SCHOOL OF HEALTH SCIENCES
DRUG PRESENTATION ON:-
TOCOLYTICS
PRESENTED BY :- PRACHI GUPTA
MSC NURSING 1ST YEAR
2440982501
INTRODUCTION
• The term "tocolytic" comes from the Greek words
tokos (birth) and lysis (to loosen), meaning they
work to inhibit uterine contractions and prevent
preterm birth. Tocolytics (also called anti-
contraction medications or labor suppressants) are
medications used to suppress premature labor.
DEFINITION
• A medication that can inhibit labor, slow down or
halt the contractions of the uterus. Tocolytic agents
are widely used today to treat premature labor and
permit pregnancy to proceed and so permit the fetus
to gain in size and maturity before being born.
TWO TYPES:-
SHORT ACTING
LONG ACTING
1. SHORT ACTING:- Short-term tocolytics are used to suppress
labor for a brief period (usually 48 hours or less)
Example:- Beta-adrenergic Agonists (e.g., Terbutaline),
Calcium Channel Blockers (e.g., Nifedipine), Magnesium Sulfate
CONT…
2. LONG ACTING:- Long-term tocolytics are used when
there is a need to maintain uterine relaxation over a
prolonged period, typically for several days to weeks.
These agents are not as commonly used, as their
efficacy over extended periods is limited, and they may
have more significant maternal and fetal side effects.
Eg:- Oxytocin antagonist( Atosiban), Progesterone
INDICATIONS:-
• Generally, from 24 gestation week onward.
• Before 37 gestational week.
• Spontaneous premature contractions longer than 30
seconds each and occur more than 3 times in 30 minutes.
• No evidence of infection.
• No life threatening maternal complication.
CONTRA INDICATIONS
Pregnant woman has severe pregnancy-induced hypertension
Fetus weighs less than 2.5 kg.
Intrauterine infection is present. Eg:- chorioamnitis.
Intrauterine fetal demise.
Placental insufficiency.
Cervical dialation more than 4cm
Presence of cardiac disease eg:- hypertension
Rupture of membranes.
CLASSIFICATION OF
TOCOLYTICS:-
>>>
1. Beta-2 Adrenergic Agonists
(e.g., Terbutaline, Ritodrine)
• Beta-adrenergic agonists activate beta-2 adrenergic receptors on
the smooth muscle cells of the uterus.
• This activation increases the levels of cyclic AMP (cAMP) within
the cells.
• Elevated cAMP levels inhibit myosin light chain kinase (MLCK)
• It reduces the phosphorylation of myosin and decreases the
interaction between actin and myosin filaments
• This leads to uterine muscle relaxation and suppression of
contractions.
DOSAGE:-
TERBUTALINE
• ORALLY:-2.5-10 mg every 4-6 hrs.
• SUB CUTANEOUS:- 0.25 mg every 30 mts every 3 -4 hrs.
•IV:-
•Starting dose: 10 mcg/min (increase by 10 mcg/min every 10–30
minutes as needed).
•Maintenance dose: 10–50 mcg/min.
•Maximum dose: 0.5 mg/hour.
RITRODRINE
• Initial Dosage (IV infusion):
• Loading Dose:
• 50 mcg/min IV
• Increased by 50 mcg every 10 min for about 12 hrs until
contraction ceases
SIDE EFFECTS:-
MATERNAL:-
HEADACHE,PALPITATIONS,TACHYCARDIA,PULMONARY EDEMA,
HYPOTENSION , HYPERGLYCEMIA
FETAL:-
TACHYCARDIA, HEART FAILURE, IUFD
2.
MAGNESIUM SULPHATE
MECHANISM OF ACTION
Magnesium sulfate acts as a calcium antagonist.
Magnesium competes with calcium for entry into smooth muscle
cells and also interferes with the release of acetylcholine at
neuromuscular junctions.
The reduced availability of calcium decreases uterine muscle
contractility, promoting relaxation of the uterus.
DOSAGE:-
• Magnesium Sulfate (intravenous)Initial Loading Dose:
• 4–6 grams IV over 20 minutes.
• Maintenance Infusion:
• 1–2 grams per hour IV.
SIDE EFFECTS:-
• MGSO4 is relatively safe
Common MATERNAL side effects are:-
• Headache, muscle weakness, flushing
FETAL side effects:-
• Decease in FHR variability.
3. CALCIUM CHANNEL BLOCKERS
example:-(NIFIDEPINE)
MECHANISM OF ACTION
Calcium channel blockersinhibit the influx of calcium ions into
smooth muscle cells by blocking calcium channels.
Since calcium is essential for uterine muscle contraction, its
reduction prevents the contractile response of the myometrial
cells and thus relaxes the uterus.
It is equally effective as that of MGSO4
DOSAGE:-
• ORAL:-
• 10-20 mg every 3-6 hours.
• Taken empty stomach.
SIDE EFFECTS:-
MATERNAL:-
• NAUSEA, HEADACHE, HYPOTENSION AND TACHYCARDIA
FETAL:-
• TACHYCARDIA
• NOTE:- COMBINED THERAPY WITH BETA MIMIETICS OR MGSO4
SHOULD BE AVOIDED.
4. PROSTAGLANDIN SYNTHESIS
INHIBITORS (Example:
INDOMETHACIN)
MECHANISM OF ACTION:-
• Prostaglandins play a central role in initiating labor by promoting uterine
contractions.
• Prostaglandin synthesis inhibitors, such as indomethacin, inhibit the enzyme
cyclooxygenase (COX), which is responsible for converting arachidonic acid
into prostaglandins.
• Reduced prostaglandin levels decrease uterine contractility, thus preventing
premature labor.
DOSAGE-
•Indomethacin (oral or rectal)
•Initial Dose:
•50 mg orally or rectally (can be given 1–2 times per day)
•Maintenance Dose:
•After initial dose, 25–50 mg orally every 6–8 hours.
•Maximum Duration: Should not be used for more than 48
hours due to risks for fetal complications (e.g., premature
closure of the ductus arteriosus).
SIDE EFFECTS:-
MATERNAL:-
• HEART BURN, ASTHMA, GI BLEEDING, DECREASED RENAL FUNCTION,
PLATLET DYSFUNCTION( CAUSING INCREASED BLEEDING)
FETAL:-
• 1. PREMATURE CLOSURE OF DUCTUS ARTREIOSIS
• 2. OLIGOHYDRAMNIOS
• 3. IUGR
5. Oxytocin Receptor Antagonists
(e.g., Atosiban)
MECHANISM OF ACTION
Oxytocin is a key hormone that stimulates uterine contractions during labor.
Oxytocin receptor antagonists, such as Atosiban, bind to and block the
oxytocin receptors on the surface of uterine smooth muscle cells.
This prevents oxytocin from binding to these receptors and thereby inhibits
uterine contractions.
DOSAGE:-
IV INFUSION:-
• 6.75 mg/0.9 ml initial bolus may be needed.
SIDE EFFECTS:-
Maternal Side Effects:
• Cardiovascular:
• Hypotension (low blood pressure)
• Tachycardia (increased heart rate)
• Gastrointestinal:
• Nausea
• Vomiting
• Abdominal pain
Fetal Side Effects:
• None
NITRIC OXIDE DONORS (EXAMPLE:-
NITROGLYCERINE)
MECHANISM OF ACTION
• Nitric oxide (NO) is a potent smooth muscle relaxant.
• Nitroglycerin and other nitric oxide donors release NO, which activates guanylate
cyclase.
• This increases cyclic GMP (cGMP) levels in uterine smooth muscle cells, leading
to relaxation of the uterus by reducing intracellular calcium concentrations.
DOSAGE:-
PATCHES.
SIDE EFFECTS:-
• CERVICAL RIPENINGH
• HEADACHE
NURSING RESPONSIBILITIES
WHILE ADMINISTERING
.
TOCOLYTIC AGENTS:-
•Confirm diagnosis of preterm labor and assess gestational age for
appropriateness.
•Assess maternal health, including vital signs and history for
contraindications.
•Monitor fetal heart rate continuously for signs of fetal distress.
•Assess uterine activity (frequency, intensity, and duration of
contractions).
•Administer tocolytic as per prescribed dose, route, and frequency.
•Monitor vital signs regularly, especially blood pressure, heart rate, and
respiratory rate.
•Watch for side effects like tachycardia, hypotension, or respiratory
depression.
•Monitor for tocolytic effectiveness by assessing reduction in uterine
contractions and cervical changes.
•Watch for signs of toxicity, such as magnesium toxicity or fluid
overload.
•Provide patient education on medication purpose, side effects, and the
need for monitoring
BIBILIOGRAPHY
BOOK
• Dutta, D. C. (2020). Textbook of Obstetrics (9th ed.). Jaypee
Brothers Medical Publishers.
WEB
• 1. https://www.slideshare.net/ankita0809/oxytocics- tocolytics
• 2. https://www.slideshare.net/SnehlataParashar/tocolytics
