oxytocics – n. 催产药
oxytocin – n. 催产素
methylergonovine – n. 甲基麦角新碱
Methergine – n. 甲基麦角新碱商标名
Pitocin – n. 匹脱新
neuroreceptor – n. 神经受体
gravid uterus – n. 妊娠子宫
milk ejection – 奶排出
uterine atony – 子宫张力缺乏
milk “let down” – 下奶
cephalopelvic – a. 胎头骨盆的
cephalopelvic disproportion – 头盆不称
fetal position – 胎方位
early pregnancy – 早孕，早期妊娠
ergotism – n. 麦角中毒
intoxication – n. 中毒
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Oxytocics 催产药
Oxytocics stimulate contraction of the uterus, much like the action of the hypothalamic hormone oxytocin, which is stored in the posterior pituitary. These drugs include methylergonovine (Methergine), and oxytocin (Pitocin)
催产药刺激子宫收缩，其作用恰似下丘脑激素催产素，催产素贮存于垂体后叶。这些药物包括甲基麦角新碱（Methergine）和催产素（匹脱新）。
Therapeutic Actions and Indications 治疗作用和适应症
The oxytocics directly affect neuroreceptor sites to stimulate contraction of the uterus. They are especially effective in the gravid uterus. Oxytocin, a synthetic form of the hypothalamic hormone, also stimulates the lacteal glands in the breast to contract, promoting milk ejection in lactating women. Oxytocics are indicated for the prevention and treatment of uterine atony after delivery. This is important to prevent postpartum hemorrhage.
The oxytocics are rapidly absorbed after parenteral or oral administration, metabolized in the liver, and excreted in the urine and feces. They cross the placenta and enter breast milk.
The oxytocics are administered IM or IV. Methylergonovine is administered as such directly after delivery and then continued in the oral form to promote uterine involution. Oxytocin is also used in a nasal form to stimulate milk “let down” in lactating women.
Oxytocics are contraindicated in the presence of any known allergy to oxytocics to avoid hypersensitivity reactions and with cephalopelvic disproportion, unfavorable fetal position, complete uterine atony, or early pregnancy, which could be compromised by uterine stimulation. Oxytocin is used during lactation because of its effects on milk ejection, but the baby should be evaluated for any adverse effects associated with the hormone. Caution should be used in patients with coronary disease and hypertension due to the effect of causing arterial contraction, which could raise blood pressure or compromise coronary blood flow, or in patients who have had previous cesarean births because of the effects on uterine contraction, which could compromise scars from previous procedures. Caution should be used in hepatic or renal impairment, which could alter the metabolism or excretion of the drug.
The adverse effects most often associated with the oxytocics are related to excessive effects (e.g., uterine hypertonicity and spasm, uterine rupture, postpartum hemorrhage, decreased fetal heart rate). GI upset, nausea, headache, and dizziness also are common.
Methylergonovine can produce ergotism, manifested by nausea, blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, and even coma. Oxytocin has caused severe water intoxication with coma and even maternal death when used for a prolonged period. This is thought to occur because of related effects of antidiuretic hormone, which is also stored in the posterior pituitary and may be released in response to oxytocin activity, causing water retention by the kidney.
1. Monitoring contractions is very important during labor. To monitor uterine contractions, what should the nurse do?
A. Observe for the client’s facial expression to know that the contraction has started or stopped.
B. Instruct the client take note of the duration of her contractions.
C. Offer ice chips to the woman.
D. Spread the fingers lightly over the fundus to monitor the contraction.
2. The most important nursing consideration in a postpartal woman with a hypotonic contraction is:
A. Assessment for infection
B. Assessment for bleeding
C. Assessment for FHR
D. Assessment for woman’s coping mechanism
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答案 Answer 1. D. Spread the fingers lightly over the fundus to monitor the contraction Rationale: The nurse should spread his/her fingers lightly over the fundus to monitor the uterine contractions. 2. B. Assessment for bleeding Rationale: During the postpartum period, the uterus should be palpated and lochia should be assessed because contractions after birth may also be hypotonic that will result to bleeding. Bleeding during pregnancy is a serious case and should be managed immediately.
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