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Tocolytics

Tocolytics. Stacy Fernandez, MD/MPH Candidate 2011. tocolytics. Drugs that decrease uterine tone (BEMP) Beta-2 agonists Ethanol Magnesium Sulfate Methylxanthines Potent (volatile) anesthetics (NO). Objectives. Delay labor for 48 hrs to administer steroids

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Tocolytics

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  1. Tocolytics • Stacy Fernandez, MD/MPH Candidate 2011

  2. tocolytics • Drugs that decrease uterine tone (BEMP) • Beta-2 agonists • Ethanol • Magnesium Sulfate • Methylxanthines • Potent (volatile) anesthetics (NO)

  3. Objectives • Delay labor for 48 hrs to administer steroids • Transport mom and baby to facility able to provide appropriate care • Prolong pregnancy with self limited conditions (pyelonephritis, abdominal surgery, etc)

  4. terbutaline and Ritodrine • Beta-2 agonists cause myometrium relaxation • MOA- Inc Adenyl Cyclase and cAMP • Side Effects

  5. Ethanol • give in 10% D5W • thought to inhibit oxytocin • associated with an increased risk of gastric aspiration

  6. Magnesium • MOA- unknown, but may interfere with Ca at the plasma membrane voltage gated channels, hyperpolarizing the cell • CNS depressant and a mild vasodilator • works at the NMJ (in the Blue Book) • Side Effects: flushing, diaphoresis, decreased fetal HR and variability • Contraindications: Myastenia Gravis, myocardial compromise

  7. Indomethacin • Nonspecific COX inhibitor, prostaglandin synthetase inhibitor • Prostaglandins increase myometrial gap junctions that increase Ca through transmembrane influx and from the sarcolemma • Side Effects: Primary Pulmonary Hypertension, premature PDA closure, predispose to bleeding (decreased Thromboxane A2)

  8. increasing uterine tone • PGF2 alpha • Ergots • Oxytocin • Ketamine • Amide local anesthetics

  9. Thank you! • Questions?

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