DOCSLIB.ORG

A Role for Adrenergic Receptors in the Uterotonic Effects of Ergometrine in Isolated Human Term Non- Laboring Myometrium

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Role for Adrenergic Receptors in the Uterotonic Effects of Ergometrine in Isolated Human Term Non- Laboring Myometrium A role for adrenergic receptors in the uterotonic effects of ergometrine in isolated human term non- laboring myometrium Rebecca A Fanning, MD, FCAI, MSc, Florike Sheehan, BSc, oxytocin in myometrium previously exposed to oxytocin15, 16. Despite Claire Leyden, BSc, Niamh Duffy, MSc, Luis F. Iglesias-Martinez, the long standing use of ergometrine, the exact mechanism by which it MSc, Michael F Carey, MD, Deirdre P Campion, PhD, John J. exerts its uterotonic effect in human tissue has never been fully O’Connor, PhD. elucidated. Its administration has been linked with an increase in 1Department of Perioperative Medicine, Coombe Women and Infants University Hospital, frequency of myometrial contractions corresponding with increased Cork Street, Dublin 8, Ireland 2UCD School of Biomolecular and Biomedical Science, UCD Conway Institute of basal tone. The increase in basal tone is thought to be due to an effect Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland on the inner layer of the myometrium, as this layer is rich in 3Systems Biology Ireland, University College Dublin, Dublin 4, Ireland 4 adrenoceptors, and reacts to epinephrine administration with an UCD School of Veterinary Medicine, University College Dublin, Dublin 4, Ireland increase in tonus and frequency of contractions17,18. The mechanism of action of ergometrine has been linked to stimulation of human α1 ABSTRACT adrenoreceptors19, 20. In this study we have investigated the effects of a Background: Ergometrine is a uterotonic agent that is recommended number of adrenoceptor ligands on the action of ergometrine on in the prevention and management of post partum hemorrhage. isolated human myometrial smooth muscle. Despite its long-standing use the mechanism by which it acts in humans has never been fully elucidated. The objective of this study METHODS was to investigate the role of adrenoreceptors in ergometrine’s Subjects mechanism of action in human myometrium. The study examined the The study was conducted as a prospective laboratory investigation. hypothesis that alpha adrenoreceptor antagonism would result in the Biopsy specimens of human pregnant myometrial tissue were reversal of the uterotonic effects of ergometrine. obtained from non-laboring women undergoing elective lower Methods: Myometrial samples were obtained from women segment cesarean delivery. All patients were ASA physical status 2 undergoing elective cesarean delivery. The samples were then pregnant women and gave written informed consent. Ethical approval dissected into strips and mounted in organ bath chambers. Following -15 for the study was obtained from the Research Ethics Committee of the generation of an ergometrine concentration-response curve (10 to Coombe Women and Infants University Hospital (2006-22). All 10-5M), strips were treated with increasing concentrations of -15 -7 -7 -5 samples were collected during the four months from September to ergometrine (10 to 10 M) alone and ergometrine (10 to 10 M) in December in each of 2011, 2012, and 2013. Women with a singleton the presence of phentolamine (10-7 M), prazosin (10-7 M), propranolol -6 -6 gestation at 38-40 weeks who were not in labor prior to their cesarean (10 M) or yohimbine (10 M). The effects of adding ergometrine and delivery were considered for inclusion. Exclusion criteria included the effect of drug combinations were analysed using linear mixed ultra-sound findings consistent with fetal IUGR, polyhydramnios or effects models with measures of amplitude (g), frequency oligohydramnios, history of a chronic medical condition in pregnancy (contractions/10min) and motility index (g*contractions/10min). or pregnancy related condition requiring the use of medication, history Results: A total of 157 experiments were completed on samples of ruptured membranes, a diagnosis of human immunodeficiency obtained from 33 women. There was a significant increase in the virus, hepatitis B or C, suspected abnormal placentation and a booking motility index (adding 0.342 g*counts/10min/µM; 95% CI from 0.253 BMI >30 kg/m2. Indications for cesarean delivery included breech to 0.431, P<0.001), amplitude (0.078 g/µM; 95% CI, from 0.0344 to presentation and prior cesarean delivery. All patients received antacid 0.121, P=5e-04) and frequency (0.051 counts/10min/µM; 95% CI, prophylaxis with 30 ml of 0.3 M sodium citrate and 400 mg 0.038 to 0.063, P<0.001) in the presence of ergometrine. The α cimetidine orally preoperatively and a spinal anesthetic with 2.0 to 2.4 adrenergic antagonist phentolamine and the more selective α1 ml 0.5% hyperbaric bupivacaine, with 20 to 25 microgram (mcg) of adrenergic antagonist prazosin, inhibited the ergometrine mediated intrathecal fentanyl and 100 to 150 mcg of intrathecal morphine. increase in motility index, amplitude and frequency (-1.63 Oxytocin (Novartis Pharmaceuticals UK Ltd., Horsham, West Sussex, g*counts/10mins/µM and -16.70 g*counts/10mins/µM for motility UK) 5IU was administered by slow intravenous bolus following index, respectively). delivery of the baby and cord clamping. Conclusions: These results provide novel evidence for a role for α adrenergic signaling mechanisms in the action of ergometrine on Tissue preparation human myometrial smooth muscle in the in vitro setting. Information The myometrial biopsy was excised from the midline of the upper that sheds light on the mechanism of action of ergometrine may have margin of the lower uterine segment incision (inner myometrial layer) implications for the development of further uterotonic agents. following delivery of the baby and placenta. All specimens were thoroughly rinsed in Ringer’s lactate solution ensuring all traces of Key Words: ergometrine, human myometrium, phentolamine, blood were removed and that the specimen was free of placental prazosin, propanolol, alpha adrenergic receptors. tissue. For tissue bath experiments the biopsies were placed in a sterile container and refrigerated at 4ºC until used, which was within 2 to 20 Corresponding Author Dr. John J. O’Connor, , UCD School of Biomolecular and Biomedical Science, Conway h of collection. Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland., +353 1716 6765, [email protected] Contractility Analysis Biopsies were dissected into longitudinal muscle strips of INTRODUCTION approximately 12 by 5 by 2 mm. Isometric tension recordings were Powerful and efficient myometrial contractions and retractions are obtained from an eight-chamber organ bath (10 ml, water jacketed) essential to compress the uterine vasculature arresting blood flow system (Myobath, World Precision Instruments Inc. Sarasota, from the placental bed after delivery of the foetus and placenta1. Florida). The organ baths contained Krebs-Henseleit physiological Failure of the uterus to contract leads to uterine atony and postpartum salt solution (PSS; NaCl 118 mmol/l, D-glucose 11.1 mmol/l, haemorrhage (PPH). PPH remains a common cause of both maternal NaHCO3 24.9 mmol/l, MgSO4 1.2 mmol/l, KCl 4.7 mmol/l, KH2PO4 2-4 morbidity and mortality . Evidence is emerging of increasing rates of 1.2 mmol/l, and CaCl2 2.5 mmol/l, pH 7.4) and were aerated with a 2, 5-8 PPH worldwide which has largely been attributed to an increased gas mixture of 95% O2 and 5% CO2 and maintained at 37 ºC. incidence of uterine atony2, 7, 9, 10. Using prophylactic uterotonic agents Myometrial strips were then allowed to equilibrate at 1 to 2 grams (g) compared to conservative management lowers maternal blood loss tension until a steady tension was achieved as previously described21. and reduces the risk of PPH11. Oxytocin is commonly used as the first During this equilibration period, the Krebs solution was changed line utertonic agent but if the uterus fails to contract adequately every 10 min. When spontaneous contractions became regular (within current practice guidelines recommend the use of additional utertonic 60-90 min) the amplitude (g) and frequency (contractions/10min) agents to prevent and treat PPH such as ergometrine, misporostol and were recorded as follows: (1) a 30 min control period followed by carboprost12-14. Availability of pharmacological agents that exert their cumulatively increasing concentrations of ergometrine every 30 min effects through alternative receptor mechanisms is extremely relevant from 10-15 M to 10-8 M (n=14) or 10-7 M to 10-5 M (n=22) and (2) a 30 in light of emergencing evidence of decreased responsiveness to min control period followed by the addition of antagonist and then 30 min later by cumulatively increasing concentrations of ergometrine contraction measurements by ergometrine in comparison to the from 10-7 M to 10-5 M. A time matched control strip from each patient, variance in the data that is unexplained by neither ergometrine nor exposed only to Krebs solution was run in parallel with each separate patient specific effects24,25. Given samples available from 23 patients, experiment to ensure tissue viability for the duration of the post hoc power calculation indicated that the available data was experiment. In addition a time-matched control for antagonists alone sufficient to identify an effect size of f-squared = 0.05 with 83% (over 120 min) was also carried out. The motility index (amplitude x power. This N was chosen to cover concentrations of ergometrine frequency; g*contractions/10min) was calculated to determine the from 10-15 M to 10-10 M and in a separate experiment, 15 samples from uterine activity and the strength of contractions with the use of the 10-9 M to 10-5 M. No individual experiment was duplicated in any one Powerlab software, Chart (version 5.0; AD Instruments Pty Ltd, Bella patient tissue. The analysis was performed using the PWR package in Vista, NSW, Australia). The primary outcome was the motility index R. of myometrial contractions induced by ergometrine, epinephrine or antagonists. Secondary outcomes included amplitude and frequency Effect of ergometrine combined with the other drugs parameters. As in the previous section, for Figures 4 and 5 we compared two LMEs to determine the effect of drugs in combination with Reagents ergometrine on contraction measurements independently.
Load more

Recommended publications
  • University of Birmingham Uterotonic Agents for Preventing Postpartum
    University of Birmingham Uterotonic agents for preventing postpartum haemorrhage Gallos, Ioannis D; Williams, Helen M; Price, Malcolm J; Merriel, Abi; Gee, Harold; Lissauer, David; Moorthy, Vidhya; Tobias, Aurelio; Deeks, Jonathan J; Widmer, Mariana; Tunçalp, Özge; Gülmezoglu, Ahmet Metin; Hofmeyr, G Justus; Coomarasamy, Arri DOI: 10.1002/14651858.CD011689.pub2 License: None: All rights reserved Document Version Publisher's PDF, also known as Version of record Citation for published version (Harvard): Gallos, ID, Williams, HM, Price, MJ, Merriel, A, Gee, H, Lissauer, D, Moorthy, V, Tobias, A, Deeks, JJ, Widmer, M, Tunçalp, Ö, Gülmezoglu, AM, Hofmeyr, GJ & Coomarasamy, A 2018, 'Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis', Cochrane Database of Systematic Reviews, vol. 2018, no. 4, CD011689. https://doi.org/10.1002/14651858.CD011689.pub2 Link to publication on Research at Birmingham portal Publisher Rights Statement: Checked for eligibility:17/05/2018 Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö, Gülmezoglu AM, Hofmeyr GJ, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD011689. DOI: 10.1002/14651858.CD011689.pub2. General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication.
    [Show full text]
  • COMPARISON of the WHO ATC CLASSIFICATION & Ephmra/Intellus Worldwide ANATOMICAL CLASSIFICATION
    COMPARISON OF THE WHO ATC CLASSIFICATION & EphMRA/Intellus Worldwide ANATOMICAL CLASSIFICATION: VERSION June 2019 2 Comparison of the WHO ATC Classification and EphMRA / Intellus Worldwide Anatomical Classification The following booklet is designed to improve the understanding of the two classification systems. The development of the two systems had previously taken place separately. EphMRA and WHO are now working together to ensure that there is a convergence of the 2 systems rather than a divergence. In order to better understand the two classification systems, we should pay attention to the way in which substances/products are classified. WHO mainly classifies substances according to the therapeutic or pharmaceutical aspects and in one class only (particular formulations or strengths can be given separate codes, e.g. clonidine in C02A as antihypertensive agent, N02C as anti-migraine product and S01E as ophthalmic product). EphMRA classifies products, mainly according to their indications and use. Therefore, it is possible to find the same compound in several classes, depending on the product, e.g., NAPROXEN tablets can be classified in M1A (antirheumatic), N2B (analgesic) and G2C if indicated for gynaecological conditions only. The purposes of classification are also different: The main purpose of the WHO classification is for international drug utilisation research and for adverse drug reaction monitoring. This classification is recommended by the WHO for use in international drug utilisation research. The EphMRA/Intellus Worldwide classification has a primary objective to satisfy the marketing needs of the pharmaceutical companies. Therefore, a direct comparison is sometimes difficult due to the different nature and purpose of the two systems.
    [Show full text]
  • Malaysian Statistics on Medicines 2009 & 2010
    MALAYSIAN STATISTICS ON MEDICINES 2009 & 2010 Edited by: Siti Fauziah A., Kamarudin A., Nik Nor Aklima N.O. With contributions from: Faridah Aryani MY., Fatimah AR., Sivasampu S., Rosliza L., Rosaida M.S., Kiew K.K., Tee H.P., Ooi B.P., Ooi E.T., Ghan S.L., Sugendiren S., Ang S.Y., Muhammad Radzi A.H. , Masni M., Muhammad Yazid J., Nurkhodrulnada M.L., Letchumanan G.R.R., Fuziah M.Z., Yong S.L., Mohamed Noor R., Daphne G., Chang K.M., Tan S.M., Sinari S., Lim Y.S., Tan H.J., Goh A.S., Wong S.P., Fong AYY., Zoriah A, Omar I., Amin AN., Lim CTY, Feisul Idzwan M., Azahari R., Khoo E.M., Bavanandan S., Sani Y., Wan Azman W.A., Yusoff M.R., Kasim S., Kong S.H., Haarathi C., Nirmala J., Sim K.H., Azura M.A., Suganthi T., Chan L.C., Choon S.E., Chang S.Y., Roshidah B., Ravindran J., Nik Mohd Nasri N.I, Wan Hamilton W.H., Zaridah S., Maisarah A.H., Rohan Malek J., Selvalingam S., Lei C.M., Hazimah H., Zanariah H., Hong Y.H.J., Chan Y.Y., Lin S.N., Sim L.H., Leong K.N., Norhayati N.H.S, Sameerah S.A.R, Rahela A.K., Yuzlina M.Y., Hafizah ZA ., Myat SK., Wan Nazuha W.R, Lim YS,Wong H.S., Rosnawati Y., Ong S.G., Mohd. Shahrir M.S., Hussein H., Mary S.C., Marzida M., Choo Y. M., Nadia A.R., Sapiah S., Mohd. Sufian A., Tan R.Y.L., Norsima Nazifah S., Nurul Faezah M.Y., Raymond A.A., Md.
    [Show full text]
  • Traditional Preparations Used As Uterotonics in Sub‐
    International Journal of Gynecology and Obstetrics 120 (2013) 16–22 Contents lists available at SciVerse ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo REVIEW ARTICLE Traditional preparations used as uterotonics in Sub-Saharan Africa and their pharmacologic effects Vandana Tripathi a,⁎, Cynthia Stanton a, Frank W.J. Anderson b a Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA b Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA article info abstract Article history: Background: Little is known about the use of traditional preparations for uterotonic effects at or near delivery Received 17 March 2012 in Sub-Saharan Africa. Objective: To describe (1) use of traditional preparations in Sub-Saharan Africa Received in revised form 25 June 2012 intended to have uterotonic effects at or near birth; and (2) results of pharmacologic investigations of the Accepted 23 August 2012 uterotonic properties of such preparations. Search strategy: Structured review of 13 databases. Selection criteria: Articles describing use of traditional preparations in Sub-Saharan Africa with primary data, published Keywords: in English between January 1, 1980 and June 30, 2010. Data collection and analysis: Full-text review using Labor augmentation standard spreadsheet templates. Main results: Objective 1 analysis identified 208 plant species used for Pharmacologic effects Plant species uterotonic effects at or near delivery. The most common use was labor induction/augmentation (n=185). Postpartum hemorrhage Other uses were to expel the placenta, shorten the third stage of labor, manage retained placenta (n=61), Retained placenta and prevent/manage postpartum hemorrhage (n=20).
    [Show full text]
  • Pharmaceutical Services Division and the Clinical Research Centre Ministry of Health Malaysia
    A publication of the PHARMACEUTICAL SERVICES DIVISION AND THE CLINICAL RESEARCH CENTRE MINISTRY OF HEALTH MALAYSIA MALAYSIAN STATISTICS ON MEDICINES 2008 Edited by: Lian L.M., Kamarudin A., Siti Fauziah A., Nik Nor Aklima N.O., Norazida A.R. With contributions from: Hafizh A.A., Lim J.Y., Hoo L.P., Faridah Aryani M.Y., Sheamini S., Rosliza L., Fatimah A.R., Nour Hanah O., Rosaida M.S., Muhammad Radzi A.H., Raman M., Tee H.P., Ooi B.P., Shamsiah S., Tan H.P.M., Jayaram M., Masni M., Sri Wahyu T., Muhammad Yazid J., Norafidah I., Nurkhodrulnada M.L., Letchumanan G.R.R., Mastura I., Yong S.L., Mohamed Noor R., Daphne G., Kamarudin A., Chang K.M., Goh A.S., Sinari S., Bee P.C., Lim Y.S., Wong S.P., Chang K.M., Goh A.S., Sinari S., Bee P.C., Lim Y.S., Wong S.P., Omar I., Zoriah A., Fong Y.Y.A., Nusaibah A.R., Feisul Idzwan M., Ghazali A.K., Hooi L.S., Khoo E.M., Sunita B., Nurul Suhaida B.,Wan Azman W.A., Liew H.B., Kong S.H., Haarathi C., Nirmala J., Sim K.H., Azura M.A., Asmah J., Chan L.C., Choon S.E., Chang S.Y., Roshidah B., Ravindran J., Nik Mohd Nasri N.I., Ghazali I., Wan Abu Bakar Y., Wan Hamilton W.H., Ravichandran J., Zaridah S., Wan Zahanim W.Y., Kannappan P., Intan Shafina S., Tan A.L., Rohan Malek J., Selvalingam S., Lei C.M.C., Ching S.L., Zanariah H., Lim P.C., Hong Y.H.J., Tan T.B.A., Sim L.H.B, Long K.N., Sameerah S.A.R., Lai M.L.J., Rahela A.K., Azura D., Ibtisam M.N., Voon F.K., Nor Saleha I.T., Tajunisah M.E., Wan Nazuha W.R., Wong H.S., Rosnawati Y., Ong S.G., Syazzana D., Puteri Juanita Z., Mohd.
    [Show full text]
  • Rational Use of Uterotonic Drugs During Labour and Childbirth
    Prevention and initial management of postpartum haemorrhage Rational use of uterotonic drugs during labour and childbirth Prevention and treatment of postpartum haemorrhage December 2008 Editors This manual is made possible through sup- Prevention of postpartum hemorrhage port provided to the POPPHI project by the initiative (POPPHI) Office of Health, Infectious Diseases and Nu- trition, Bureau for Global Health, US Agency for International Development, under the POPPHI Contacts terms of Subcontract No. 4-31-U-8954, under Contract No. GHS-I-00-03-00028. POPPHI is For more information or additional copies of implemented by a collaborative effort be- this brochure, please contact: tween PATH, RTI International, and Engen- Deborah Armbruster, Project Director derHealth. PATH 1800 K St., NW, Suite 800 Washington, DC 20006 Tel: 202.822.0033 Susheela M. Engelbrecht Senior Program Officer, PATH PO Box 70241 Overport Durban 4067 Tel: 27.31.2087579, Fax: 27.31.2087549 [email protected] Copyright © 2009, Program for Appropriate Tech- www.pphprevention.org nology in Health (PATH). All rights reserved. The material in this document may be freely used for educational or noncommercial purposes, provided that the material is accompanied by an acknowl- edgement line. Table of contents Preface………………………………………………………………………………………………………………………………………………….3 Supportive care during labour and childbirth…………………………………………………………………………………….4 Rational use of uterotonic drugs during labour………………………………………………………………………………...5 Indications and precautions for augmentation
    [Show full text]
  • Postpartum Hemorrhage
    FOURTH EDITION OF THE ALARM INTERNATIONAL PROGRAM CHAPTER 6 POSTPARTUM HEMORRHAGE Learning Objectives By the end of this chapter, the participant will: 1. Define postpartum hemorrhage, differentiate between primary and secondary postpartum hemorrhage. 2. Describe appropriate prevention (active management of the third stage of labour) and treatment of postpartum hemorrhage. 3. Recall the four Ts as causes of postpartum hemorrhage. 4. Identify possible risk factors for postpartum hemorrhage 5. Describe the implications of postpartum hemorrhage on the health and well-being of the mother and her new baby. Incidence Postpartum hemorrhage (PPH) is the world‘s leading cause of maternal mortality, accounting for one-third of all maternal deaths worldwide (Derman, 2006: 1248). PPH causes up to 60% of all maternal deaths in developing countries. The majority of these deaths occur within 4 hours of delivery, indicating they are a consequence of events in the third stage of labour (Ramanthan, 2006: 967). All health care providers providing maternity care require a range of life-saving skills to enable them to make a significant contribution to reducing maternal deaths and to promote safe motherhood. Women must have access to skilled attendants. Definition and Recognition Primary (immediate) postpartum hemorrhage is defined as excessive bleeding that occurs within the first 24 hours after delivery. About 70% of immediate PPH cases are due to uterine atony. Atony of the uterus is defined as the failure of the uterus to contract adequately after the child is born. Secondary (late) postpartum hemorrhage is defined as excessive bleeding occurring between 24 hours after delivery of the baby and 6 weeks postpartum.
    [Show full text]
  • Tyler's Herbs of Choice: the Therapeutic Use of Phytomedicinals Category
    Tyler’s Herbs of Choice The Therapeutic Use of Phytomedicinals Third Edition © 2009 by Taylor & Francis Group, LLC Tyler’s Herbs of Choice The Therapeutic Use of Phytomedicinals Third Edition Dennis V.C. Awang Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business © 2009 by Taylor & Francis Group, LLC CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2009 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-13: 978-0-7890-2809-9 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher can- not assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers.
    [Show full text]
  • First Trimester Abortion Guidelines and Protocols Surgical and Medical Procedures from Choice, a World of Possibilities
    From choice, a world of possibilities First trimester abortion guidelines and protocols Surgical and medical procedures From choice, a world of possibilities IPPF is a global service provider and a leading advocate of sexual and reproductive health and rights for all. We are a worldwide movement of national organizations working with and for communities and individuals. IPPF works towards a world where women, men and young people everywhere have control over their own bodies, and therefore their destinies. A world where they are free to choose parenthood or not; free to decide how many children they will have and when; free to pursue healthy sexual lives without fear of unwanted pregnancies and sexually transmitted infections, including HIV. A world where gender or sexuality are no longer a source of inequality or stigma. We will not retreat from doing everything we can to safeguard these important choices and rights for current and future generations. Acknowledgments Written by Marcel Vekemans, Senior Medical Advisor, International Planned Parenthood Federation (IPPF) Central Office. The IPPF Abortion Team gratefully acknowledges the contributions of the reviewers of the guidelines and protocols: Kiran Asif, Cherie Etherington-Smith, Jennifer Friedman, Pak-Cheung Ho, Rebecca Koladycz, Celal Samad, Nono Simelela and Tran Nguyen Toan. Printing this publication was made possible through the financial contribution of an anonymous donor. Upeka de Silva’s contributions were essential to bring this publication to fruition. Inside these guidelines
    [Show full text]
  • In Vitro Inhibitory Effect of Methanol Leaf Extract of Stachytarpheta Jamaicensis (Verbenaceae) on Non- Pregnant Rat Uterus
    Amaechina & Bafor Tropical Journal of Pharmaceutical Research December 2016; 15 (12): 2557-2562 ISSN: 1596-5996 (print); 1596-9827 (electronic) © Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria. All rights reserved. Available online at http://www.tjpr.org http://dx.doi.org/10.4314/tjpr.v15i12.4 Original Research Article In vitro inhibitory effect of methanol leaf extract of Stachytarpheta jamaicensis (Verbenaceae) on non- pregnant rat uterus Fabian C Amaechina* and Enitome E Bafor Department of Pharmacology & Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria *For correspondence: Email: [email protected] Received: 27 March 2013 Revised accepted: 11 July 2016 Abstract Purpose: To investigate the effect of the methanol extract of the plant, Stachytarpheta jamaicensis (Verbenaceae) (SJ) on uterine smooth muscles of non-pregnant female rats, with the aim of examining the oxytocic or otherwise effect of the extract. Methods: In the first phase of experiments, the effects of SJ (0.41 and 4.01 mg/ml) on oxytocin (OT) induced uterine contractions were determined and repeated after addition of salbutamol (SBL) (41.7 nM). In the second phase, verapamil (VER) (2.03 μM), SBL (41.7 nM), and SJ (0.41 and 4.01 mg/ml) were applied to the tissues after pre-contraction with K+ (80 mM). In the third phase, the effects of VER, SBL, and SJ on CaCl2-induced contractions (0.03 – 10.83 mM) were examined. In the fourth and final phases, the second phase experiments were repeated in a calcium-free medium and in the absence and presence of propranolol (1.54 mM) respectively.
    [Show full text]
  • COMPARISON of the WHO ATC CLASSIFICATION & Ephmra/Intellus Worldwide ANATOMICAL CLASSIFICATION
    COMPARISON OF THE WHO ATC CLASSIFICATION & EphMRA/Intellus Worldwide ANATOMICAL CLASSIFICATION November 2020 Comparison of the WHO ATC Classification and EphMRA / Intellus Worldwide Anatomical Classification The following booklet is designed to improve the understanding of the two classification systems. The development of the two systems had previously taken place separately. EphMRA and WHO are now working together to ensure that there is a convergence of the 2 systems rather than a divergence. In order to better understand the two classification systems, we should pay attention to the way in which substances/products are classified. WHO mainly classifies substances according to the therapeutic or pharmaceutical aspects and in one class only (particular formulations or strengths can be given separate codes, e.g. clonidine in C02A as antihypertensive agent, N02C as anti-migraine product and S01E as ophthalmic product). EphMRA classifies products, mainly according to their indications and use. Therefore, it is possible to find the same compound in several classes, depending on the product, e.g., NAPROXEN tablets can be classified in M1A (antirheumatic), N2B (analgesic) and G2C if indicated for gynaecological conditions only. The purposes of classification are also different: The main purpose of the WHO classification is for international drug utilisation research and for adverse drug reaction monitoring. This classification is recommended by the WHO for use in international drug utilisation research. The EphMRA/Intellus Worldwide classification has a primary objective to satisfy the marketing needs of the pharmaceutical companies. Therefore, a direct comparison is sometimes difficult due to the different nature and purpose of the two systems. The aim of harmonisation is to reach a “full” agreement of all mono substances in a given class as listed in the WHO ATC Index, mainly at third level: whenever this is not possible, or harmonisation of third level is too difficult or makes no sense (e.g.
    [Show full text]
  • Drug/Substance Trade Name(S)
    A B C D E F G H I J K 1 Drug/Substance Trade Name(s) Drug Class Existing Penalty Class Special Notation T1:Doping/Endangerment Level T2: Mismanagement Level Comments Methylenedioxypyrovalerone is a stimulant of the cathinone class which acts as a 3,4-methylenedioxypyprovaleroneMDPV, “bath salts” norepinephrine-dopamine reuptake inhibitor. It was first developed in the 1960s by a team at 1 A Yes A A 2 Boehringer Ingelheim. No 3 Alfentanil Alfenta Narcotic used to control pain and keep patients asleep during surgery. 1 A Yes A No A Aminoxafen, Aminorex is a weight loss stimulant drug. It was withdrawn from the market after it was found Aminorex Aminoxaphen, Apiquel, to cause pulmonary hypertension. 1 A Yes A A 4 McN-742, Menocil No Amphetamine is a potent central nervous system stimulant that is used in the treatment of Amphetamine Speed, Upper 1 A Yes A A 5 attention deficit hyperactivity disorder, narcolepsy, and obesity. No Anileridine is a synthetic analgesic drug and is a member of the piperidine class of analgesic Anileridine Leritine 1 A Yes A A 6 agents developed by Merck & Co. in the 1950s. No Dopamine promoter used to treat loss of muscle movement control caused by Parkinson's Apomorphine Apokyn, Ixense 1 A Yes A A 7 disease. No Recreational drug with euphoriant and stimulant properties. The effects produced by BZP are comparable to those produced by amphetamine. It is often claimed that BZP was originally Benzylpiperazine BZP 1 A Yes A A synthesized as a potential antihelminthic (anti-parasitic) agent for use in farm animals.
    [Show full text]