Introduction

These are the drugs called as uterine relaxants These drugs decrease uterine motility
Used to delay the labour,

threatened abortion, in dysmenorrhoea

Betamimetics Indomethacin Calcium channel blockers Magnesium sulphate Oxytocin antagonist

1) Betamimetics
Drugs included in this category are Ritodrine- I.V. 50ug/min Terbutaline- S.C 0.25 mg inj every 3-4 hrs Isoxsuprine

MOA
Activation of intracellular

enzymes(adenyl cyclase, cAMP, protein kinase) reduces free calcium & inhibits the activation of MLCK. This reduces the interaction of actin & myosin leading to smooth muscle relaxation.

Side effects
Maternal Headache Palpitaions Hyperglycemia ARDS

Pulmonary edema
Tachycardia Cardiac failure

Hyperinsulinemia
Lactic acidemia Hypokalemia

Death

Side effects
Fetal
Tachycardia Heart failure IUFD Neonatal Hypglycemia Intraventricular haemorrhage

2) Indomethacin
MOA
Reduces synthesis of PGs thereby reducing

intracellular Ca++ Leads to activation of MLCK & uterine contractions Dose- 50mg PR followed by 25mg 6 hrs

Side effects
Heartburn
GI bleeding Asthama

Thrombocytopenia
Renal injury

3) Ca Channel Blockers
Drugs included in this category are
Nifedipine- 10-20mg evry 6-8hrs Nicadipine- 10-20mg evry 6-8hrs

MOA
Blocks the entry of Ca inside the cell
Thereby reducing interaction between actin

& myosin leading to smooth muscle relaxant

Side effects
Hypotension
Headache Flushing Nausea

4) Magnesium Sulphate
DOSE- loading dose 4-6g I.V. for 20-30 min followed by an infusion of 1-2g/hr
MOA Competetive inhibition of Ca ions at motor endplate reducing Ca influx Dec Acetylcholine release Has direct depressant action on uterine muscle

Side effects
Maternal Flushing Prespiration Headache Muscle weakness Contraindications Myasthenia gravis Impaired renal function Neonatal Lethargy Hypotonia Resp. depression

5) Oxytocin antagonist
Atosiban I.V 300ug/min
MOA Blocks myometrial oxytocin receptors

Also inhibits intracellular Ca release & release of PGs

Side effects

Nausea
Vomiting Chest pain