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BSC SEM 4 PHARMACOLOGY UNIT 4 drugs used for hormonal disorders and supplementation cotraction and medical termination of pregnancy

UNIT 4 drugs used for hormonal disorders and supplementation cotraction and medical termination of pregnancy

  • Estrogens and progesterones Composition, actions dosage route indications contraindications, drugs interactions, side effects, adverse, effects, adverse effects, toxicity and role of nurse

1. Composition

  • Estrogens:
    • Natural: Estradiol, Estrone, Estriol
    • Synthetic: Ethinyl estradiol, Mestranol
  • Progesterones:
    • Natural: Progesterone
    • Synthetic: Medroxyprogesterone acetate, Norethindrone, Levonorgestrel, Desogestrel, Drospirenone

2. Actions

  • Estrogens:
    • Promotes development of secondary sexual characteristics.
    • Regulates menstrual cycle and maintains endometrial growth.
    • Inhibits FSH (Follicle Stimulating Hormone) to prevent ovulation.
    • Increases bone density and cardiovascular health.
  • Progesterones:
    • Prepares uterus for implantation.
    • Maintains pregnancy.
    • Inhibits ovulation.
    • Thickens cervical mucus to prevent sperm penetration.

3. Dosage & Route

Estrogens:

  • Oral: 0.5-2 mg/day (Ethinyl estradiol)
  • Transdermal: 0.025-0.1 mg/day (Estradiol patch)
  • Intramuscular: 1-5 mg/week (Estradiol valerate)
  • Vaginal Creams/Tablets: 0.5 mg daily (for atrophic vaginitis)
  • Implants: Estradiol pellets (50-100 mg subcutaneously)

Progesterones:

  • Oral: 2.5-10 mg/day (Medroxyprogesterone)
  • Injectable: 150 mg IM every 3 months (Depot Medroxyprogesterone Acetate – DMPA)
  • Transdermal: Combined in estrogen-progesterone patches
  • Vaginal: 90 mg gel (for luteal phase support)
  • Intrauterine System (IUS): Levonorgestrel 52 mg (Mirena)

4. Indications

✅ Estrogens:

  • Hormone Replacement Therapy (HRT) in menopause
  • Contraception (combined with progesterone)
  • Osteoporosis prevention
  • Female hypogonadism
  • Dysfunctional uterine bleeding

✅ Progesterones:

  • Contraception
  • Menstrual irregularities
  • Endometriosis
  • Prevention of preterm labor
  • Hormone therapy in menopause

5. Contraindications

❌ Estrogens:

  • Pregnancy
  • Breast cancer or estrogen-dependent tumors
  • History of thromboembolism
  • Liver dysfunction
  • Uncontrolled hypertension

❌ Progesterones:

  • Unexplained vaginal bleeding
  • Breast cancer
  • Liver disease
  • History of thromboembolism

6. Drug Interactions

  • Estrogens:
    • ↓ Effect with Rifampicin, Carbamazepine, Phenytoin (CYP450 inducers)
    • ↑ Risk of clotting with Warfarin, Antiplatelets
    • ↓ Hypoglycemic effect of Insulin and Oral Antidiabetics
  • Progesterones:
    • ↓ Effect with Rifampicin, Anticonvulsants
    • May reduce efficacy of Oral Contraceptive Pills
    • Enhances sedation with Benzodiazepines

7. Side Effects

  • Estrogens:
    • Nausea, breast tenderness
    • Weight gain, bloating
    • Headache, mood swings
    • Skin pigmentation
  • Progesterones:
    • Irregular bleeding
    • Depression, fatigue
    • Acne, hirsutism (with androgenic progestins)
    • Breast tenderness

8. Adverse Effects

⚠️ Estrogens:

  • Thromboembolism (DVT, Pulmonary Embolism)
  • Increased risk of breast and endometrial cancer
  • Hypertension
  • Liver dysfunction

⚠️ Progesterones:

  • Increased clotting risk
  • Weight gain, metabolic syndrome
  • Breast cancer risk (prolonged use)

9. Toxicity

🚨 Estrogen Toxicity:

  • Overdose may cause severe nausea, vomiting, fluid retention, clot formation, and stroke.
  • Management: Discontinue drug, administer anticoagulants for thrombosis.

🚨 Progesterone Toxicity:

  • Symptoms: Drowsiness, dizziness, metabolic disturbances
  • Management: Supportive care, monitoring for severe effects.

10. Role of Nurse

👩‍⚕️ Assessment:
✔ Check patient history (clotting disorders, breast cancer, liver disease)
✔ Monitor blood pressure, lipid profile, and liver function

💊 Administration:
✔ Give oral pills at the same time daily
✔ Rotate estrogen patches to prevent skin irritation
✔ IM injections (DMPA): Administer deep intramuscularly

📢 Patient Education:
✔ Teach about risk of thrombosis (DVT signs: swelling, redness, pain in leg)
✔ Instruct to report unusual vaginal bleeding
✔ Advise healthy lifestyle (diet, exercise) to reduce risks

🩺 Monitoring:
✔ Observe for hypertension, liver toxicity, or clot symptoms
✔ Regular breast exams and Pap smears in long-term users

  • Oral contraceptives and hormone replacement therapy

1. Oral Contraceptives (OCPs)

Oral contraceptives are medications used to prevent pregnancy by inhibiting ovulation, altering cervical mucus, and modifying the uterine lining.

Types of Oral Contraceptives

  1. Combined Oral Contraceptives (COCs)
    • Contain Estrogen (Ethinyl Estradiol) and Progesterone (Levonorgestrel, Desogestrel, Drospirenone, etc.).
    • Example: Mala-N, Mala-D, Yasmin, Loestrin.
  2. Progestin-Only Pills (POPs)
    • Contain only progestins (Norethindrone, Desogestrel).
    • Used for women who cannot take estrogen (e.g., breastfeeding mothers, those with a history of blood clots).

Mechanism of Action

✅ Combined Oral Contraceptives (COCs)

  • Inhibit ovulation by suppressing FSH and LH.
  • Make cervical mucus thick, preventing sperm penetration.
  • Thin endometrial lining, preventing implantation.

✅ Progestin-Only Pills (POPs)

  • Primarily thicken cervical mucus.
  • Inhibit ovulation (though not as consistently as COCs).

Dosage & Route

  • COCs: 1 tablet daily for 21 days, followed by a 7-day break (or placebo pills).
  • POPs: 1 tablet daily, without a break.

Indications

✔ Contraception
✔ Regulation of menstrual cycles
✔ Management of dysmenorrhea, PCOS, endometriosis
✔ Reduce the risk of ovarian and endometrial cancer

Contraindications

❌ Absolute:

  • Pregnancy
  • History of thrombosis, stroke, myocardial infarction
  • Estrogen-dependent cancer (breast, endometrial)
  • Uncontrolled hypertension
  • Severe liver disease

❌ Relative:

  • Migraine with aura
  • Smokers (>35 years old)
  • History of gallbladder disease

Drug Interactions

🚫 Reduces OCP efficacy:

  • Rifampicin, Carbamazepine, Phenytoin (CYP450 inducers)
  • Antibiotics (may affect gut flora involved in estrogen metabolism)

🚫 Increased risk of thrombosis:

  • Warfarin, Anticoagulants
  • NSAIDs, Aspirin

Side Effects

  • COCs:
    • Nausea, breast tenderness, weight gain
    • Hypertension, mood changes
    • Breakthrough bleeding
  • POPs:
    • Irregular bleeding
    • Headaches, acne
    • Decreased libido

Adverse Effects

⚠ Increased risk of:

  • Deep vein thrombosis (DVT), Pulmonary embolism (PE)
  • Stroke, Myocardial infarction (especially in smokers)
  • Liver tumors (rare but serious)

Role of Nurse

🩺 Patient Assessment:
✔ Check medical history (clotting disorders, liver disease).
✔ Monitor blood pressure and lipid profile.

💊 Administration & Education:
✔ Take pill at the same time daily.
✔ Report severe headaches, chest pain, leg swelling (possible thrombosis).
✔ Encourage smoking cessation.

Hormone Replacement Therapy (HRT)

HRT is used to relieve menopausal symptoms by supplementing estrogen and/or progesterone.

Types of HRT

  1. Estrogen-Only HRT
    • Used in hysterectomized women (those who have had their uterus removed).
    • Examples: Estradiol, Conjugated Estrogens (Premarin).
  2. Combined Estrogen-Progesterone HRT
    • Used in women with an intact uterus to prevent endometrial hyperplasia.
    • Examples: Estradiol + Medroxyprogesterone Acetate (Prempro).

Mechanism of Action

  • Estrogen: Maintains bone density, relieves hot flashes, improves skin elasticity.
  • Progesterone: Prevents endometrial overgrowth and reduces cancer risk.

Dosage & Route

  • Oral: 0.3-1.25 mg/day (Premarin)
  • Transdermal: 0.025-0.1 mg/day (Estradiol patch)
  • Vaginal: 0.5 mg daily (Estrogen creams for atrophic vaginitis)
  • IM/SC Injection: 1-5 mg/week

Indications

✔ Menopausal symptoms (hot flashes, night sweats)
✔ Osteoporosis prevention
✔ Vaginal atrophy (dryness, pain during intercourse)
✔ Hypogonadism (low estrogen levels)

Contraindications

❌ Similar to OCPs

  • History of breast/endometrial cancer
  • Thrombosis, stroke, heart disease
  • Liver disease
  • Unexplained vaginal bleeding

Drug Interactions

🚫 Increased risk of thrombosis with:

  • Warfarin, NSAIDs, Aspirin

🚫 Reduced effect with:

  • Anticonvulsants, Rifampicin

Side Effects

  • Breast tenderness
  • Weight gain, bloating
  • Mood swings, depression

Adverse Effects

⚠ Serious Risks:

  • Thrombosis (DVT, PE)
  • Breast cancer risk (long-term use)
  • Endometrial cancer (if estrogen given without progesterone in women with uterus)

Role of Nurse

👩‍⚕️ Assessment & Monitoring:
✔ Check blood pressure, lipid profile, mammograms regularly.
✔ Monitor for signs of DVT (swelling, pain in legs).

📢 Patient Education:
✔ Short-term HRT is recommended to avoid cancer risk.
✔ Encourage regular exercise and calcium intake for bone health.

  • Vaginal contraceptives

Vaginal Contraceptives: Composition, Actions, Dosage, Route, Indications, Contraindications, Drug Interactions, Side Effects, Adverse Effects, Toxicity, and Role of Nurse

1. Introduction

Vaginal contraceptives are birth control methods that act locally within the vagina to prevent pregnancy. They work by killing sperm, creating barriers, or releasing hormones to prevent fertilization.

2. Types of Vaginal Contraceptives

  1. Spermicides (Chemical Contraceptives)
    • Contains nonoxynol-9 (a sperm-killing agent).
    • Available in foams, gels, creams, suppositories, and films.
    • Example: VCF (Vaginal Contraceptive Film), Conceptrol Gel.
  2. Vaginal Contraceptive Rings (Hormonal)
    • Contains estrogen and progestin to prevent ovulation.
    • Releases hormones continuously for 3 weeks.
    • Example: NuvaRing, Annovera.
  3. Vaginal Contraceptive Sponge
    • Contains spermicide (nonoxynol-9) and acts as a barrier.
    • Example: Today Sponge.
  4. Vaginal Barrier Devices
    • Diaphragm and Cervical Cap used with spermicide.
    • Covers the cervix and blocks sperm entry.
    • Example: Caya Diaphragm, FemCap.

3. Mechanism of Action

✅ Spermicides: Kill sperm before they reach the egg.
✅ Contraceptive Rings: Inhibit ovulation and thicken cervical mucus.
✅ Sponges and Barriers: Block sperm from entering the uterus.

4. Dosage & Route

TypeDosage & UseDuration
SpermicidesInsert 5-15 minutes before intercourseEffective for 1 hour
Contraceptive RingInsert into vagina, remove after 3 weeks1 week break, then insert a new ring
Vaginal SpongeMoisten with water, insert before intercourseEffective for 24 hours
Diaphragm & Cervical CapInsert with spermicide before intercourseRemove after 6-8 hours

5. Indications

✔ Contraception for women preferring non-oral methods
✔ Alternative to daily pills (e.g., contraceptive ring)
✔ Postpartum contraception (barrier methods)
✔ Can be used during breastfeeding (except estrogen-based rings)

6. Contraindications

❌ Spermicides:

  • Allergy to nonoxynol-9
  • History of recurrent UTIs or vaginal irritation

❌ Hormonal Rings:

  • History of thrombosis, stroke, or heart disease
  • Breast cancer or estrogen-dependent cancer
  • Uncontrolled hypertension

❌ Diaphragm & Cervical Cap:

  • Pelvic organ prolapse
  • Frequent urinary tract infections
  • Allergy to latex/silicone

7. Drug Interactions

🚫 Spermicides:

  • Can damage latex condoms, reducing effectiveness.

🚫 Contraceptive Rings:

  • Reduced effect with Rifampicin, Carbamazepine, Phenytoin (CYP450 inducers).

8. Side Effects

  • Spermicides: Vaginal irritation, increased UTI risk.
  • Contraceptive Ring: Breast tenderness, nausea, headache.
  • Vaginal Sponge: Vaginal dryness, allergic reactions.
  • Diaphragm & Cap: Risk of urinary infections, discomfort.

9. Adverse Effects

⚠ Spermicides:

  • Increased risk of HIV transmission due to vaginal irritation.

⚠ Contraceptive Ring:

  • Risk of deep vein thrombosis (DVT), stroke, hypertension.

⚠ Diaphragm & Cap:

  • Risk of toxic shock syndrome (TSS) if left too long.

10. Toxicity

🚨 Spermicide Toxicity:

  • Accidental oral ingestion may cause nausea, vomiting, diarrhea.

🚨 Hormonal Ring Overuse:

  • Excess estrogen exposure can lead to thrombosis, liver issues.

11. Role of Nurse

👩‍⚕️ Patient Assessment:
✔ Check for allergies to latex, spermicide, or estrogen.
✔ Assess history of blood clots, infections, and reproductive health.

💊 Administration & Education:
✔ Teach proper insertion & removal technique.
✔ Instruct to replace the ring on time to avoid pregnancy.
✔ Spermicides must be reapplied with each act of intercourse.
✔ Advise diaphragm users to urinate after sex to reduce UTI risk.

🩺 Monitoring:
✔ Watch for vaginal irritation, infections, or allergic reactions.
✔ Educate about signs of blood clots (leg swelling, chest pain).

  • Drugs for infertility and medical termination of pregnancy

Drugs for Infertility and Medical Termination of Pregnancy (MTP)

1. Drugs for Infertility

Infertility is the inability to conceive after 12 months of unprotected intercourse. Medications are used to stimulate ovulation, improve sperm quality, or support implantation.

Types of Drugs for Infertility

  1. Ovulation Induction Agents
    • Clomiphene Citrate
    • Letrozole (Aromatase Inhibitor)
    • Human Menopausal Gonadotropins (hMG)
    • Recombinant FSH and LH
    • hCG (Human Chorionic Gonadotropin)
  2. Gonadotropin-Releasing Hormone (GnRH) Modulators
    • GnRH Agonists: Leuprolide, Nafarelin
    • GnRH Antagonists: Cetrorelix, Ganirelix
  3. Dopamine Agonists (For Hyperprolactinemia)
    • Cabergoline
    • Bromocriptine
  4. Insulin Sensitizers (For PCOS-Related Infertility)
    • Metformin
  5. Progesterone Support (For Luteal Phase Deficiency)
    • Micronized Progesterone
    • Dydrogesterone

Mechanism of Action

  • Clomiphene & Letrozole: Stimulate ovulation by increasing FSH & LH.
  • Gonadotropins (FSH, hMG): Directly stimulate ovarian follicles.
  • hCG: Triggers ovulation and supports corpus luteum.
  • GnRH Agonists/Antagonists: Control hormone levels during assisted reproductive techniques (ART).
  • Dopamine Agonists: Reduce prolactin levels, restoring ovulation.
  • Metformin: Improves insulin sensitivity in PCOS, aiding ovulation.
  • Progesterone: Supports implantation and early pregnancy.

Dosage & Route

DrugDosageRoute
Clomiphene Citrate50-150 mg/day for 5 daysOral
Letrozole2.5-5 mg/day for 5 daysOral
FSH/LH (hMG)75-225 IU/dayIM/SC Injection
hCG5000-10,000 IUIM Injection
GnRH Agonists0.5 mg dailySC Injection
GnRH Antagonists0.25 mg dailySC Injection
Cabergoline0.25-1 mg twice weeklyOral
Metformin500-2000 mg/dayOral
Progesterone200-400 mg/dayOral, Vaginal, IM

Indications

✔ Anovulatory Infertility (PCOS, Hypothalamic Dysfunction)
✔ Male Factor Infertility (Low sperm count/motility)
✔ Assisted Reproductive Techniques (IVF, IUI)
✔ Hyperprolactinemia-related infertility
✔ Luteal phase defect

Contraindications

❌ Pregnancy
❌ Liver or kidney disease
❌ Uncontrolled thyroid disorders
❌ Ovarian cysts (for Clomiphene)

Side Effects & Adverse Effects

  • Clomiphene & Letrozole: Hot flashes, ovarian hyperstimulation syndrome (OHSS), multiple pregnancies.
  • Gonadotropins & hCG: OHSS, bloating, abdominal pain.
  • GnRH Agonists: Menopausal symptoms (hot flashes, vaginal dryness).
  • Cabergoline/Bromocriptine: Nausea, dizziness, hypotension.
  • Metformin: GI disturbances, lactic acidosis (rare).

Role of Nurse

👩‍⚕️ Assessment:
✔ Monitor ovulation through ultrasound & hormonal tests.
✔ Check for signs of OHSS (sudden weight gain, bloating, abdominal pain).

💊 Patient Education:
✔ Explain timing of ovulation for intercourse or ART.
✔ Teach self-administration of injections (gonadotropins, hCG).

🩺 Monitoring:
✔ Watch for ovarian hyperstimulation symptoms.
✔ Monitor for multiple pregnancies (twins, triplets).

2. Drugs for Medical Termination of Pregnancy (MTP)

Medical termination of pregnancy (abortion) is legal up to 24 weeks in India under the MTP Act, but usually performed within the first 12 weeks using medications.

Drugs Used in MTP

  1. Antiprogestin (Mifepristone)
    • Blocks progesterone, causing detachment of pregnancy.
    • Example: Mifepristone (RU-486)
  2. Prostaglandins (Misoprostol)
    • Induces uterine contractions for expulsion of the fetus.
    • Example: Misoprostol (Cytotec)
  3. Oxytocic Agents
    • Used for later-stage abortions or incomplete abortions.
    • Example: Oxytocin, Carboprost (PGF2α)

Mechanism of Action

  • Mifepristone: Blocks progesterone receptors → Detaches fetus.
  • Misoprostol: Causes uterine contractions → Expels fetus.
  • Carboprost: Enhances contractions for second-trimester abortion.

Dosage & Route

DrugDosageRoute
Mifepristone200-600 mg (Single dose)Oral
Misoprostol400-800 mcgOral, Vaginal, Buccal
Carboprost250 mcg every 3-4 hoursIM Injection
Oxytocin20-40 IU in IV dripIV Infusion

Indications

✔ First-trimester medical abortion
✔ Missed abortion (fetal death with retained pregnancy)
✔ Incomplete abortion
✔ Second-trimester abortion (with Carboprost/Oxytocin)

Contraindications

❌ Ectopic Pregnancy (risk of rupture)
❌ Hemorrhagic disorders
❌ IUD in place
❌ Allergy to prostaglandins

Side Effects & Adverse Effects

  • Mifepristone: Nausea, cramping, heavy bleeding.
  • Misoprostol: Diarrhea, fever, strong uterine contractions.
  • Carboprost: Hypertension, severe cramps, vomiting.
  • Oxytocin: Hyperstimulation of uterus, fetal distress in live pregnancies.

Toxicity & Emergency Management

🚨 Heavy Bleeding (Hemorrhage):

  • Monitor hemoglobin & hematocrit.
  • Manage with Oxytocin, IV fluids, blood transfusion.

🚨 Severe Pain:

  • NSAIDs or opioids for pain control.

🚨 Uterine Rupture (rare but severe):

  • Emergency surgical intervention (D&C, laparotomy).

Role of Nurse

👩‍⚕️ Pre-Procedure Assessment:
✔ Confirm intrauterine pregnancy by ultrasound.
✔ Assess Rh-negative status (give Anti-D if needed).

💊 Administration & Education:
✔ Teach how to take Misoprostol at home (if outpatient).
✔ Inform about expected side effects (cramping, bleeding).

🩺 Monitoring:
✔ Observe for severe pain, excessive bleeding (>2 pads/hour).
✔ Ensure complete expulsion (follow-up ultrasound after 7-14 days).

📢 Post-Procedure Care:
✔ Counsel on contraception to prevent unintended pregnancy.
✔ Monitor for infection signs (fever, foul-smelling discharge).

  • Uterine stimulants and relaxants

Uterine Stimulants and Relaxants: Composition, Actions, Dosage, Route, Indications, Contraindications, Drug Interactions, Side Effects, Adverse Effects, Toxicity, and Role of Nurse

1. Uterine Stimulants (Uterotonics)

Uterine stimulants are drugs that increase uterine contractions. They are used in labor induction, postpartum hemorrhage (PPH) control, and abortion.

Types of Uterine Stimulants

  1. Oxytocic Agents (Peptide Hormones)
    • Oxytocin (Pitocin, Syntocinon)
  2. Prostaglandins (PGs)
    • Dinoprostone (PGE2)
    • Misoprostol (PGE1)
    • Carboprost Tromethamine (PGF2α)
  3. Ergot Alkaloids
    • Methylergonovine (Methergine)
    • Ergometrine

Mechanism of Action

✅ Oxytocin: Binds to uterine oxytocin receptors → stimulates contractions.
✅ Prostaglandins: Induce uterine contractions, soften cervix (cervical ripening).
✅ Ergot Alkaloids: Cause sustained uterine contraction (not rhythmic).

Dosage & Route

DrugDosageRoute
Oxytocin5-10 IU IV (induction)IV, IM
Misoprostol25-50 mcg (labor), 600 mcg (PPH)Oral, Vaginal
Carboprost250 mcg every 15-90 min (max 2 mg)IM
Methylergonovine0.2 mg every 2-4 hrs (PPH)IM, Oral

Indications

✔ Induction of Labor (Oxytocin, Prostaglandins)
✔ Postpartum Hemorrhage (Oxytocin, Ergometrine, Carboprost)
✔ Incomplete/Missed Abortion (Misoprostol, Carboprost)
✔ Cervical Ripening (Dinoprostone, Misoprostol)

Contraindications

❌ Fetal distress (non-reassuring fetal heart rate)
❌ Uterine rupture risk (previous C-section, grand multipara)
❌ Placenta previa (risk of severe bleeding)
❌ Severe hypertension (Ergometrine can worsen it)

Drug Interactions

🚫 Oxytocin + Prostaglandins → Risk of uterine hyperstimulation
🚫 Ergometrine + Hypertensive drugs → Severe hypertension
🚫 Prostaglandins + NSAIDs → Reduced effectiveness

Side Effects & Adverse Effects

  • Oxytocin: Uterine hyperstimulation, fetal distress, water intoxication
  • Prostaglandins: Fever, nausea, diarrhea, tachysystole
  • Methylergonovine: Hypertension, chest pain, seizure
  • Carboprost: Bronchospasm, severe diarrhea

Role of Nurse

👩‍⚕️ Monitoring:
✔ Fetal heart rate (for oxytocin use)
✔ Blood pressure (for ergometrine)
✔ Signs of uterine rupture (sudden severe pain, fetal distress)

💊 Administration & Education:
✔ IV Oxytocin must be titrated carefully.
✔ Teach signs of labor progression.

2. Uterine Relaxants (Tocolytics)

Tocolytics are drugs that inhibit uterine contractions, used in preterm labor.

Types of Uterine Relaxants

  1. Beta-2 Adrenergic Agonists
    • Terbutaline
    • Salbutamol
  2. Calcium Channel Blockers (CCBs)
    • Nifedipine
  3. Magnesium Sulfate
    • MgSO₄ (used for eclampsia & tocolysis)
  4. Oxytocin Receptor Antagonist
    • Atosiban
  5. NSAIDs (Prostaglandin Synthesis Inhibitors)
    • Indomethacin

Mechanism of Action

✅ Beta-2 Agonists (Terbutaline, Salbutamol): Relax smooth muscles by increasing cAMP.
✅ CCBs (Nifedipine): Inhibit calcium entry → smooth muscle relaxation.
✅ Magnesium Sulfate: Competes with calcium → reduces uterine contraction.
✅ Atosiban: Blocks oxytocin receptors in the uterus.
✅ Indomethacin: Inhibits prostaglandin synthesis (reducing contractions).

Dosage & Route

DrugDosageRoute
Terbutaline250 mcg every 4-6 hrsSC, IV
Nifedipine10-20 mg every 6 hrsOral
Magnesium Sulfate4-6 g loading dose, then 2 g/hrIV
Atosiban6.75 mg IV bolus, then 18 mg/hrIV
Indomethacin50-100 mg loading, then 25 mg every 6 hrsOral

Indications

✔ Preterm Labor (≤34 weeks gestation)
✔ Eclampsia (MgSO₄ for seizure prevention)
✔ Uterine hyperstimulation (Atosiban, Terbutaline)

Contraindications

❌ Severe preeclampsia/eclampsia (CCBs, Beta-agonists worsen it)
❌ Fetal distress (non-reassuring heart rate)
❌ Active infection (chorioamnionitis)

Drug Interactions

🚫 Beta-Agonists + Corticosteroids → Risk of pulmonary edema
🚫 MgSO₄ + CCBs → Severe hypotension
🚫 NSAIDs + Anticoagulants → Risk of bleeding

Side Effects & Adverse Effects

  • Terbutaline: Palpitations, tremors, hyperglycemia
  • Nifedipine: Hypotension, dizziness, flushing
  • Magnesium Sulfate: Respiratory depression, muscle weakness
  • Indomethacin: Fetal ductus arteriosus closure, oligohydramnios

Role of Nurse

👩‍⚕️ Monitoring:
✔ Monitor fetal heart rate & uterine contractions.
✔ Check magnesium levels (if using MgSO₄) to prevent toxicity.
✔ Observe for side effects like tremors, dizziness, and hypotension.

💊 Administration & Education:
✔ Terbutaline should not be used long-term (risk of heart issues).
✔ Teach mothers about bed rest and hydration in preterm labor.

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Categorized as BSC SEM 4 PHARMACOLOGY II, Uncategorised