Tocolytic drugs (tocolytic agents), mechanism, classification, side effects, pharmacology made easy

💊 Tocolytics, which are also known as anti-contraction medications, are agents that have been widely used in the treatment of premature labor. Most commonly used tocolytics are magnesium sulfate, calcium channel blockers like Nifedipine, beta2 agonist like terbutaline and NSAIDS like indomethacin. Tocolytics prolong pregnancy for up to 7 days, but do not improve fetal morbidity or mortality.
📍 When tocolytics are administered they cause smooth muscle relaxation in the uterus via various mechanisms. Both magnesium sulfate and calcium channel blockers, block calcium channels which inhibits the entry of calcium ions into uterine smooth muscles and thus decreases their contractility. Beta-2 agonists bind to the beta-2 receptors located on the surface of smooth muscle cells, ultimately leading to a decrease in the level of intracellular calcium and decreasing their contractility. Finally, NSAIDs inhibit the enzyme cyclooxygenase which normally helps to produce prostaglandins. As a result, there is a decrease in prostaglandin levels, which ultimately results in relaxation of the uterine smooth muscle.
📍 Tocolytics can cause several maternal and fetal side effects. Tocolytic therapy with magnesium sulfate is known to affect calcium homeostasis and result in hypocalcemia and hypercalciuria. Calcium channel blockers can cause vascular smooth muscle relaxation, which may result in headache, dizziness, flushing, nausea and hypertension, which could decrease blood flow to the fetus.
📍 Tocolytics are generally contraindicated if pregnancy continuation poses a risk on the client's life, as in severe preeclampsia or eclampsia, intra-uterine infection and active vaginal bleeding. Tocolytics are also contraindicated before the 20th week and after the 34th week of gestation as well as in clients with premature rupture of the membranes.
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Chapters:
0:00 - preterm birth
0:27 - tocolytic drugs (anti-contraction medication)
0:38 - examples of tocolytic drugs
1:26 - mechanism of action of tocolytic drugs (tocolytic agents)
2:31 - side effects of tocolytic drugs (tocolytic agents)
4:05 - side effects of NSAIDs
4:55 - contraindications of tocolytic drugs (tocolytic agents)

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