Drugs acting on uterus

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Drugs acting on uterus

  1. 1. Jincy Anna Iype DRUGS ACTING ON UTERUS
  2. 2. Introduction  Pregnancy  Post Partum Haemorrhage (PPH)
  3. 3. • Oxytocin • Ergot alkaloids • Prostaglandins • Misc. drugs Stimulants • ß2 selective agonist • Calcium channel blockers • MgSO4 • Oxytocin antagonist • Misc. drugs Relaxants Classification
  4. 4. UTERINE STIMULANTS OXYTOCIN, DESAMINO OXYTOCIN ERGOMETRIN E, METHYLERGO METRINE ETHACRIDINE, QUININE PROSTAGLANDIN ES (PGE2, 15-methyl PGF2α, Misoprostol
  5. 5. OXYTOCIN
  6. 6. MECHANISM OF ACTION
  7. 7. Physiological role • BREAST – milk ejection  CVS- Transient vasodilation & tachycardia -Constriction of umbilical arteries and veins  CNS -Causes maternal behaviour s • KIDNEY – ADH like actions.
  8. 8. PHARMACOKINETICS  Not absorbed orally  Administered by i.v. , i.m. ,rarely nasal route.  Plasma t1/2- approx. 15 mins  It is primarily inactivated in the KIDNEY and the LIVER.  DOSAGE- OXYTOCIN, SYNTOCINON 2 IU/2ml and 5 IU/ml inj. PITOCIN 5 IU/0.5ml inj.
  9. 9. USES  Induction & Augmentation of labor:  Oxytocin DOC  i.v. infusion pump  Dilution-5 IU in 500ml NS/Glucose  0.2-2ml/mt. depending on response contraindications: ﹡malposition ﹡cephalopelvic disproportion ﹡birth canal abnormality
  10. 10.  Postpartum hemorrhage :Third stage of labour, 5 IU i.m or i.v infusion.  Breast engorgement: Nasal spray before suckling  Oxytocin challenge test: To assess placental insufficiency
  11. 11. ADVERSE EFFECTS
  12. 12. Desamino-oxytocin  Buccal formulation, uses same as oxytocin, less consistent action.  INDICATIONS: -Induction of labour : 50 IU every 10min, max 10 tablets -Uterine inertia : 25 IU every 30 mins - Promotion of uterine involution: 25-50 IU - Breast engorgement : 25-50 IU before breast feeding CARBETOCIN •long acting structural analogue of human oxytocin •given as a single IV bolus following the delivery of baby at Elective or Emergency caesarean section. •Carbetocin is as effective as an oxytocin infusion with respect to blood loss following delivery DOSE: Dilute 100mcg Carbetocin with 10mls Saline. Administer over one minute following delivery of the baby
  13. 13. Ergometrine and Methyl ergometrine  Amine ergot alkaloid and methyl derivative. duration of uterine contractions  Methyl ergometrine more potent action on uterus and less on CVS, CNS, GIT etc.  ACTION  Increase force, frequency,  Moderate increase of dose→Basal tone increased  Lower segment also contracts.
  14. 14. USES  Post Partum Haemorrahge(PPH )→  After anterior shoulder presentation Prevention → 0.2-0.3 mg i.m Treatment → 0.5 mg i.v.  Prevent uterine atony  To promote involution in multipara → 0.125mg TDS -7days.  Diagnosis of variant angina during Coronary angiography
  15. 15. ADRs  Nausea, vomiting, rise in BP.  Decreases milk secretion  Avoided in Vascular disease, Hypertension, toxemia  Sepsis→gangrene  Liver and kidney disease.  Safe in obstetrical.doses Contraindications: in pregnancy & early stages of labour
  16. 16. PROSTAGLANDINS  PGE2(Dinoprostone) → Vaginal application → Induce II trimester abortion, missed abortion, ripening of cervix in near term Preperations-  Misoprostol → with mifepristone for early abortion  15-Methyl-PGF2α(Carboprost) → IInd trimester abortions  Facilitate labour- Unlabelled use in cardiac, renal disease, eclampsia.
  17. 17. ETHACRIDINE  Available as 50 mg/ml solution  For extra-amniotic infusion  EMCREDIL , VECREDIL
  18. 18. 1. Oxytocin low dosage: rhythmic contraction of uterus; fundus contracts while cervix relaxes; used via ivd for induction or augmentation. high dosage: sustained contraction in whole uterus; used via im or iv for hemostasia or restoration of postpartum uterus. 2. Ergot alkaloids stimulation of sustained contraction in whole uterus, ergometrine used via po, im or iv for hemostasia or restoration of postpartum uterus; stimulation of blood vessel constriction, ergotamine used via po or im for migraine. 3. Prostaglandins PGE2 & PGF2α stimulation of rhythmic uterine contraction, used via ivd for induction (abortion)

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