Tocolytic drugs

TOCOLYTICS Drug name Magnesium sulfate *High Alert Medication* nifedipine (Procardia) terbutaline indomethacin (Indocin) Class Electrolyte Calcium channel blocker Beta2-agonist Inhibits production of prostaglandins Mechanism of action Decreases the entry of calcium ions into uterine smooth muscle Decreases calcium availability within uterine smooth muscle cells Inhibits production of prostaglandins Indications Preterm labor Route(s) of administration IV PO SL SUBQ PO PR Side effects Nausea; Flushing; Headache; Toxicity: respiratory depression, cardiac arrest, altered LOC, decreased DTRs, pulmonary edema, Neonatal hypotonia Hypotension, Headache, Dizziness Tachycardia, Arrhythmias, Palpitations, Hypotension, Hyperglycemia, Hypokalemia, Pulmonary edema, Fetal tachycardia Gastritis, Oligohydramnios, Premature PDA closure Contra-indications and cautions Myasthenia gravis, Impaired kidney function, Recent myocardial infarction Hypotension, Hemodynamic instability Heart disease, Poorly controlled diabetes Bleeding disorders, Peptic ulcer disease, Renal disease, Gestational age ≥ 32 weeks Nursing considerations All tocolytics • Client education: purpose of medication is being administered to help delay labor, potential side effects to report, required nursing monitoring • Assessment and monitoring: vital signs; SpO 2; weight; heart and lung sounds; uterine activity; cervical dilation and effacement; FHR, and variability • Notify OB / midwife: indeterminate or abnormal FHR • Prepa...

WARNING: PROLONGED TOCOLYSIS Terbutaline sulfate has not been approved and should not be used for prolonged tocolysis (beyond 48-72 hours). In particular, Terbutaline sulfate should not be used for maintenance tocolysis in the outpatient or home setting. Serious adverse reactions, including death, have been reported after administration of Terbutaline sulfate to pregnant women. In the mother, these adverse reactions include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration (see Terbutaline Description Terbutaline Sulfate, USP, the active ingredient of Terbutaline Sulfate Injection, USP, is a beta‑adrenergic agonist bronchodilator available as a sterile, nonpyrogenic, aqueous solution in vials, for subcutaneous administration. Each milliliter of solution contains 1 mg of Terbutaline Sulfate, USP (0.82 mg of the free base), sodium chloride for isotonicity, 0.055% edetate disodium dihydrate as a stabilizing agent, and hydrochloric acid for adjustment to a target pH of 4. Terbutaline sulfate is (±)-a-[( tert‑butylamino) methyl]-3,5-dihydroxybenzyI alcohol sulfate (2:1) (salt). The molecular formula is (C 12H 19N0 3) 2•H 2SO 4 and the structural formula is: Related/similar drugs Terbutaline - Clinical Pharmacology Terbutaline sulfate injection is a beta-adrenergic receptor agonist. In vitro and in vivo phar...

[ Tocolytics (also called anti-contraction medications or labor suppressants) are medications used to suppress tókos, " lúsis, "loosening"). Preterm birth accounts for 70% of neonatal deaths. Commonly used tocolytic medications include 2 agonists, Indications [ ] Tocolytics are used in preterm labor, which refers to when a baby is born too early before 37 weeks of pregnancy. As Types of agents [ ] There is no clear 2 agonists, calcium channel blockers, or NSAIDs to prolong pregnancy for up to 48 hours is the best course of action to allow time for glucocorticoid administration. Various types of agents are used, with varying success rates and side effects. Some medications are not specifically approved by the [ citation needed] According to a 2022 Cochrane review, the most effective tocolytics for delaying preterm birth by 48 hours, and 7 days were the nitric oxide donors, calcium channel blockers, oxytocin receptor antagonists and combinations of tocolytics. Drug Mechanism of action Description Possible contraindications Maternal side effects Fetal and neonatal side effects 2 agonist Off-label use, FDA has advised that injectable terbutaline should only be used in urgent situations, and that the oral form of the drug should never be used Cardiac tachyarrhythmias, poorly controlled Fetal 2 agonist No longer FDA approved Poorly controlled thyroid disease, hypertension, and diabetes Metabolic hyperglycemia, Neonatal 2 agonist Not approved for tocolysis by FDA Palpitations, ( ...

AMA Citation Dudzik G, Gauthier M, Geddam L, David M. Dudzik G, & Gauthier M, & Geddam L, & David M Dudzik, Gregory, et al.Tocolytic Drugs. In: Freeman BS, Berger JS. Freeman B.S., & Berger J.S.(Eds.), Eds. Brian S. Freeman, and Jeffrey S. Berger.eds. Anesthesiology Core Review: Part Two Advanced Exam. McGraw Hill; 2016. Accessed June 16, 2023. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=1750§ionid=117322844 APA Citation Dudzik G, Gauthier M, Geddam L, David M. Dudzik G, & Gauthier M, & Geddam L, & David M Dudzik, Gregory, et al. (2016). Tocolytic drugs. Freeman BS, Berger JS. Freeman B.S., & Berger J.S.(Eds.), Eds. Brian S. Freeman, and Jeffrey S. Berger. Anesthesiology Core Review: Part Two Advanced Exam. McGraw Hill. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=1750§ionid=117322844 MLA Citation Dudzik G, Gauthier M, Geddam L, David M. Dudzik G, & Gauthier M, & Geddam L, & David M Dudzik, Gregory, et al. "Tocolytic Drugs." Anesthesiology Core Review: Part Two Advanced Exam Freeman BS, Berger JS. Freeman B.S., & Berger J.S.(Eds.), Eds. Brian S. Freeman, and Jeffrey S. Berger. McGraw Hill, 2016, https://accessanesthesiology.mhmedical.com/content.aspx?bookid=1750§ionid=117322844. The causes of preterm labor are multifactorial and vary according to gestational age. An extensive list of pathological processes has been implicated including decidual hemorrhage, myometrial and fetal membrane overdistention, precocious fetal endocr...

Tocolytics are drugs that are used to delay your delivery for a short time (up to 48 hours) if you begin labor too early in your pregnancy. Doctors use these drugs to delay your delivery while you are being transferred to a hospital that specializes in preterm care, or so that they can give you corticosteroids or magnesium sulfate. The corticosteroid injections help mature the baby’s lungs. Other drugs that can be used as a tocolytic include: • beta-mimetics (for example, • • non-steroidal anti-inflammatory drugs or NSAIDs (for example, General information about these drugs is given below. There is no data showing that one drug is consistently better than another, and doctors in different parts of the country have different preferences. In many hospitals, terbutaline is given especially if a woman is at low risk of delivering her baby early. For women at high risk of delivering within the next week, magnesium sulfate (administered intravenously) is usually the drug of choice. Tocolytic medications for preterm labor aren’t used before 24 weeks of pregnancy. In certain situations, your doctor may use it when you are at 23 weeks of pregnancy. Many doctors stop giving tocolytics after a woman has reached her 34th week of pregnancy, but some doctors begin tocolytics as late as 36 weeks. Your doctor may first try treating your preterm labor with bed rest, extra fluids, pain medicine, and a single dose of a tocolytic medication. They may also do further screening (like a fetal fi...

Continuing Education Activity Tocolysis is an obstetrical procedure to prolong gestation in patients, some of which are experiencing preterm labor. This is achieved through various medications that work to inhibit contractions of uterine smooth muscle. The main medications used are beta-adrenergic agonist receptors, calcium channel blockers, cyclooxygenase inhibitors, and magnesium sulfate. This activity reviews and evaluates tocolysis and highlights the role of the interprofessional team in evaluating and managing tocolysis. Objectives: • Identify the indications for tocolysis. • Summarize the different medications used for tocolysis. • Review the risk factors for specific tocolysis medications. Introduction Tocolysis is an obstetrical procedure carried out with the use of medications with the purpose of delaying the delivery of a fetus in women presenting preterm contractions. These medications are administered with the hope of decreasing fetal morbidity and mortality. Tocolysis is intended to prolong gestation for two to seven days and works by creating a quiescent environment in the uterus. This is important to allow transportation to a higher care facility, to administer a fetal lung maturity scheme with antenatal corticosteroids, and the additional time is also used to determine the group B streptococcus (GBS) status of the pregnant woman, and provide prophylaxis if she is either positive or the GBS culture status is unknown. Tocolysis is not intended to increase ges...