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Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
Pharmacotherapy in obstetrics
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Pharmacotherapy in obstetrics

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  • 1. Pharmacotherapy in obstetrics
  • 2. Topics of the lecture
    Introducton
    Medications used during pregnancy – hormones and neuro-peptide analogues
    Medications used in labor
    Medications used for miscarriage treatment
    Medications used for fetal hypoxia and gestosis treatment.
    Medications used for treatment of extra-genital pathology.
    Medications used for treatment of puerperium diseases.
  • 3. Introduction
    Neuro-humoral system of woman is aimed for keeping uterus’ muscle relaxed during pregnancy. It’s possible because of increasing of blood levels of steroid hormone pregesterone which is “pregnancy pretector”
  • 4. Both estrogens and proges-terone are increased during pregnancy but proges-terone prevails
  • 5. Influence of steroid hormones
    Progesterone performs its acton on uterus only in case estrogenes are synthesised enough by corpus luteumand placenta
    In other case, progesterone looses its relaxing action on uterus’ muscle
  • 6. Progesterone
    Increases level of adenosinmonophosphate (AMP) which ties Са2+ ions and blocks actine-myosine contractions
  • 7. Progesterone
    Increases membrane potential of myocyte and particularly blocks impulses between myocytes
    Myometrium becomes insensitive to irritatons
    myometrium
  • 8. Progesterone
    Since placenta is formed, progesterone is synthesized by it.
    Consequently, placental site is more relaxed than the rest of myometrium
  • 9. Progesterone
    Keeps its relaxing action even in case of retention of the part of the placenta inside of the uterus in puerperium.
    It can provoke sub-involution of uterus and post-partum bleeding
  • 10. Influence of steroid hormones
    Before labor level of progesterone decreases and estrogenes are rised
    Estrogenes take out myometrium block
  • 11. Influence of steroid hormones
    Membranes of myocytes become sensitive to:
    oxitocine,
    prostaglandines,
    catheholamines,
    serotonine.
  • 12. Mechanism of myometrium contractions
    Depolarization of membtanes
    Releasing of Ca2+
    Interaction of calcium ions with contractive proteins.
  • 13. Mechanism of myometrium contractions
    Myometrium has alpha and beta-adrenoreceptors.
    Stimulation of alpha-receptors by catheholamines causes uterus contraction
    Stimulation of beta-receptors by catheholamines causes uterus relaxation
  • 14. Mechanism of myometrium contractions
    Uterus body contains alpha and beta catheholamines receptors
    Lower segment contains choline and
    serotonine receptors
    Cervix contains chemo-, baro- and mechanoreceptors
  • 15. Uterotonics and tocolytics drugs
    Uterotonics increase uterine contractions (oxytocine, prostaglandines, serotonine, kinines, cathecholamines).
    Tocolytics decrease uterine contracions (spasmolytics, beta-receptor-stimulating medications, anti-oxytocin drugs).
  • 16. Oxitocine
    It’s a hormone of supra-optic and para-ventricular nuclei of hypothalamus
    Transported to pituitary by axons
    Performs its influence on membranous level
  • 17. Prostaglandines
    Play very big role in preparing to labor and delivery onset.
    “Tissue hormones” are made from fatty (lipid) acides
  • 18. Prostaglandines
    Nowadays synthetic analogues of E2 and F2-alpha prostaglantines are popular because of their high activity
    E2 medications (dinoprostone, prepidil-gel, 1 mg) prepare cervix for labor (makes it “ripe”)
    F2-alpha medications (dinoprost, enzaprost, i.v. 5 mg/ml) cause regular uterine contractions
  • 19. Prostaglandines
    Their administration causes termination of pregnancy in any term
  • 20. Pharmacotherapy of miscarriage
    Spasmolytics: drotaverine (No-spa) 2 ml i.m., papaverine in average doses
    Homeopatic medication: Viburcol
  • 21. Magnesial treatment
    MgSO4 25% - 40 ml i.v. soluted in 400 ml of 0.9% NaCl
    MagneB6 1 pill 4-6 times daily (200-300 mg of Mg daily),
  • 22. Tocolysis (after 16 weeks of pregnancy)
    Beta-adrenoreceptor agonist:
    Gynipral (hexoprenalini
    sulphatis)
    Pills 0.5 mg each 6-12 hrs
    I.v. vials 5 mcg
    Side effects should be treated by calcium antagonists: verapamil (isoptin) 1 pill (40 mg) 3 times daily
  • 23. Tocolysis (after 16 weeks of pregnancy)
    Calcium-chanel-blocking agents:
    Corinfar (nifedipine) 10 mg every 20 min until symptoms of threatening of pre-term labor are resolved
  • 24. Key points of hormonal therapy of mascarriage
    Hormonal medications should be strictly indicated;
    Risk/benefit should be assessed thoroughly;
    Individual dosage;
    Prescription after 8 weeks of pregnancy should be preferred.
  • 25. Gestagens
    Progesterone 10-25 mg daily;
    Utrogestane 100 mg p.o. per vaginum 2 times per day (till 27 weeks);
    Duphastone (didrogesterone) – 40 mg p.o.at once, then 1 pill(10 mg) 2-3 times daily.
  • 26. Treatment of post-partum hemorrage
    Oxitocine 5-20 IU
    Methylergometrine— 1 ml i.m.
    Prostaglandines
  • 27. Thank You!

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