546 -

p1t.
-----~~~=--
_..

,1
-
. ·t
,-eel n, p sHl, 1 s
.
. . , ., hould be re~ t, icted , as it is likely t
h . , ·..: ~)rcr1dy l l )we r t'l1 Tl 11~ m ,1y r~s u·lto .~\\\J~ l
rou tin e u!-<: ..
l i1 e w tc 1 1, ' , in :l'1 ~
.,tc rn,1 1 p l.isrn,1 vo ui _' misc . Other h,! lMds include lhrnrnk , c n1U\t,~
111 ➔ - , to fe t.1 1 t..n mp ro ,.x)._,;v top 'll
... , pei lu : -,inn !en'-- 11 1b · ~111a l
1
h ypl'l13tr,H.' 1l1li'I - zr:: -s o mg tvb , d ,1 il y ,1 f tcr bre,1kf..lst for C,
· 1 1· 11 irc r) - Dose :J . d b b . d,H -
H11drochlartlua zi , c ( ~ . as th ,t o f fru sc mt e, ut y <lCting on t}-,
,<· pr() 1 1~
- ,~,Ii\
. II :irne rn ec 11;_1 n1 s n1 ,
Mode ot adion - w ~. nd fetal hazards ,, re the ~ame a~ tho~t· of t·r ' Tr.1
1~
.
d1su l convolute tu u c ·
d b I ~s M.1ten1a 1 a
. , , b y compehtiv p
u..,ern Cu.>
4
dr ug an tagonises aldosteron€ 1 hb
spirono
· 1,u- tone (A /dacto11c ) - TJ 1e
t"ng '
the potass ium excretion ,md decre,.h tng the n,rl 1 1t l(ln 1•
dis ta l tubules .thereb ·r · •y prevenmg tab 1.1
may be raised .
to even 1 00 mg m divided do')(,>~l1'j1un-i A r\'<lc,
pt1on. Dose - im ia 11 y 25 _· e h otens ive action . -~ dvant,
There is no potassium loss. It has also som YP g

TOCOLYTIC AGENTS
The physiology of uterine contraction has led to the idea of trying to prolong the pregn
the . drugs which can inhibit uterine contractions . The following
.- •
drugs a re u sed apart
c.
.1ney
fr om pu ttb·1 ~
patient to absolute bed rest. The patients are to be sedated with either morphine o r barbit . ng
f · · hi b '
o lflJ . morp ne 10 mg or tab phenobar 1tone
60 2 3 · d
mg - times a ay. Any one of t he foll
urates 'n ~
· ut
drugs may be used in an attempt to inhibit uterine contractions. mving tc\\1:
DRUGS : The commonly used drugs are given in the table 33.7.

Table 33 7 · Tocolytic agents -

.
Drugs Mechanism of <lCtion Doses Side effects
-
• Initial Ma intenance
Isoxsuprine Stimulation of I.V . drip-100 mg in 5% I.M . 10 mg 6 hrly
(Duvadi/an)
Hypotension; tachmr-
adrenergic dextr~se. Rate - 0.2 µg for 24 hrs . dia, nausea, vomiting
receptors. per mm, gradually Tab-10 mg Pulmonary oedemJ
increased to 0.8 µg/min. 6-8 hrly. cardiac arrhythmiJs,
To continue at least adult resptratorv Jc;tre
2 hours after the syndrome, ·
contractions cease. hyperglycemia,
hypokalemi,1, lactic
acidosis, mdtemal
death (rarely).
Ritodrine do
hydro- LV. drip in 5% dextrose After 12 hrs-oral -do-
chloride Rate-SO µg-100 µg/min . therapy with but less pronounced
gradually increased 10-20 mg tab .
until the contractions every 4-6 hrs.
stop to a maximum
350 µg/min.
Salbutamol Stimulation of
(Croysal) adrenergic LV. infusion- 5 mg in 4 mg tab . 6 hrly Tremor, tachycard_ia,
receptors. 5% de~trose, Rate-10 hypotension, palpitd·
µg/mm initially tion.
gradually stepp~ upto
a maximum 50 µg / min
to stop uterine
Ethanol contractions.
i) lnhib·ltory action
9 .5% alcohol in 5% d rn1t~
of on hypothala- Nausea an v0 •h\-.r
mus, preventing dextrose (50 m1 95 % intoxication, h~~,fl
release of oxyto- e~yl alcohol in 450 m1 emia, fetal respJra
cm_ and antidiu- 5 Yo dextrose) . lnitiaU dep~ ion-
retie hormones - 7.S ml/kg for first y
ii) Direct depres- . 2 hours. followed
sant action on by 1.5 ml/kg
~ cV1-r..i
~ . .• myometrium . per hr for 10-12 hrs. T~b!f )JI
~
 547
cHA//T1:J< 33 PH.AR.i~~ITTHERAPEUTICS fN OBSTETRICS

Urugs M~chanism of Doses Side effects

4'ction
r
1ml ral Mamtenrm ce

Ma,r,,,swm Dtrf,t depres5.ant 4 gm 1.V ,lowly over 10 Mat~m<ll h v putt·n,Lon,

!:t lllfJHilf.- cldH\n Pn th~ utennP mm.,, followed. by 2 gm/hr h 't pnth ·111\1,l, <.:drdi.ll
mu~l4 d(,"CH .,~ .1 rrh ythmM, respire1tory
and then l gm/hr m dr1p
:le..., t~} d,< lme and o f 5.,.f, d~tro"'e depre~u.>n Ft'.-'tc, l
mt ran llu Jar deprt>..,!>1on (,nly with
'--4 i( t U t'l1 htgh Jo ~♦' .1t dt>ltv~ry
--- - l
/> ro:.tii.lll,rn,hn uihti:ntor:. f Ab.r . nn ur lnJom~ h.icm ) The drug has been eHectl vt- , but c.1Jv~ r,t • tdJl dt e<·t~
,ut·h ,i , pri..~,n~tur~ duMJr~• n1 pah-nt dut ru, a rt ...-no\u.:, ..1nd conge~tive cardiac fdilure mc1y o(-cur
Nifcdipin e (c.iluwll chan.nd blodw\"6 Jt(~nt} (~• p'1g~ 545)
To(olytic1; th~t are cu~ntly undf'i- clinicaJ tri,11 :
Ato~iban - .s.n o x,to1.,n .lfl,w. 0 ~._.. 1...ountt· racb the ~ffec t of endogen o u ~ uxy toon . So 1t <.d n ,nh1b1t tht:-
l"' ' tt1.._ 1n rnduu'\J pn l(crm l.itx"ur Nitnc oxide donors bke sodium n 1tropru":>!>LJ t.> are p o tent .,mo,,th mu.,clt>
rt.>l ..,x ..mh ~, ex~ ~'--•nous '\.U ..~d- .,..., J lrn.1...)lyttc agt>nt Pot.usium channel op~ners .1rl1 e ffi.:ctt\. ~ c,mc,oth mu~,d~
rt'l.l,.n,h

ANTICONVULSANTS
 TEXT BOOK
OF
OBSTETRICS
Including
PERINATOLOGY and CONTRACEPTION

G3FSf5

' l J

D.C. DUTT A M.B.B.S., D.G.0!, M.O. (CAL~)

Professor & Head, Dept. of Obstetrics and Gynaecology,
Nilroton S, rcar Medical College & Hospital, Calcutta, India

\> sc- Nursing 0

0 · -:,_---· N \:')'?2\ 2
•V ~n.-- .f/
~ t ~·~r-~):,,.,--- Edited by
HIRALAL KONAR
(HONS; GOLD MEDALLIST)
M .8 .B.S. (CAL) ; M.0 . (PGI) ; 0 .N.8 . (INDIA); MRCOG (LONDON)
A ~~tt Profe~~or, Dept. of Obstetric5 and Gynaecology,
N drutan Si, car M edical College & Hospital, Calcutta, India
< ) 11 , · 1 1111 , · 1-:_ , ,tat 1011
lfr8 1st mr 111 Obstet rics, Gynaecology and Oncology;
Nur//1011 mui Yorkshire Re~i0t1 , Newcastle- Upon - Tyne, U.K.
Lxa 111 i1wr, Ut11vC'rs1ty of Caimi ta

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1993
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