Drugs Used in Obstetric Emergencies: Vasanthakumari, MSC (N)
Drugs Used in Obstetric Emergencies: Vasanthakumari, MSC (N)
Drugs Used in Obstetric Emergencies: Vasanthakumari, MSC (N)
emergencies
Vasanthakumari,Msc (N)
Lecturer(pediatrics)
Sri manakula vinayagar nursing clg,pudhucherry.
Drugs in Pregnancy
FIRST TRIMESTER :
congenital malformations (teratogenesis)
NEAR TERM :
adverse effects on Labour or
neonate after delivery
Drug categories
Category –A - practically Not harmful
during any trimester of pregnancy.
eg- antibiotics( penicillin, ampicillin,
amoxicillin, cloxacillin,
erythromycin stearate,
cephalosporin)
vitamin and mineral in standard
doses
Thyroxin and humanized insulin
Conti….
Category B - used in pregnancy with out
adverse effect
eg- metronidazole, tinidazole,
azithromycin,
nystatin, paracetamol,
ranitidine, ritodrine,
Conti…..
• Category – C - Shown adverse fetal effects in
the animal model, but no adequate studies in
pregnant women
• - immediate benefits have to be
weighed against the potential risks of drug used
• Eg- trimethoprim, anti tuberculosis
drugs, norfloxacin, ciprofloxcin,lfloxacin,
– aminophylline, quinine, acyclovir, zidovudine,heparin,
– hydralazine, Beta blockers, MAO- inhibitors,
lorazepam etc.
Conti..
• Category –D - known to be potentially harmful.
Evidence of positive fetal risks. Certain situation
maternal benefits may outweigh the potential fetal risks.
• Eg – Tetracycline's, streptomycin, kanamycin,
phenytoin,phenobarbitone,
valproicacid, alprazolam,chlordiazepoxide,
lithium, tricyclic depressants, ACE inhibitors,
spironolactone, propyl thiouracil, corticosteroids,
tobacco, iodine, warfarin, thiazides, alcohol,
etc.
Conti…….
• Category- X - proven to exert harmful effects
on the fetus in both animal and humans.
• Fetal risks outweigh any possible benefits to mother
• Hence should be avoided.
Eg.
Aminoptterin.,androgens,clomphene,diethylstilboestrol,
oestrogens,antimalignancy drugs,
substance abuse, such as heroin,opium,lysergic acid
diethylamide,etc
used by drug addicts.
Definition of
Obstetric Emergencies:
NE
IG
R
E ”
H
ET edy
OXYTOCIN M pe
“The Champ” “S
Cytotec
Inexpensive (?) Effective
Mechanism of myometrium
contractions
• Myometrium has alpha and beta-
adrenoreceptors.
• Stimulation of alpha-receptors by
catheholamines causes uterus contraction
• Stimulation of beta-receptors by
catheholamines causes uterus relaxation
Mechanism of myometrium
contractions
• Uterus body contains alpha and beta catheholamines
receptors
• Lower segment contains choline and
serotonine receptors
• Cervix contains chemo-, baro- and
mechanoreceptors
Severe Pre eclampsia / HTN
• IV Labetolol (ß blocker):
- Side effects: headache, nausea, vomiting, postural
hypotension & liver damage
- Contraindication: Asthma, marked bradycardia
• IV hydralazine (vasodilator) :
- Side effects: headache,nausea, vomitting, dizziness,
flushing, tachycardia, palpitation & hypotension
- Because of hypotension preload with gelofusin adv.
- Contraindication- SLE, severe tachycardia & MI
Nifedipine
• Calcium Channel blocker
• Clinical use:
• Mild to moderate- 5-20 mg TDS/PO
• Severe HTN- 10 mg Retard/PO
• Tocolytic- Incremental doses every 20 min until
contraction stop, then 20 mg TDS/PO
myometrium
Estrogen
• Contraceptive - COC
• DUB/menorrhagia-COC
• Endometriosis- COC continued for 9 months
• PCOS/Hirsutism - Dianette
• PMS- E2 patches + Mirena
• HRT
• Hypogonadism- cyclical therapy initially oestogen
then combined oestrogen & progesterone
Gonadorelin analogue
• Mechanism- Initial stimulation then down regulation
of GnRH receptors reducing the release of
gonadotrophins and in-turn release of estrogen &
androgen production
• Clinical use:
- Endometriosis
- Benign fibrocystic disease(breast tenderness)
• Tibolone
- Synthetic prep with oestogenic,progestogenic &
androgenic effect
- Same benefits & risks as HRT
- Improves libido
Management of vasomotor symptoms
of menopause
• Systemic HRT
• Tibolone
• Clonidine
• Venlafaxine
• Fluoxetine
• Not recommended- ginseng,Kosh,Soya prep( ?
safety)
Anticholenergics for Urge incontinence
• Preparations:
- Tolterodine (Detrusitol XL) 4mg/OD
- Solifenacin(Vesicare) 5-10mg OD
- Trospium chloride(Regurin) 20mgBd
- Oxybutynin- tab 2.5 mg OD
- patches 36mg twice weekly
Thank you