know their indications, contraindications, dosage, adverse effects and more!

2. OXYTOCICS Venkataramu.B.S 9term, MIMS

3. “ OXYTOCICS are the drugs of varying chemical nature that have the power to excite contraction of the uterine muscles .” Ergometrine & Methergin E2&F2 ά PGE 2 & PGF 2 ά OXYTOCICS OXYTOCIN ERGOT DERIVATIVES PROSTAGLANDINS

5. Diagram depicts a sagittal section through the hypothalamus and pituitary gland. The posterior pituitary consists of axon terminals of magnocellular neurons arising in the supraoptic and paraventricular nuclei of the hypothalamus. ● ● ● ●

7. During lactation … Axon terminals myoepithelial cells contract STIMULUS RESPONSE oxytocin mechanoreceptors in the nipple/ areola hypothalamic neuronal activity MILK EJECTION Suckling

14. Seizures & death Inadvertent activation of vasopressin receptors - 30-40mIU/min 40-50IU/min Pul. Edema Heart Failure water Intoxication- hyponatremia Antidiuresis excessive fluid retention activation of vasopressin receptors -

16. INDICATIONS -To accelerate Abortion (inevitable, Missed). -Molar preg. -To stop bleeding. -Induction of Abortion. To induce labour. For cervical ripening. Augmentation of labour. Uterine inertia. Active management of 3 rd stage To minimise blood loss. Control PPH DIAGNOSTIC Contraction stress test (CST) Oxytocin sensitivity test (OST) THERAPEUTIC PREGNANCY LABOUR PUERPERIUM EARLY LATE

20. Methods of administration Controlled intravenous Infusion 1-4mU/min (↑gradually) . INTRAMUSCULAR

22. Calculation of dose delivered in milliunits(mU) & its correlation with drop rate per minute NOTE: In majority of cases, max. response is seen with 16 mU/min i.e 2U in 500ml RL at 60 drops per min Units of oxytocin mixed in 500ml Ringer solution 1unit=1000 miliunits(mU) Drops per minute (15drops=1ml) 15 30 60 In terms of mU/min 1 2 8 2 4 8 4 8 16 16 32 64

24. Table showing convenient regime Dose of oxytocin Solution used Escalating Drop rate at intervals of 20-30min To start with 1unit If no response-2units If still no response-8units 500ml Ringer solution -do- -do- 15-30-60 15-30-60 15-30-60

28. PHARMACOKINETICS of Ergometrine & methergin -:Composition of ergot preparations:- Absorption ORAL PARENTERAL(IM,IV) rapidly absorbed peak concentrations (plasma) -60 to 90min PREFERED ROUTE Preparation ampoules tablets Ergometrine 0.25mg/ 0.5mg 0.5-1.0mg methergin 0.2mg 0.5-1.0mg Syntometrine (sandoz) 0.5mg Ergometrine+ 5U-syntocinon

31. The uterine smooth muscle fibers when contracted compress traversing blood vessels –Principle for its clinical use.

33. PROPHYLACTIC : AFTER DELIVERY OF ANT. SHOULDER / FOLLOWING DELIVERY OF BABY at the time of delivery of the placenta.

34. CAUTIONS

38. SYNTHESIS & ACTION Lungs & liver Lungs & liver

42. PROSTAGLANDIN

44. PG analogues & Common ROA PGE 1 (methyl ester) – MISOPROSTOL (vaginal, oral, rectal) PGE 2 – DINOPROSTONE (vaginal, extra amniotic) (NOTE: less toxic, more effective so widely used.) PGF 2 ά - DINOPROSTONE TROMETHAMINE PGF 2 ά (methyl analogue) – CARBOPROST (i.m., intra/extra-amniotic) -:Preparations:- Tablet -0.5mg dinoprostone (prostinE 2 ) Vaginal suppository- 20mg PGE 2 /50mg PGF 2 ά lipid base Vaginal pessary- 3mg PGE 2 ProstinE 2 gel- 500 μ g into cervical canal, below internal OS/1-2mg in the posterior fornix. -:Parenteral :- PGE 2 - ProstineE 2 1mg/ml PGF 2 ά -ProstinF 2 ά (Dinoprost tromethamine) 5mg/ml Methyl analogue of PGF2 ά - Carboprost 2.5mg/10ml vial

48. T H A N K Y O U ☻