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Tocolytics: Classification, Mechanism, Uses, Adverse Effects, and Management of Preeclampsia/Eclampsia

Classification of Tocolytics

  • Beta-2 Agonists: e.g., Terbutaline, Ritodrine
  • Calcium Channel Blockers: e.g., Nifedipine
  • Prostaglandin Synthetase Inhibitors (NSAIDs): e.g., Indomethacin
  • Magnesium Sulfate
  • Oxytocin Receptor Antagonists: e.g., Atosiban

Mechanism of Action

  • Beta-2 Agonists: Relax uterine smooth muscle by stimulating beta-2 adrenergic receptors.
  • Calcium Channel Blockers: Inhibit calcium influx, reducing uterine contractility.
  • Prostaglandin Synthetase Inhibitors: Decrease prostaglandin production, inhibiting labor initiation.
  • Magnesium Sulfate: Calcium antagonist, inhibiting uterine contractions.
  • Oxytocin Receptor Antagonists: Block oxytocin receptors, inhibiting uterine contractions.

Therapeutic Uses

  • Prevention and treatment of preterm labor.
  • Allow for corticosteroid administration to enhance fetal lung maturity.
  • Delay labor for patient transfer to specialized care.

Adverse Effects

  • Beta-2 Agonists: Tachycardia, tremors, pulmonary edema, hyperglycemia.
  • Calcium Channel Blockers: Hypotension, dizziness, headache, tachycardia.
  • Prostaglandin Synthetase Inhibitors: Gastric irritation, peptic ulcers, premature closure of ductus arteriosus.
  • Magnesium Sulfate: Respiratory depression, hypotension, hypermagnesemia, loss of reflexes.
  • Oxytocin Receptor Antagonists: Nausea, hypotension, tachycardia.

Contraindications

  • Beta-2 Agonists: Pre-existing heart disease, diabetes, severe preeclampsia.
  • Calcium Channel Blockers: Heart block, severe hypotension.
  • Prostaglandin Synthetase Inhibitors: Peptic ulcer disease, renal impairment, bleeding disorders.
  • Magnesium Sulfate: Renal failure, cardiac arrhythmias.
  • Oxytocin Receptor Antagonists: Severe hypotension, active vaginal bleeding.

Management of Preeclampsia and Eclampsia

Preeclampsia Management

  • Mild Preeclampsia: Monitoring BP, urine protein levels, antihypertensive drugs.
  • Severe Preeclampsia: Hospitalization, antihypertensives, magnesium sulfate, corticosteroids.

Eclampsia Management

  • Seizure control with magnesium sulfate, antihypertensive therapy, and delivery.
  • Postpartum care includes magnesium sulfate for seizure prevention.