DRUGS

By- Dr. Rekha Agrawal

Ass. Professor
Department Of OBGY
IMCHRC
 Oxytocin
• M.O.A -- acts through receptor and voltage-mediated
calcium channels to initiate myo metrial contractions.

• The uterine contractions are physiological, i.e. causing fundal

contraction with relaxation of the cervix.

• Preparations used –
(i) Synthetic oxytocin.
(ii) Syntometrine- A combination of syntocinon 5 units
and ergometrine 0.5 mg.
(iii) Desamino-oxytocin
(iv) Oxytocin nasal solution contains 40 units/mL.
 USES
1)THERAPEUTIC
Pregnancy
Labor
Puerperium
Pregnancy
Early : — To accelerate abortion—inevitable or missed and to expedite expulsion of hydatidiform
mole
— To stop bleeding following evacuation of the uterus
— Used as an adjunct to induction of abortion along with other abortifacient agents (PGE1 or
PGE2).
Late: — To induce labor
— To ripen the cervix before induction.
— Augmentation of labor
— Uterine inertia
Labor: — Inactive management of third stage of labor
— Following expulsion of placenta as
an alternative to ergometrine.
Puerperium: To minimize blood loss and to
control postpartum hemorrhage.
2) DIAGNOSTIC:
Contraction stress test (CST)
Oxytocin sensitivity test (OST)
DANGERS OF OXYTOCIN
MATERNAL
Uterine hyperstimulation (overactivity)
Uterine rupture
Water intoxication
Hypotension
Antidiuresis
FETAL: Fetal distress, fetal hypoxia or even fetal death may
occur due to uterine hyperstimulation.
ROUTES OF ADMINISTRATION
• Controlled intravenous infusion is the widely used method.
• Bolus IV or IM—5–10 units after the birth of the baby as an
alternative to ergometrine.
• Intramuscular—the preparation used is syntometrine.
• Buccal tablets or nasal spray—Limited use on trial basis.
Regimen
In majority of cases, a dose of less than 16 mIU/min (2 units in
500 mL Ringer solution with drop rate of 60/minute) is enough to
achieve the objective. Conditions where fluid overload is to be
avoided, infusion with high concentration and reduced drop rate
is preferred.
Contraindications
 Methergine
MODE OF ACTION:
• Ergometrine acts directly on the myometrium.
• It excites uterine contractions which come so frequently one after
the other with increasing intensity that the uterus passes into a
state of spasm without any relaxation in between.

Uses - A. Prophylactic-Active management of third stage of labor as

prophylaxis to excess bleeding following delivery.
B. Therapeutic-To stop the atonic uterine bleeding, following
delivery, abortion or expulsion of hydatidiform mole.
Composition- methergine ( methyl ergonovine)
-Ampoules-0.125–0.250mg. Tablet - 0.125–0.5 mg.
CONTRAINDICATIONS
• Suspected pleural pregnancy.
• Organic cardiac disease.
• Severe pre eclampsia and eclampsia.
• Rh negative mother .
• Heart disease or severe hypertensive disorder.

Complications -
• Nausea vomiting
• Vasoconstrictive action -precipitate rise of blood pressure.
• gangrene of the toes due to its vasoconstrictive effect.
• Prolonged use in puerperium may interfere with lactation
 ANTIHYPERTENSIVE
• Methyldopa
• Labetalol
• Nifidipine
• Hydralazine
• Propanolol

USES
• Antihypertensive drugs are essential when the BP is
160/110 mm Hg to protect the mother from
eclampsia, cerebral hemorrhage, cardiac failure and
placental abruption.
• First line therapy is either methyldopa or labetalol
Second line drug is nifedipine.
 Methyldopa
M.O.A -Drug of first choice. Central and peripheral
antiadrenergic action. Effective and safe for both the mother and
the fetus.
Dose - Orally – 250 mg bid – may be increased to 1 g qid
depending upon the response.
IV infusion—250–500 mg.
SIDE EFFECTS
Maternal –
• Postural hypotension
• hemolytic anemia
• sodium retention
• excessive sedation.
Fetal – Intestinal ileus
CONTRAINDICATION
• Hepatic disorders
• psychic patients
• congestive cardiac failure
Precaution- Postpartum (risk of depression)
 Labetalol
M.O.A -Combined α and β adrenergic blocking agent.
Dose - Orally – 100 mg TID may be increased up to 2,400 mg daily.
• IV infusion (Hypertensive crisis) 20–40 mg IV every 10–15 min until
desired effect, maximum up to 220 mg.
SIDE EFFECTS
• Tremors
• headache
• asthma
• congestive
• cardiac failure
CONTRAINDICATION AND PRECAUTION
• Hepatic disorders
• Asthma, congestive cardiac failure
 NIFEDIPINE
M.O.A -Direct arteriolar vasodilatation by inhibition of slow inward
calcium channels in vascular smooth muscle.
Dose -Orally 5–10 mg tid maximum dose 60–120 mg/day.
Side effects
• Flushing hypotension
• headache
• tachycardia
• inhibition of labor.
Contraindication
Simultaneous use of magnesium sulfate could be hazardous due to
synergistic effect..
 DIURETICS
Frusemide (Loop diuretic) (LASIX)
MOA—It directly prevents reabsorption of sodium and potassium
mainly from the loop of Henle.
Dose – 40 mg tablet daily following breakfast for 5 days a week.
In acute conditions, the drug is administered parenterally in doses of
40–120 mg daily.
Uses
• Pregnancy-induced hypertension with pathological edema.
• Eclampsia with pulmonary edema.
• Severe anemia in pregnancy with heart failure.
• Prior to blood transfusion in severe anemia.
• As an adjunct to certain antihypertensive drugs such as
hydralazine or diazoxide.
Side effects
Maternal-
• Weakness , fatigue
• Muscle cramps
• Hypokalemia
• Postural hypotension
Fetal -
• Thrombocytopenia
• Hyponatremia
Contraindication in pre eclampsia.
 TOCOLYTICS - Isoxsuprine & Ritodrine
M.O.A -Activation of the intracellular enzymes (adenylate cyclase,
cAMP, Protein kinase), reduces intracellular free calcium (Ca++ ↓↓)
and inhibits activation of MLCK (↓↓) →
Reduced interaction of actin and myosin → smooth muscle
relaxation.β (β2) receptor stimulation causes smooth muscle
relaxation.
Uses -Preterm labor and delivery can be delayed by drugs in order
to improve the perinatal outcome.
Side effects -Maternal- Headache,palpitation, tachycardia,
pulmonary edema, hypotension, cardiac failure, hyperglycemia,
ARDS, hyperinsulinemia, lactic acidemia, hypokalemia and even
death.
Fetal: Tachycardia, heart failure, IUFD.
Neonatal: Hypoglycemia and intraventricular hemorrhage.
Contraindication
• Tachycardia of >130/min
• Chronic cardiac disease
• Dead or severely malformed fetus
• Chorioamniointis
• Concomitant use of steroids.
Ritodrine is given by IV infusion, 50 µg/min and is increased by
50 µg every 10 min until contractions cease. Infusion is
continued for about 12 hrs after the contractions cease.
M.O.A-
Magnesium sulfate
• It decreases the acetylcholine release from the nerve endings and
reduces the motor end-plate sensitivity to acetylcholine.
• It also blocks the calcium channels.It causes vasodilatation, increases
cerebral, uterine and renal blood flow. It decreases intracranial edema.
Uses - Prevention of Eclampsia in Pregnancy induced hypertension
• Severe Pre eclampsia
• Treatment of Eclampsia
• Used as Tocolytic Agent
Fetus effects are usually absent
Contraindication in mysthenia gravis
Should be used with Caution in Women with Impaired Renal
Function
 Diazepam
M.O.A -Central muscle relaxant and anticonvulsant.
Uses -
• Treatment of eclampsia
• Prevent eclampsia in case of severe pre eclampsia
• To releive anxiety
• As hypnotic to do minor surgery
• Preanesthetic medication.
Side effects -
• Mother—Hypotension, Drowsiness, Lethargy, Dependance
• Fetus—Respiratory depressant effect which may last for even 3
weeks after delivery. Hypotonia, thermoregulatory problem in
newborn
Dose- Initially 20–40 mg IV to be followed by an infusion
containing 500 mL of dextrose with 40 mg of diazepam, the drip
rate being 30 drops/min or adjusted as per need.
Status epilepticus: 10–20 mg IV slowly, to be repeated if needed
after 1 hr may be followed by IV infusion to a maximum of 3 mg/
kg over 24 hrs
 ANTICOAGULANTS
Heparin- (unfractionated heparin)
Low-molecular weight heparin(LMWH)
M.O.A-Inhibits action of thrombin, it also enhances the activity of
antithrombin III, increases factor Xa inhibitor.
USES -
• Cardiac disease
• venous thrombosis,
• antiphospholipid syndrome
Dose -5,000–10,000 IU to be administered parenterally.
DVT and pulmonary embolism: loading dose 5,000 units IV
followed by continuous infusion of 18 units/kg/hr.
Pregnancy: 5,000-10,000 SC every 12 hrs (with monitoring).
LMWH: Enoxaparin 1 mg/kg twice daily SC, less antithrombotic
effect.
SIDE EFFECTS
MATERNAL:
Hemorrhage
urticaria
with long-term use thrombocytopenia and osteopenia,
hyperkalemia.
Fetal: It does not cross the placenta, not teratogenic.
Low-molecular-weight heparins—as effective and safe as
unfractionated heparin.
Warfarin
M.O.A -Interferes with synthesis of vitamin K
dependent factors (II, VII, IX, X).
Dose -5–10 mg orally daily for initial 2 days then 3–9
mg daily (taken at the same time each day) depending
upon the prothrombin time (INR) (INR-2.5–3.5).
Side effects
Maternal: Hemorrhage
Fetal: Warfarin embryopathy (5%)
• nasal hypoplasia,
• bone stiplings,
• optic atrophy,
• mental retardation,
• microcephaly,
• chondrodysplasia punctata.
Women with mechanical heart valves, warfarin is preferred. To
avoid first trimester.
 Prostaglandin
M.O.A -
• change in myometrial cell membrane permeability and/or
alteration of membrane-bound Ca++.
• also sensitize the myometrium to oxytocin.
• PGF2α acts predominantly on the myometrium, while PGE2
acts mainly on the cervix due to its collagenolytic property.
• PGE2causes dissolution collagen bundles and increases
submucosal water content of the cervix.
 Advantages
• Powerful oxytocic eff ect, irrespective of duration of gestation
• Induction of labor (PGE2, PGE1): In cases with (a) low preinduction score; (b) IUFD
• Used in induction of abortion (PGE1) with success
• It has got no antidiuretic eff ect (cf oxytocin)
• PGE1 (misoprostol) can be used for augmentation of Labor

Disadvantages and Side Effects

• It is costly compared to oxytocin
• Nausea, vomiting, diarrhea, pyrexia, bronchospasm, tachycardia and chills
• Cervical laceration may occur (PGF2α) when used as an Abortifacient
• Tachysystole (hyperstimulation) of the uterus, may occur during induction and may
continue for a variable period
• Risk of uterine rupture in cases with previous scar
USE IN OBSTETRICS
• Induction of abortion (MTP and missed abortion)
• Termination of molar pregnancy
• Induction of labor
• Cervical ripening prior to induction of abortion or labor
• Augmentation (acceleration) of labor
• Management of atonic postpartum hemorrhage
• Medical management of tubal ectopic pregnancy

CONTRAINDICATIONS-
1. Hypersensitivity, 2. Uterine Scar , 3. Active Cardiac,Pulmonary,
renal & Hepatic Disease, 4. Hypotention 5. Bronchial Asthma.
PREPRATIONS – Dinoprostone gel – 500ug in cervical canal or 1-2mg in
posterior fornix
- PGF2a (carboprost) - dose 250ug/ml
- PGE1 (Mesoprostol) – 25-50ug every 3-6 hours by oral
/vaginal route
 Tetanus Toxoid
• Use - Give to mother during pregnancy to produce active
immunity in mother and passive immunty in foetus.
• Dose- 0.5 ml
• Administration- I/M
1st Dose- First visit
2nd Dose- 4-6 Weeks after first dose
Adverse reaction-
Local- excessive pain, redness & swelling arround site of
injection persisting for 3-4 days.
 IRON Dextran
• Indication- (parentral iron therapy)
1. In malabsorpion syndrome
2. Intolerance to oral iron
3. Patient with chronic bleeding
4. Unreliable patient
5. No response to oral iron
I/M – 25 mg test dose, 100mg daily on alternate day
Utilization is 50-90% , deep I/M Inj. By 2 Technique
Side effect- Pain due to local inflammation, disc;oration, Inj. Abscess
I/V- Utilization is 70-100%
Total dose I/V direct on in drip of normal saline or 5% glucose
Complication- 1) Malaise (2)fever (3)Lymphdanopathy (4) Arthalgia (5)
Urticaria
 Human chorionic gonadotropin
•
Injection
Used as an ovulation inducer
• It supports corpus lutuem
• Used to enhance the production of progesterone in
certaain circumstance
• In males it stimulate leydig cells to synthesize Testesterone
 Tranexamic Acid
• MOA- Antifibrinolytic agent reduces menstrual blood loss
by 50% by counter act endometrial fibrinolytic system
• DOSE- 500mg to 1 gm 6 hrly x 5 days In AUB
• USE-
• Used in Dysfunctional uterine bleeding
• Useful in IUCD induced Menorrhagia
• Hemostatic agent
• Side effect-
1.Nausea 2. vomiting 3. diarhoea 4. headache 5.Visual
disturbance 6. Hypotension
 Cabergoline Or Bromocriptine
• MOA- Dopamine agonist ,Increase ovarian responsiveness
to clomiphene
• Indication-1)Hyper prolactinemia
2) Inhibition of lactation
Side effect- 1) Abdominal pain (2)Dyspepsia (3) Dizziness (4)
Orthostatic hypotension (5) Vomiting
Contraindication-uncontrolled hypertension
 Clomiphene citrate
• MOA- Antiestrogenic as well as estrogenic , Block estrogen receptor in
hypothalamus , seen on endometrium and cervical mucus
• Dose- Initial dose 50 mg daily to max. 250mg daily
• Use-
1. In female – Ovulation induction in case of PCOD
2. In male- Patient with oligozoospermia
Side effect- Hot flashes , nausea , vomiting , headache, visual symptom,
ovarian hyperstimulation
Contraindication-
1. Liver disease
2. Pregnancy
3. Abnormal uterine bleeding of unknown cause
 Letrozole
• MOA- Aromatic inhibitor, inhibit ovarian estradiol
production
• Dose- 2.5mg or 5 mg
• Uses- Ovulation induction , Control ovarian stimulation
• Side effect- fetal congenital malformation and multiple
pregnancy
 Atropine
• MOA- Muscuranic blocker
• Uses- 1) preanesthetic medication before hysteroscopy,
D&C, MTP, Tubal ligation
2) Severe bradycardia
Dose- 0.6 Mg/ml , I/M 30min. Before operation
Contraindication- 1) Congestive heart failure 2) chronic lung
disease
Side effect- constipation, tachycardia, respiratory depression
 ASPIRIN
• Dose- 60-100mg per day starting from as early as 12 weeks.
• Uses- Prevent PIH & IUGR
1) Women with recurrent abortion whose anticardiolipin
antibody and lupus anticoagulation antibody is raised that
is primary antiphospholipid antibody syndrome here it is
started as soon as urine pregnancy test positive
2) Pregnant women with autoimmune disease like SLE
 Folic acid & Ferrous sulphate Tablet
• FOLIC ACID-
• Use prophylactically in all women of reproductive age
• Treatment of anemia
• DOSE- 400 microgm daily ,additional amount 4 mg when
demand is high
• Ferrous sulphate- Use in prophylaxis and curative therapy
of iron deficiency anemia
 MALA-N & MALA-D
• Combined OCP Provided by gov. of india
• Levonorgestrel 0.15mg + Ethinyl Estradiol 30 microgm
• Contain 21 steroids + 7 iron Tablet
• MOA- Inhibition of ovulation by acting negative feedback
on HPO axis , Alteration of character of cerviacl mucus.,
Interfer with tubal motility, causing static endometrial
hyperplasia
• Improvement of menstrual abnormality
• Prevention of malignancy
 Hydrocortisone & Dexamethasone
MOA- maximum Mineralocorticoid (HYDROCORTISONE)
maximum Glucocorticoid (DEXAMETHASONE)
Uses-
• Natural Glucorticoids used in anaphylactic shock – 100-200mg i/v stat
• Large doses in septic shock 50-75mg/kg/day
• Acute stressful condition
• Mendelson syndrome
• Microsurgery
• Hydrotubation
• To enhance lung maturity
• Cerebral edema
• C/I- Cushing syndrome , TB, Peptic ulcer, DM
• S/E- LONG TERM USE- Acute Gastritis , osteoporosis , myopathy , psychotic
reaction
 Sodium Bicarbonate

• USES – Metabolic Acidosis – eg prolonged Labour,

Hyperemesis Gravidarum, Septicemia.
Renal Failure in Obstetrics
Asphyxia Neonatorum
Respiratory Distress Syndrome
 DROTAVARIN
• It is an isoquinoline antispasmotic.
• Gives smooth muscle relieves spasm by correcting
Cyclic AMP & Ca imbalance
• Given as 40 mg i/m injection
• Available as 20mg / ml injection
• USE - Antispasmodic in Dysmenorrhoea & other
colic
• Ondensetron
• MOA – 5HT3 receptor Blocker
• Use –Nausea & Vomiting

• ACILOC (Ranitidine)
• MOA- H2 Blocker
• Use- Acidity, Peptic Ulcer ,
• S/E – Headache , Dizziness, Diarrhoea/constipation.

Pantoprazole -
• MOA- Proton Pump Inhibitor
• USES – Peptic Ulcer, GERD ,ZollingerEllison Syndrome, Aspirational
Pneumonia
• S/E – nausea, loose stool, Abdominal pain , Muscle & Joint pain , headache ,
dizziness. Osteoporosis, Megaloblastic Anemia, Long term use increase
infection.
• Anti-D – MOA - block Rh antigen of fetal cell
Indication –
- Delivery of Rh +ve Fetus
- Abortion of > 7weeks Pregnancy
- Amniocentesis
- External Cephalic Version
- Cesarean section
- Ectopic pregnancy
- APH
- Manual Removal of Placenta
Contraindication-
- Rh+ve women
- already sensitised Rh –ve women
- when infant is Rh -ve
DOSE – 300ug im to mother following delivery
50ug im to unsensitised women with in 72 hrs of
induced or spontaneousst
abortion , ectopic or molar
pregnancy or CVS in 1 trimester
300 ug to women beyond 12 week pregnancy
• TRAMADOL -
MOA- Central acting analgesic act on u opioid receptor
inhibit Reuptake of NA & 5HT
USE- mild to moderate Pain in Diagnostic Procedure & surgeries,
chronic pain , cancer pain.
S/E - dizziness, nausea, sleepiness, sweating , dry mouth.

• MIFEPRISTONE -
MOA- block the action of natural progestrone
USE – 1st Trimester Abortion, Emergency Contraceptive
Cervical ripening ,
DOSE- 200mg on Day 1 of Mifepristone orally on Day 3
Misoprostol 400 ug orally or 800ug vaginally (abortion)
Mifepristone 100mg single dose (EC)
• CALCIUM (Caiser)-
• Uses - High Blood Pressure
High Cholestrol
to reduce high flouride
Nutritional suppliment during Pregnancy
Calcium Carbonate & Calcium Acetate are also used
for Reducing Phosphate level in Kidney disease.