Oxytocin

Oxytocin in a nine amino acid peptide that is synthesized in hypothalamic neurons and transported down axons of the posterior pituitary for secretion into blood. Oxytocin is also secreted within the brain and from a few other tissues, including the ovaries and testes. Oxytocin differs from antidiuretic hormone in two of the nine amino acids. Both hormones are packaged into granules and secreted along with carrier proteins called neurophysins.

Physiologic Effects of Oxytocin In years past, oxytocin had the reputation of being an "uncomplicated" hormone, with only a few well-defined activities related to birth and lactation. As has been the case with so many hormones, further research has demonstrated many subtle but profound influences of this little peptide, particularly in regards to its effects in the brain. Oxytocin has been implicated in setting a number of social behaviors in species ranging from mice to humans. For example, secretion or administration of oxytocin in humans appears to enhance trust and cooperation within socially-close groups, while promoting defensive aggression toward unrelated, competing groups. Oxytocin has been best studied in females where it clearly mediates three major effects:

Stimulation of milk ejection (milk letdown): Milk is initially secreted into small sacs within the mammary gland called alveoli, from which it must be ejected for consumption or harvesting. Mammary alveoli are surrounded by smooth muscle (myoepithelial) cells which are a prominant target cell for oxytocin. Oxytocin stimulates contraction of myoepithelial cells, causing milk to be ejected into the ducts and cisterns.

Stimulation of uterine smooth muscle contraction at birth: At the end of gestation, the uterus must contract vigorously and for a prolonged period of time in order to deliver the fetus. During the later stages of gestation, there is an increase in abundance of oxytocin receptors on uterine smooth muscle cells, which is associated with increased "irritability" of the uterus (and sometimes

the mother as well). Oxytocin is released during labor when the fetus stimulates the cervix and vagina, and it enhances contraction of uterine smooth muscle to facilitate parturition or birth. In cases where uterine contractions are not sufficient to complete delivery, physicians and veterinarians sometimes administer oxytocin ("pitocin") to further stimulate uterine contractions - great care must be exercised in such situations to assure that the fetus can indeed be delivered and to avoid rupture of the uterus.

Establishment of maternal behavior: Successful reproduction in mammals demands that mothers become attached to and nourish their offspring immediately after birth. It is also important that non-lactating females do not manifest such nurturing behavior. The same events that affect the uterus and mammary gland at the time of birth also affect the brain. During parturition, there is an increase in concentration of oxytocin in cerebrospinal fluid, and oxytocin acting within the brain plays a major role in establishing maternal behavior.

Evidence for this role of oxytocin come from two types of experiments. First, infusion of oxytocin into the ventricles of the brain of virgin rats or nonpregnant sheep rapidly induces maternal behavior. Second, administration into the brain of antibodies that neutralize oxytocin or of oxytocin antagonists will prevent mother rats from accepting their pups. Other studies support the contention that this behavioral effect of oxytocin is broadly applicable among mammals. While all of the effects described above certainly occur in response to oxytocin, doubt has recently been cast on its necessity in parturition and maternal behavior. Mice that are unable to secrete oxytocin due to targeted disruptions of the oxytocin gene will mate, deliver their pups without apparent difficulty and display normal maternal behavior. However, they do show deficits in milk ejection and have subtle derangements in social behavior. It may be best to view oxytocin as a major facilitator of parturition and maternal

behavior rather than a necessary component of these processes. Both sexes secrete oxytocin - what about its role in males?Males synthesize oxytocin in the same regions of the hypothalamus as in females, and also within the testes and perhaps other reproductive tissues. Pulses of oxytocin can be detected during ejaculation. Current evidence suggests that oxytocin is involved in facilitating sperm transport within the male reproductive system and perhaps also in the female, due to its presence in seminal fluid. It may also have effects on some aspects of male sexual behavior.

Control of Oxytocin Secretion The most important stimulus for release of hypothalamic oxytocin is initiated by physical stimulation of the nipples or teats. The act of nursing or suckling is relayed within a few milliseconds to the brain via a spinal reflex arc. These signals impinge on oxytocin-secreting neurons, leading to release of oxytocin.

If you want to obtain anything other than trivial amounts of milk from animals like dairy cattle, you have to stimulate oxytocin release because something like 80% of the milk is available only after ejection, and milk ejection requires oxytocin. Watch someone milk a cow, even with a machine, and what you'll see is that prior to milking, the teats and lower udder are washed gently - this tactile stimulation leads to oxytocin release and milk ejection.

A number of factors can inhibit oxytocin release, among them acute stress. For example, oxytocin neurons are repressed by catecholamines, which are released from the adrenal gland in response to many types of stress, including fright. As a practical endocrine tip - don't wear a gorilla costume into a milking parlor full of cows or set off firecrackers around a mother nursing her baby.

Both the production of oxytocin and response to oxytocin are modulated by circulating levels of sex steroids. The burst of oxytocin released at birth seems to be triggered in part by cervical and vaginal stimulation by the fetus, but also because of abruptly declining concentrations of progesterone. Another wellstudied effect of steroid hormones is the marked increase in synthesis of

uterine (myometrial) oxytocin receptors late in gestation, resulting from increasing concentrations of circulating estrogen.

GENERIC NAME: OXYTOCIN - INJECTABLE (ox-ee-TOE-sin) BRAND NAME(S): Pitocin

WARNING: This medication is recommended to be used only in pregnancies that have a medical reason for inducing labor (e.g., eclampsia). It is not recommended for elective (voluntary) procedures or to make the birthing process more convenient. For additional information, consult your doctor. USES: Oxytocin is a hormone used during the late stage of pregnancy to induce labor (contractions). It is often used to induce labor in difficult pregnancies or pregnancies at risk for complications (e.g., preeclampsia, eclampsia, diabetes). OTHER USES: This drug may also be used during pregnancy to test the heartbeat of the fetus; and to remove the afterbirth (placenta) and control bleeding of the womb (uterus) after childbirth. HOW TO USE: Follow all instructions for proper mixing and dilution with the correct IV fluids. If you have questions regarding the use of this medication, consult your pharmacist. Give this medication slowly by vein (IV) as prescribed by the doctor. This drug should be mixed in a saline, dextrose, or Lactated Ringers solution. The dosage and length of treatment is based on your medical condition and response to therapy. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard needles and medical supplies safely. Consult your pharmacist. SIDE EFFECTS: Nausea, vomiting, cramping, and stomach pain may occur. If any of these effects persist or worsen, notify the doctor promptly. Tell the doctor immediately if any of these serious side effects occur in the mother: irregular heartbeat, dizziness, lightheadedness, swelling, severe bleeding (after childbirth), seizures, headache, blurred vision, one-sided weakness. Tell your doctor immediately if any of these serious side effects occur in the newborn: irregular heartbeat, yellowing eyes or skin, bleeding in the eyes, seizures. An allergic reaction to this drug is unlikely, but seek immediate medical attention if

it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

GENERIC NAME: MAGNESIUM SULFATE - INJECTION (mag-NEE-zeeum SULL-fate) USES: This medication is used to control seizures in pregnancy, to treat low magnesium levels and problems related to kidney conditions (nephritis) in children. This drug is also used for preventing premature contractions in pregnancy and to treat heart attack and asthma patients. HOW TO USE: Use exactly as directed by vein (IV) or injection into muscle (IM). Dosage is adjusted according to individual requirements and the response to treatment. SIDE EFFECTS: Unlikely but report: flushing, sweating, muscle weakness, dizziness, drowsiness, muscle weakness, slowed/shallow breathing or other breathing trouble. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Before using this drug, tell your doctor your medical history, including: allergies (especially drug allergies), kidney or heart disease, low blood calcium, myasthenia gravis. Avoid alcohol intake, since the possible drowsiness effect of this medication may be increased. Caution when performing tasks requiring mental alertness. While magnesium use is safe during pregnancy, continuous IV use near the time of delivery may result in newborn adverse effects. Do not use magnesium during the final two hours before delivery. This drug is excreted into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Tell your doctor of all nonprescription or prescription medication you use, especially of: nerve blocking medicines (e.g., pancuronium). Medications that can increase the drowsiness effect of this drug include: sedatives, tranquilizers, drugs for sleep, narcotic pain relievers, psychiatric

medications (e.g., chlorpromazine), certain antidepressants (e.g., amitriptyline), certain antihistamines, muscle relaxants, anti-seizure medications. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include nausea, vomiting, slow heartbeat, flushing, decreased alertness, confusion, muscle weakness, and loss of consciousness. GENERIC NAME: HYDRALAZINE - ORAL (hye-DRAL-a-zeen) BRAND NAME(S): Apresoline Medication Uses | How To Use | Side Effects | Precautions | Drug

Interactions | Overdose | Notes |Missed Dose | Storage USES: Hydralazine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Hydralazine is called a vasodilator. It works by relaxing blood vessels so blood can flow through the body more easily. OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Hydralazine may also be used with other medications to treat heart failure. HOW TO USE: Take this medication by mouth with or without food, usually 2 to 4 times daily or as directed by your doctor. The dosage is based on your medical condition and response to treatment. Your doctor may start you at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. It is important to continue taking this medication even if you feel well. Most people with high blood

pressure do not feel sick. It may take up to several weeks before you get the full benefit of this drug.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.Tell your doctor if your condition worsens (for example, your routine blood pressure readings increase).

SIDE EFFECTS: Headache, pounding/fast heartbeat, loss of appetite, nausea, vomiting, diarrhea, or dizziness may occur as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness, get up slowly when rising from a sitting or lying position.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may infrequently cause nerve problems. Tell your doctor promptly if you experience numbness or tingling. Your doctor may recommend a vitamin B6 supplement (pyridoxine).Tell your doctor immediately if any of these unlikely but serious side effects occur: severe tiredness, aching/swollen joints, rashon nose and cheeks, swollen glands, change in the amount of urine, bloody/pink urine, signs of infection (such as fever, chills, persistent sore throat), easy bruising/bleeding.Seek immediate medical attention if this rare but serious side effect occurs: chest/jaw/left arm pain.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.