Oxytocics are drugs that stimulate uterine contractions and are used to induce labor, treat postpartum hemorrhage, and other conditions. Oxytocin is considered the first-line oxytocic agent due to its effectiveness and low cost. Other commonly used oxytocics include ergot alkaloids like ergometrine, prostaglandins, and newer agents like carbetocin, while tocolytics are used to relax the uterus.
A brief introduction regarding oxytocics & tocolytics which are the indispensable drugs in obstetrics. It consists of illustrative images, classification of drugs with their dosage, uses & side-effects along with contraindications
A brief introduction regarding oxytocics & tocolytics which are the indispensable drugs in obstetrics. It consists of illustrative images, classification of drugs with their dosage, uses & side-effects along with contraindications
β –agonists use is decreasing worldwide due to safer alternative: Atosiban.
Atosiban: as effective as nifedipine with fewer cardiovascular side effects.
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
β –agonists use is decreasing worldwide due to safer alternative: Atosiban.
Atosiban: as effective as nifedipine with fewer cardiovascular side effects.
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
This topic includes Introduction for analgesia and anesthesia used in obstetrics, maternal risk factors for anesthesia, anatomical and physiological considerations, analgesia during labour and delivery, sedatives and analgesia, opioid analgesics, combination of narcotics and antiemetics, inhalation methods, commonly used local anesthesia in obstetrics, spinal anesthesia, infiltration anesthesia, patient controlled anesthesia, psychoprophylaxis, general anesthesia for cesarean section, complication of general anesthesia and its management.
OXYTOCIN, ERGOT ALKALOIDS
&
UTERINE RELAXARS
Uterine stimulants (uterotonics) are medications given to cause a woman's uterus to contract, or to increase the frequency and intensity of the contractions. These drugs are used to induce (start) or augment (speed) labor; facilitate uterine contractions following a miscarriage; induce abortion; or reduce hemorrhage following childbirth or abortion.
“Tocolytic Drugs”
Relax the uterus and arrest threatened abortion or delay premature labor.
Posterior Pituitary or Neurohypophysis composed mainly of glial-like cells called pituicytes.
The pituicytes do not secrete hormones.
They act simply as a supporting structure for large numbers
of terminal nerve fibers and terminal nerve endings from nerve tracts.
That originate in the supraoptic and paraventricular
nuclei of the hypothalamus.
Dr. Minnu Panditrao's Dexmedetomidine for intraoperative sedation & analgesiaMinnu Panditrao
Prof. Minnu Panditrao shares her own ideas about the use dexmedetomidine for various indications i.e. for sedation, intra and post operative analgesia.
Does scorpion bite lead to resistance to action of local anaesthetic agentsby...Minnu Panditrao
Professor Minnu M. Panditrao gives her award winning (SAARC Bengaluru 2011) and recently published paper in Inidan Journal of Anaesthesia 56, 6 Nov.dec 2012, 575-78, paper where she explains the peculear responswe seen by herself and her team, about the developement of resistance to the local anaesthetic agents given via various routes, inpatients who give history of old single/ or usually multiple scorpion bites.
Delayed recovery from anaesthesia by prof. minnu m. panditraoMinnu Panditrao
Prof. Minnu M. Panditrao analyses the very common and potentially dangerous problem/s of the Delayed post-ooperative/ anaesthetic recovery and how to overcome the problem
Jehowah's witnesses and blood conservation strategies by Dr.Minnu M. PanditraoMinnu Panditrao
dr. Mrs. Minnu M. Panditrao explains the problems faced by anesthesiologists in anesthetising the Jehowah's Witness patients because of their beliefs. Ina ddition she also discribes various strategies of Blood conservation.
Nalbuphine given intrathecally as an adjuvant to LAAsMinnu Panditrao
Dr. Minnu M. Panditrao, shares her own experience of adding nalbuphine, a newer, agonist- antagonist to bupivacaine as an adjuvant in elderly males coming for lower limb surgeries
Deep Vein Thrombosis and Pulmonary Embolism, by Prof. Minnu M. PanditraoMinnu Panditrao
Dr. Mrs. Minnu Panditrao, goes in depth with the very important topic of Deep Vein Thrombosis, Pulmonary embolism, aetio patheogenesis, clinical features, management etc.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Dr. Mrs. Minnu M. Panditrao
Consultant
Department of Anesthesiology
&
Intensive Care
Public Hospital Authority’s
Rand Memorial Hospital
Freeport, Bahamas
3. OXYTOCICS
• Oxytocics are the drugs of varying chemical
nature that have the power to stimulate the
contraction of uterine muscles.
• Also called Uterotonics
• The introduction of oxytocic drugs for the
treatment of Post Partum Hemorrhage (PPH)
has been regarded as “ one of the enduring
achievements of modern science”
(Moir, 1964)
6. OXYTOCIN
OXYTOCIN
“The Champ”
• The common medication
used to achieve uterine
contraction
• First-line agent to
prevent and treat PPH
7. Oxytocin
( Hormone of love, cuddle chemical )
• A nonapeptide.
• Synthesized in Supraoptic and Paraventricular nuclei of
Hypothalamus
• Transported through nerve axons to posterior pituitary,
where it is stored and eventually released.
• Sensory stimuli arising from cervix, vagina and breasts,
emotional stimuli and nonspecific stimuli like pain, and
apprehension, can lead to secretion/release of oxytocin
from posterior pituitary.
• First synthesized by Vincent Du Vigneaud in 1953, for
which he was awarded Nobel Prize in Chemistry in 1955.
8. Oxytocin
Mechanism of action:
• Acts through oxytocin receptors present in
smooth muscles of myometrium.
• Stimulates the amniotic and decidual
prostaglandin production.
• Mobilization of bound intracellular calcium from
sarcoplasmic reticulum to activate the contractile
protein.
• There is increase in frequency and force of
uterine contractions, similar to physiological
uterine contractions
9. Oxytocin
oxytocin receptors
• The concentration of oxytocin receptors in myometrium is
lower in non pregnant state and early pregnancy, but it
increases markedly as the pregnancy advances (becomes
nearly 100 folds at 32 weeks and 300 folds at the onset of
labour).
• Also the sensitivity of these receptors to oxytocin is lower
in first and second trimester, but increases tremendously in
late pregnancy and labour, due to modulation of the
oxytocin receptors by estrogen/prostaglandins, making the
uterus highly sensitive to oxytocin ( small doses ) during
labour.
• The action of oxytocin on myometrium is independent of
innervations.
10. Oxytocin
• Contraction of myoepithelial cells surrounding the
alveoli of mammary glands resulting in expulsion of
milk from alveoli and ducts into the milk sinusoids
and cisterns; ‘milk letdown / milk ejection reflex’.
• This reflex (naturally) is initiated by the stimulus of
suckling, which leads to the release of oxytocin.
• It has been (mis)used in milch cattle to facilitate
milking.
11. Oxytocin
Effects on other systems
• CVS: Small doses cause vasodilatation ,producing diastolic
hypotension, reflex tachycardia and flushing.
Higher doses produce tachycardia and increased cardiac output,
marked constriction of umbilical vessels, facilitating their
closure, at birth.
• Kidneys: Higher doses (100 m.I.U.) produce Anti-Diuretic Action
leading to decreased urine output, due to constriction of renal
cortical vessels (in the presence of oestrogens). Pulmonary
oedema can get precipitated if large amounts of i.v. fluids and
oxytocin are infused together.
• CNS: Appears to function as a peptide neurotransmitter in
hypothalamus and brainstem to regulate autonomic neurons,
can produce emotional behavior- maternal bonding, adult
bonding, role in autism (?).
12. Oxytocin
Duration of action: approximately 20 minutes. In non pregnant
women, half life (t1/2) is 10-15 minutes and the removal from
circulation is due mainly to kidneys and liver, but t1/2 in
pregnant women is only 3 minutes, because of presence of
enzyme oxytocinase in placenta, uterine tissue and plasma
which inactivates it.
• Given orally it is ineffective as it is inactivated rapidly in the
Gastro-intestinal tract by enzyme, trypsin, needs to be
administered by parenteral, nasal or buccal routes.
Unitage and Preparation: 1 international unit (i.u.) of oxytocin
is equivalent to 2 microgram of pure hormone.
• Commercially available preparation is produced synthetically.
Oxytocin injections are available in concentration of 5 i.u. / ml
(Syntocinon) , 5 i.u/ 0.5ml. (pitocin) or 2 i.u./ 2ml. (oxytocin).
• Oxytocin nasal spray contains 40 units/ ml.
13. Oxytocin
Indications
• Induction of labour: Given as a slow i.v. infusion
(5 i.u. in 500 ml of glucose or normal saline solution ).
Started at 0.2 ml/ min and gradually increased, once optimal
response ( 3 Conts. in 10 minutes, each lasting 45 seconds),
continued at that rate Aim is to initiate and maintain uterine
contractions not only till delivery but also 30 to 60 minutes
beyond that. Usual rate is 16 to 32 m.I.U. / minute.
• For uterine inertia: Admn. Same as above.
• In active management of third stage of labor:
(to reduce the blood loss) 5 I.U., i.m. or slow i.v. for an
immediate response where ergometirne is contraindicated.
14. Oxytocin
Indications
• For prevention/control of post partum haemorrhage (PPH);
Oxytocin is administered by i.m. (2-5 i.u.) inj./ i. v. infusion (10
i.u./500ml) after the delivery of placenta, to produce a firm
contraction of uterus and thus prevent PPH.
• To accelerate abortion, used along with prostaglandins,
especially in second trimester abortion
• To stop bleeding following evacuation of uterus.
• In cases of breast engorgement to promote milk ejection. It is
given intranasally, 40 i.u., 2-5 minutes before breast feeding.
• For contraction stress test, oxytocin sensitivity test ; not
commonly done these days.
15. Oxytocin
Indications for stopping the infusion
Abnormal uterine contractions
• occurring too frequently ( less than every 2 minutes),
• lasting more than 60 seconds ( hyper stimulation)
• and increased tonus in between the contraction
Evidence of Foetal distress
Appearance of untoward maternal signs and symptoms
16. Oxytocin
Dangers of Oxytocin
Maternal
• Uterine hyper stimulation; increased frequency and duration of uterine
contractions & / or increased tonus, is often associated with abnormal
foetal heart rate pattern
• Urine rupture; high risk in grand multipara, malpresentation, contracted
pelvis, prior uterine scar and excessive dosages.
• Water intoxication; due to its ADH like antidiuretic action, when used in
high dosages i.e. 30 – 40 i.u. / min., manifested by hyponatremia, confusion,
convulsions, coma, CHF and even death. Can be prevented by strict intake
output record, use of salt solutions, and by avoiding high doses oxytocin for
a longer time.
• Hypotension; it is seen with bolus i.v. injection especially when the patient
is hypovolemic or in patients with heart disease. Occasionally may produce
anginal pain.
• Anti- diuresis; especially with higher dosages
Foetal
• Foetal distress, foetal hypoxia or even foetal death may occur due to
reduced placental blood flow due to uterine hyper stimulation.
17. Oxytocin
Drug Interactions and anaesthetic implications:
• Drugs such as Halothane, Propranolol or Quinidine can
antagonize uterotonic action of oxytocin.
• Inhaled Anaesthetics may augment hypertensive effects of
large doses of oxytocin.
• Concomitant administration of sympathomimetics,
phenylephrine or ephedrine is not associated with any
incidence of hypertension as was believed earlier
• Careful assessment of fluid and electrolyte status is necessary
in patients who have received prolonged oxytocin induction.
• I.V. Bolus of oxytocin may be avoided until the placenta is
delivered, to avoid the risk of retained placenta.
18. Carbetocin
• A newer analogue of Oxytocin, still in trial phase.
• Advantages quoted are, much rapid onset and longer
duration of action.
• Recommended dose is, 0.25 mg every 15 minutes given
upto the maximum dose of 2 mg.
• The half life is much longer (45 minutes) as compared to
that of oxytocin (4- 10 minutes).
• Reported to be successful in controlling uterine atony in
nearly 84 – 94 % patients.
• Side effects include nausea, vomiting, diarrhea, headache,
hypertension and bronchospasm. Should not be used in
patients with CVS, pulmonary, hepatic and renal diseases.
19. Vasopressin
• Not commonly used as an oxytocic.
• It has more prominent oxytocic effect on non pregnant
uterus than oxytocin.
• Foetal hypoxia is a powerful stimulus for its release and
foetal distress can lead to high umbilical cord blood levels
of vasopressin.
• If this vasopressin passes from foetal to maternal
circulation, significant oxytocic potency can be added to the
maternal oxytocin.
20. Prostaglandins (PGs)
• C 20 fatty acid compounds containing cyclopentane ring,
derivatives of Prostanoic acid
• Were first isolated from human seminal fluid with probable
origin from prostate gland, hence named Prostaglandins.
• Act as local hormones.
• PGE2, PGF2α and recently PGE1, found useful for the
induction of abortion, induction/augmentation of labor and
control of PPH.
21. Prostaglandins (PGs)
The pharmacological effects are:
• Contraction of smooth muscles of uterus, blood vessels, GIT
and bronchioles
Clinical effects:
• Myometrial contraction
• Softening and dilatation of cervix
• Inhibition of secretion of progesterone by corpus luteum.
• Response of the uterus to PGs is maximum in the middle
trimester (13th to 20th weeks).
• Prior administration of mifepristone (anti-progestin drug)
sensitizes the uterus to the action of PGs.
22. Prostaglandins (PGs)
Pharmacokinetics:
• Rapidly metabolized in lungs and liver.
• About 90% inactivated in one circulation.
• Given by intra vaginal, oral, rectal, intra muscular or intra
myometrial routes. Prostin 15m (carboprost) has longer
duration of action.
Side effects:
• Nausea, vomiting, diarrhea, fever, flushing and
bronchospasm. CVS side effects: tachycardia, increased
mean arterial pressure and pulmonary artery pressure.
• Use caution in hypertension, diabetes, angina epilepsy and
raised intra-ocular pressure.
• Contraindicated in bronchial asthma, uterine scar, cardiac
renal or hepatic diseases.
24. Ergot derivatives
Ergometrine & Methyl ergometrine(Methergine)
• Ergometrine, an alkaloid, isolated by Dudley and Moir,(1935)
from Ergot, derived from a fungus, Claviseps purpurea,
growing on rye,wheat etc.
• Methergine is semi synthetic, derived from lysergic acid. Onset
of ergometrine is quicker (45-60 secs) than methergine (90 secs)
Duration is similar (3hrs).
25. Ergot derivatives
Pharmacological effects
• Act directly on myometrium and cause tonic uterine
contractions without any relaxation in between. Action is
through the partial agonistic action on 5HT2 /α adr. receptors.
Gravid uterus is more sensitive, esp. at term
& early peurperium.
• Should not be used for induction of labour/abortion,
very effective for haemostasis, to stop bleeding from
uterine sinuses following delivery/abortion.
• Higher doses can increase peristalsis.
• CVS effects: adrenergic agonists, cause contractions of
smooth muscles, both arterial and venous vasoconstriction,
increased PVR, CVP and MAP.
26. Ergot derivatives
• Partly metabolized in liver and excreted in urine.
• Can be given by oral, intramuscular and i.v.
routes.
Indications
Used for prevention/control of PPH (delivery/LSCS)
bleeding after abortion
& to ensure normal involution of uterus.
27. Ergot derivatives
Adverse effects
• Nausea, vomiting , headache, pruritus,
hypertension, blurring of vision, dizziness, seizures,
retinal detachment, suppression of lactation and
gangrene of toes after prolonged use.
• Contraindicated in hypertensive patients and those
with pre-eclampsia
• Also contra-indicated during pregnancy or before
the third stage of labor.
28. Ergot derivatives
Anaesthetic implications
• Should be used with caution in patients with
hypertensive disorders or in patients who have
received sympathomimetics like ephedrine, as
acute hypertensive crisis may result.
• Due to severe vasoconstriction, risk of
myocardial infarction is very high following
intravenous administration.
• In cardiac patients, the increased venous tone can
precipitate pulmonary oedema
29. Ethacridine
• It’s an acridine compound.
• It is used intra-amniotically for second trimester
termination of pregnancy.
• It takes about 30 hours to effect the abortion.
• Side effects are adverse GI effects, nausea and
vomiting etc.
30. Pharmacology of oxytocic agents
Drug Regimen Side-effects Contra-indications/
cautions
Oxytocin 10 unit i.m. /or Vasodilatation Hypovolemia Do not
10units/hr infusion Hypotension, give undiluted as an i.v.
Tachycardia bolus
Methyl ergometrine 250µgm i.m./ slow i.v. Vasoconstriction Hypertension, cardiac
repeat every 5-15 min. Hypertension, disease
as needed (max 5 doses) bradycardia
15 methyl PGF2α 250 µgm i.m./intra Bronchospasm, Cardiac, renal, hepatic
(Carboprost) myometrial Repeat pulmonary and pulmonary disorders
every 15 min. as needed edema,
(max 8 doses)
Misoprostol 200- 400 µgm Uterine scar
sublingual, 800- 1000
µgm per rectally
31. Tocolytics
Tocolytics : Uterine Relaxants
• Decrease uterine contractility/motility.
• Used to delay/postpone labour, arrest threatened abortion
& treatment of dysmenorrhea.
• Suppression of labour
o Allow the foetus to mature
o Initiate glucocorticoid therapy for foetal lung maturation
o Transfer the woman in labour to proper facilities
They are likely to succeed only if cervical dilatation is < 4 cms,
taking up of the lower segment is minimal,
effective in reducing the risk of delivery within 24 to 48 hours
only.
32. Tocolytics
Contraindications:
• Rupture of membranes
• Placenta previa, abruption placenta
• Severe toxemia of pregnancy
• Intra uterine infection
• Intra uterine death of the foetus.
34. β 2 adrenergic receptor agonists
• Terbutaline
• Retodrine
• Isoxsuprine
• Mechanism of action is through beta 2 receptor stimulation,
causing smooth muscle relaxation.
• Used in uncomplicated premature labour between 24th to
33rd weeks of gestation.
• Given as i.v. infusions. Terbutaline by i.v., oral or subcut.
Isoxsuprin by oral or i.m.
• Continued for 12 hours after the contractions cease.
Should not be administered for more than 48 hours, as it
can lead to increased risk to the mother.
35. β 2 adrenergic receptor agonists
• Side effects: Nausea, vomiting, tachycardia,
palpitations, headache, tremors, hypertension,
pulmonary oedema, CHF, arrhythmias, myocardial
infarction, hyperglycemia, hyperinsulinemia and
hypokalemia.
Neonates may develop hypoglycemia and ileus.
• Contraindications: Pregnant diabetics or pregnancy
induced diabetic patients, cardiac disease, patients
on steroids, beta blockers, digitalis, severe anaemia,
hyperthyroidism and hypertension.
36. β 2 adrenergic receptor agonists
Anaesthetic implications:
• Patients who are being administered these
drugs, require very careful monitoring of
intake/output, minimal fluid volume loading to
be done to prevent precipitation of pulmonary
oedema
• electrolyte and CVP monitoring as there is
increased risk of tachyarrhythmias & cardiac
failure.
37. Magnesium sulphate
• Acts by competitive inhibition of calcium ions at
motor endplates/cell membrane, reducing calcium
influx.
• Direct depressant action on uterine smooth muscle
• Given by i.v. infusion, loading dose: 4-6 gm. i.v. over
15 to 20 minutes, titrated infusion: 1-2 gm/ hour
• Infusion continued for 12 hours after cessation of
contractions.
38. Magnesium sulphate
Side effects:
• Nausea, vomiting, flushing, perspiration,
headache, drowsiness, respiratory depression,
muscle weakness, blurred vision and cardiac
arrhythmias.
Foetal/ neonatal: Lethargy, hypotonia and
respiratory depression
Contraindications:
• Myasthenia gravis, heart blocks and renal
disease.
39. Magnesium sulphate
Anaesthetic implications:
• Delayed post-operative recovery due to CNS/
respiratory depression
• Prolongation of action of non depolarizing
NMBDs and their difficult reversal
• Risk of arrhythmias
40. Calcium Channel Blockers
Nifedipine & Nicardipine
• Block the influx of calcium ions, thereby reducing the intra
cellular calcium, reduces the tone of myometrium &
opposes the contraction.
• Nifedipine, which has prominent smooth muscle relaxant
action, is effective, if used early enough.
Oral nifedipine 10 mg every 20-30 minutes, till uterine
contractions subside, followed by 10 mg every 6 hourly.
• Tachycardia, hypotension, headache, flushing, nausea and
peripheral oedema are some of the important side effects.
• Reduced placental perfusion may cause foetal hypoxia.
41. Calcium Channel Blockers
Side effects.
• Tachycardia, hypotension, headache, flushing, nausea
and peripheral oedema are some of the important
• Reduced placental perfusion may cause foetal hypoxia.
Contraindications
• CHF, Hypotension, Aortic stenosis.
• Anaesthetic implications: There may be marked
hypotension, especially if the patient is volume depleted,
dehydrated or in CHF. So judicious intra and post
operative intake and output and vitals monitoring is
necessary.
42. Oxytocin Receptor antagonists
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
• Administered i. v., 6.75 mg as a bolus over 1 minute
followed by infusion at 18 mg/hour for 3 hours &
6mg/ hour for up to 45 hours.
Total duration of treatment not to exceed 48 hours and
total dose not to exceed 330 mg.
• Side effects: nausea, vomiting, dyspnoea, chest pain.
• Contraindication: hepatic and renal disease.
Anaesthetic implications: Very expensive
43. Prostaglandin Synthetase inhibitors
Indomethacin, aspirin, ibuprofen and sulindac
• Maternal side effects: Headache, dizziness, nausea,
vomitting, diarrhea, haematemesis, and malena.
• Foetal side effects: Oligohydramnios, premature
closure of Ductus arteriosus and necrotizing
enterocolitits
• Contraindications: Thrombocytopenia, bronchial
asthma and renal disease
• Anaesthetic implications: Can lead to platetlet
dysfunction and increased bleeding
44. OTHER AGENTS
• Nitric Oxide Donors: Nitroglycerine patches,
not very reliable. Side effects: tachycardia,
hypertension and methaemoglobinemia.
• Halothane: Very effective uterine relaxant
has been used as an anaesthetic for external/
internal versions & manual removal of
retained placenta
45. Conclusion
Oxytocics and Tocolytics
• The most commonly administered drugs to the
parturient and other obstetric patients
• The varied pharmacological actions of these drugs
and their possible interactions with anaesthetic
agents, make them of significant importance from
anaesthesiologist’s point of view!