Drug presentation

Oxytocin

definition
Oxytocics are the drugs of varying chemical nature that have the power to excite contractions of the uterine muscles. Pharmacology-it is a nonpeptide. It is synthesised in the supraoptic & paraventricular nuclei of the hypothalamus. By nerve action it is transported from the hypothalamus to the posterior pitutary where it is stored and eventually released.

Mode of action
It increases the intensity frequency and accelerates the contraction waves through the myometrium similar to the physiological pattern i.e.,causing fundal contraction with relaxation of the cervix. The action is quick but short lived. It is administered as continous infusion. Action starts within 2-4 min and the peak effects is attained within 10 15 mins.

Preparations used
Synthetic oxytocin- ampoule 5iu/ml. Syntometrine- syntocinon5units & ergometrine 0.5mg. Desamino oxytocin-it is 50-100% more effective than oxytocin.it is used as buccal tablets containing 50iu.

Indications
It may be conveniently used in pregnancy, labour or puerperium. The indications are grouped as follows. early pregnancy to accelerate abortion. - to stop bleeding following evacuation of uterus. - to induce abortion along with. late pregnancy to induce labour. - to facilitate cervical ripening for effective induction. labour augmentation of labour. - uterine inertia. - inactive management of third stage. puerperium to minimise blood loss - to control pph.

contraindications
Grand multipara Contracted pelvis Previous lscs Malpresentations Obstructed labour Hypovolaemic state Cardiac disease

dangers

MATERNAL uterine rupture hypotension antidiuresis pitutary shock

FOETAL Asphyxia due to impairment of placental blood flow.

Routes of administration
Controlled iv infusion intramuscular buccal tablets

Principles of administration
Start with low dose. At optimal dose conc to be continued. To maintain normal pattern of uterine activity.

How to minimize the hazards

Judicious selection of cases To administer acontrolled iv infusion starting with low dose Meticulous supervision To stop the infusion at the earliest moment if any adverse feature develops

Nursing responsibilities
Explanation to relieve anxiety Preparation of the patient. Maintain partogram. Observe rate of flow of infusion. Observe uterine contractions. Monitor FHR. Monitor TPR. Asses progress of labour by PV exam.

observation
Rate of flow of the infusion Respond to uterine contraction FHR Maternal condition Progress of labour

Indications of stoping the infusion

Nature of uterine contractions Evidence of foetal distress Appearance of untoward maternal symptoms