pituitary. The other hormone is vasopressin
  • 4. Biosynthesis - Physiology  Synthesized as cell bodies of praventricular nucleus and supraoptic nucleus of hypothalumus as prohormone  Precursor broken down to active hormone and neurophysin complex  Packaged into the secretor granules by oxytocin- neurophysin complex  Secreted from nerve endings in posterior pituitary gland (neurohypophysis)
  • 5. Oxytocin - Physiological Role 1. Labour 2. Milk ejection reflex 3. Neurotransmission
  • 6. Oxytocin secretion  Sensory stimuli from cervix, vagina and breast suckling  Expulsive phase is triggered by sustained distension of uterine cervix and vagina  Oestrogen increases its secretion  Ovarian polypeptide relaxin inhibits its release  ADH: Pain, haemorrhage and dehydration increases secretion
  • 7. Actions of Oxytocin – Uterus  Increase in force and frequency of contractions  Low doses: Full relaxation occurs between the contractions, but high doses – basal tone increases  Mechanism - High electrical activity of myometrium cell membrane – burst of discharges  Very low level of motor activity in the first two trimesters - 3rd trimester onwards – spontaneous motor activity progressively increases and sharp rise initiates labor  Uterine sensitivity - 8 fold increase in in last 9 weeks and 30 fold increase in number of oxytocin receptors between early pregnancy and early labour – estrogen  No. of receptors and myometrium sensitivity increases late in pregnancy – labour initiation and postpartum involution  Increase in contraction is restricted to fundus and the body  Non pregnant uterus are resistant to its action  Oxytocin antagonist ATOSIBAN suppresses preterm labor
  • 8. … Actions – contd. Breast  Role in milk ejection  Breast suckling and manipulation induces oxytocin release  Mechanism: Contractions of myoepithelial surrounding alveolar channels in mammary gland forces milk into large collecting sinuses – milk ejection reflex
  • 9. Oxytocin – other effects CVS  No effect in low dose but at higher doses fall in BP, reflex tachycardia and flushing Kidney  ADH like effect in high doses – decreased urine output, pulmonary oedema etc.
  • 10. Oxytocin – Mechanism of action (OXTR)  Specific G protein-coupled membrane receptors related to Vasopressin (V1 and V2) receptors  Depolarization of muscle fibres and Ca++ influx  Human myometrium – receptors coupled to Gq activation leads to generation of IP3 – release of Ca+ + ions  Increase in local prostaglandin concentration – uterine contraction  Kinetics:  Being a peptide not effective orally  Short half life – 3 to 6 minutes  Available as injections for IM and IV use – 0.5 ml, 1 ml and 5 ml etc.
  • 11. Clinical uses of oxytocin 1. Induction of labour To induce or augment labor in pregnant women  Indications:  Premature rupture of membranes  Pre and post maturity  Intra uterine growth retardation (IUGR)  Placental insufficiency – diabetes, preeclampsia or eclampsia  Before induction, rule out:  Abnormal fetal position  Cephalopelvic disproportion  Evidence of fetal distress  Placental abnormalities  Previous uterine surgery Oxytocin is the drug of choice for induction of labor
  • 12. Clinical uses of oxytocin (Pitocin or syntocinon) – contd.  5 IU is diluted in 500 ml of 5% glucose or 0.9% saline – 5 milli IU/ml  Start at low dose progressively increase 0.2 – 2 ml/min  Induces labour within 2 – 4 IU  If no induction after giving upto 30 – 40 mU/min – higher doses are unsuccessful  If labour – reduce the dose progressively  Unitage: 1 IU of Oxytocin = 2 mcg of pure hormone
  • 13. Oxytocin infusion Monitoring  Presence of Physician  Mother and fetus monitoring – fetal and maternal heart rate, maternal BP and strength of contractions  If uterine hyper stimulation – discontinue infusion  Higher dose (more than 20 mu/min) may reduce water clearance – leading to water intoxication, coma and death
  • 14. Clinical uses of oxytocin – contd. 2. Augmentation of labour  In hypotonic contractions in dysfunctional labour (nulliparous) – administer as above  But be careful, normal progression of labor should never be tried to hasten, because over stimulation may cause  Uterine rupture  Trauma of mother  Trauma of fetus  Compromised fetal oxygenation  Useful in prolong latent phase of cervical dilation or arrest of dilation
  • 15. Clinical uses of oxytocin – contd 3. Post partum haemorrhage, cesarean section:  5 IU IM or slow IV for immediate response  Especially useful in hypertensive women where ergometrine cannot be used  Also to maintain normal tone of uterine muscle 4. Breast engorgement:  Inefficient milk ejection reflex  Intranasal spray before suckling
  • 16. Ergometrine  Natural ergot alkaloid also called ergonovine and methylergometrine is its derivative - an amine alkaloid  Recall ergots: amino acid, amine and semisynthetic derivatives  Amino acid alkaloids – ergotamine, ergotoxin etc.  Amines – ergometrine  Semisynthetic derivatives - DHE  Claviceps purpurea
  • 17. Pharmacological Actions - ergometrine  Uterus:  Increases force, frequency and duration of contractions  At low dose contraction is phasic in nature with normal relaxation in between  But moderate increase in dose – sustained contraction occurs  More sensitive - Gravid uterus and at puerperium  Contractions involve lower segment also  CVS:  Weaker vasoconstrictors than their amino acid counterparts - less chance of developing endothelial damage  No significant rise in BP  CNS:  Interacts partially with dopaminergic, adrenergic and serotonergic receptors  No significant effect in usual doses  GIT: High doses cause increased peristalsis
  • 18. Ergometrine – contd.  Methylergometrine is preferred over ergometrine - higher potency and less marked other effects  Pharmacokinetics:  Near complete absorption form GIT  Immediate onset of action with IV route  Metabolized in liver and excreted in urine  Half life – 1 to 2 hrs  Adverse effects:  No complication in usual doses - Nausea, vomiting and rise in BP may occur  Decrease in milk secretion (dopaminergic)  Contraindications: Pregnancy before 3rd stage of labour, vascular disease, hypertension, liver and kidney diseases
  • 19. Ergometrine - Uses  Postpartum haemorrhage: to prevent  Used the dose of 0.2 to 0.3 mg IM immediately after delivery  Continued for 4 - 7 days post partum  If already PPH, use higher dose 0.5 mg IV  Cesarean section and instrumental delivery – to prevent uterine atony  For normal involution: 0.125 mg orally tds for 4 – 7 days postpartum
  • 20. Prostaglandins  PGE2 and PGF2α – tocolytics  Uses:  Abortion  In early termination with antiprogesterone (Mifepristone)  Midtrimester abortion – extra-amniotic injection followed by oxytocin (1o mg/ml available)  Induction/augmentation of labour – intravaginal route is preferred  Cervical priming – intravaginal gel (cerviprime)  Post-partum haemorrhage
  • 22. Tocolytics - drugs  These are drugs that inhibit uterine contractions  Beta-sympathomimetics (beta-2)  Ritodrine, isoxsuprine, terbutaline and salbutamol  Calcium channel blockers: Nifedepine  Magnesium sulfate  Prostaglandin inhibiting agents: Indomethacin  Oxytocin antagonist: Atosiban  Ethyl alcohol
  • 23. Tocolytics  Therapeutic uses:  Delay or postpone labor – to allow fetus to mature and transfer of mother to a healthcare centre  Threatened abortion  Dysmenorrhoea
  • 24. Ritodrine  MOA: Relaxation of uterine smooth muscle by stimulation of beta-2 receptors  Doses: 50 mg of ritodrine in 500 ml of 5% glucose solution. Start by 10 drops per minute and increase by 5 drops every 10 minutes until uterine contractions cease  Infusion should be continued for 12-48 Hrs after cessation of contractions  Oral therapy should be continued every 8 Hrs after food  Monitor maternal pulse, BP and FHS  Adverse effects: CVS effects like hypertension, tachycardia, arrhythmia etc. & metabolic effects like hyperglycemia, hyperinsulinemia and hypokalaemia – also foetal hypoglycaemia and paralytic ileus
  • 25. Ritodrine – contd.  Contraindications:  Heart disease - Hypertension or hypotension    Hyperthyroidism and diabetes  Antepartum haemorrhage (dilatation of the uterine arteries may increase the bleeding)  Rupture of membrane  Preparations: available as Ritodie/yutopar  Tablet 10 mg / tablet or injections 10 mg/ml – 1ml or 5 ml  Isoxsuprine (duvadilan) is available as oral and injections (10, 20, 40 mg tablets) 
  • 26. Magnesium sulfate and Calcium channel blockers  Magsulf:  Action: The intracellular calcium is displaced by magnesium ion leading to inhibition of the uterine activity  Dosage: The initial dose is 40 cc of 10% solution given slowly IV. The subsequent doses depend upon the response and the development of MgSO4 toxicity so reflexes and respiratory rate should be observed  Uses: Used for prevention of seizures in eclampsia, not used for arrest of preterm labor for its toxicites  Nifedepine: equal efficacy with beta-2 agonists  Dose: 10 mg every 30 minutes and followed by 10 mg every 6 hrly  Problems: tachycardia, hypotension and foetal hypoxia
  • 27. Summary – must know  Drugs used as uterine stimulants - Classification  Oxytocin – Mechanism of action o uterus and its therapeutic uses  Ergometrine – Pharmacological actions in uterus and therapeutic uses  Drugs used as Tocolytics – role of ritodrine (beta-2 agonists) in arrest of labor

Notas do Editor

  1. Each mL of sterile nonpyrogenic solution prepared by synthesis contains: oxytocin activity 10 IU (10 USP Posterior Pituitary Units), sodium acetate 2 mg, sodium chloride 5.1 mg and chlorobutanol 5 mg (as preservative) in water for injection. pH adjusted with acetic acid to approximately 3.9. Single-dose ampuls of 0.5, 1 and 5 mL. Sleeves of 5 or 10. Use only if solution is clear. Discard unused portion. Store at room temperature (15 to 30°C). Protect from freezing.
  2. Amino acid alkaloids – partial agonist and antagonist of alpha receptor, serotonergic and dopeminergic, Amine alkaloides – no alpha blocking action, hydrogenation – produces more alpha blocking but no vasoconstriction