Drugs Used In Obstetric and Gynecology Shadman H. Abdullah University of Sulaimani Faculty of Medical Sciences School of Medicine

Contraceptive Methods

Name of the drug : Mirena Component : intrauterine device ( levonorgestrel releasing IUD) Mechanism of action : endometrial shedding , cervical mucus thickening Usage : 1-long-term contraception (up to 5 years) . 2-dysmenorrhoea. 3-menorrhagia. 4-decrease incidence and severity of PID. Dosage : release 20mcg/24 hours. Inserted in first 7 days of cycle. Side effects : 1-headache,acne. 2-perforation (during insertion). 3-expulsion (first month). 4- 1% failure = ectopic.

Name of the drug : Component : intrauterine device ( copper bearing IUD) Mechanism of action : 1-inflammatory reaction (inhibit implantation). 2-toxic effect on sperm motility (inhibit fertilization). Usage : long-term contraception (up to 5 years) . Dosage : contain 380 mm copper. Inserted in first 7 days of cycle. Side effects : 1-copper allergy. 2-dysmenorrhoea. 3-menorrhagia. 4-not protect against PID. 2-perforation (during insertion). 3-expulsion (first month). 4- 1% failure = ectopic.

Name of the drug : Yasmin. Component : 30 mcg ethinylestradiol + 3mg drospirenone. Mechanism of action : combined oral contraceptive pill (OCP). Usage : contraception , severe menorrhagia. Dosage : 1 tab/day for 21 days (5 – 25 of cycle) + 7 days tab free (3 weeks on, 1 week off) Side effects :

Name of the drug : Primolut Component : norethisterone 5mg Mechanism of action : Progesterone. Usage : contraception , severe menorrhagia , dysmenorrhoea , endometriosis. Dosage : 1capsule /day for 3 months (250mg) Side effects : 1-Fluid retention. 2-Breast discomfort. 3-Dizziness. 4-Depressed mood.

Name of the drug : Depo Provera Component : Medroxyprogesterone acetate Mechanism of action : Progesterone . Usage : contraception , severe menorrhagia , dysmenorrhoea , endometriosis. Dosage : 150 mg IM injection every 3 months. Side effects : 1-Fluid retention. 2-Breast discomfort. 3-Dizziness. 4-Depressed mood.

Name of the drug : Component : 11 white tablets (2mg estradiol) 10 brown tablets (2mg estradiol with 0.5mg norgestrel) Mechanism of action : estrogen and progesterone. Usage : HRT in menopause of premature ovarian failure. Dosage : 1 tab/day for 21 days (5 – 25 of cycle) + 7 days tabfree (3 weeks on, 1 week off) Side effects : Weight gain or loss Headache lower abdominal pain

Name of the drug : Diane 35 Component : Cyproterone acetate (2 mg) + Ethinylestradiol (0.035 mg) Mechanism of action : anti-androgen effect and estrogenic effect. Usage : Hirsutism of PCOS , contraception. Dosage : 1 tab/day for 21 days (5 – 25 of cycle) + 7 days tab free (3 weeks on, 1 week off) Side effects : 1-abdominal cramping, bloating. 2-appetite changes. 3-breast pain, tenderness, swelling.

Drugs used in Infertility

Name of the drug : Component : copy of the natural human FSH Mechanism of action : stimulates the maturation of ova. Usage : 1-ovulation induction 2-assisted reproductive techniques (IVF) 3- patient not respond to treatment with clomiphene citrate Dosage : Side effects : 1-ovarian cyst. 2-ovarian hyperstimulation syndrome (OHSS)

Name of the drug : Component : choriogonadotropin alfa : copy of the human hCG. Mechanism of action : trigger ovulation (like LH hormone). Usage : 1-ovulation induction 2-assisted reproductive techniques (IVF) Dosage : 250 micrograms SC given 24 to 48 hours after the ovaries have produced follicles that are mature to ovulation. Side effects : 1-ovarian cyst. 2-ovarian hyperstimulation syndrome (OHSS)

Name of the drug : Clomid Component : clomiphene citrate. Mechanism of action : estrogen receptor antagonist. Usage : ovulation induction (Amenorrhoea , PCOS). Dosage : 50mg/day for 5 days(day 2-6 of cycle) , try 100mg/day if ineffective. Side effects : 1-hot flush. 2-abdominal discomfort 3-ovarian hyperstimulation syndrome 4-ectopic pregnancy…

Name of the drug : Diclair Component : gonadotrophin. Mechanism of action : human chorionic gonadotrophin. Usage : ovulation induction. Dosage : SC in 2-6 days of cycle (for 5 days). Side effects :

Name of the drug : Fempro Component : Letrozole. Mechanism of action : aromatase inhibitor (inhibit estrogen formation) Usage : premature ovarian failure. Dosage : 2.5 mg tablet , used in 2-6 days of the cycle (for 5 days). Side effects :

Name of the drug : DOSTINEX Component : cabergoline Mechanism of action : dopamine receptor agonist Usage : hyperprolactinemia (infertility – galactorrhoea) Dosage : 2 tabs/week for 4 weeks (0.5mg) Side effects : 1-Nausea. 2-Sleepiness.

Name of the drug : Colette Component : cabergoline. Mechanism of action : dopamine receptor agonist. Usage : hyperprolactinemia (infertility – galactorrhoea) Dosage : 2tabs/week for 4 weeks (0.5mg) Side effects : 1-Nausea. 2-Sleepiness.

Name of the drug : Dopergin Component : Lisuride Mechanism of action : partial dopamine receptor agonist.. Usage : hyperprolactinemia (infertility – galactorrhoea) Dosage : 3 tab/day for 14 days (0.2mg) . Side effects : 1-Nausea. 2-Sleepiness.

Name of the drug : PIOPHAGE Component : metformin. Mechanism of action : decrese peripheral insulin resistance. Usage : insulin resistance in PCOS. Dosage : Side effects :

Drugs used for menstrual abnormality

Name of the drug : Regelle Component : norethisterone. Mechanism of action : progesterone. Usage : regulate menstruation , endometriosis , dysmenorrhoea. Dosage : 3 tabs /day for 10 days (5mg) Side effects : 1- breakthrough bleeding, spotting. 2- changes in liver function. 3- depression, headache, dizziness. 4- fluid retention, bloating, weight gain.

Name of the drug : Zoladex. Component : goserelin . Mechanism of action : GnRH analogue (agonist). Usage : menorrhagia , endometriosis. Dosage : 3.6mg Side effects :

Name of the drug : AMINOR. Component : 5mg norethisterone acetate. Mechanism of action : progesterone. Usage : regulate menstruation , endometriosis , dysmenorrhoea. Dosage : 1 tablet/day for 20 days. Side effects :

Name of the drug : EXACYL Component : tranexamic acid (cyklokapron). Mechanism of action : anti-fibrinolytic , reversibly inhibit plasminogen activator. Usage : menorrhagia. Dosage : 1 tablet/day for 20 days. Side effects : 1-nausea , vomitting. 2-rarely thrombosis.

Drugs used in pre-eclampsia

Name of the drug : MAGNESIUN SULFATE Component : magnesium sulfate. Mechanism of action : physiologic calcium antagonist. Usage : prophylaxis and treatment of eclamptic fit. Dosage : 4 g over 5–15 minutes followed by IV infusion , 1 g/hour for at least 24 hours. Side effects : 1- respiratory depression. 2-drowsiness, confusion, loss of tendon reflexes 3-oliguria. Require Calcium Gluconate!

Name of the drug : Calcium Gluconate 10% Component : calcium Mechanism of action : antidote of magnesium sulfate toxicity. Usage : used for magnesium sulfate overdose. Dosage : 1g IV single dose slowly. Side effects : 1- tingling sensations. 2-arrhythmia.

Name of the drug : Apresoline Component : hydralazine hydrochloride Mechanism of action : vasodilator. Usage : pre-eclampsia. Dosage : 5-10 mg slow IV injection, repeated after 20 minutes if necessary. Side effects : 1- palpitation. 2-headache. 3-flushing. 4- dizziness,.

Drugs used in labor

Name of the drug : Syntocinon Component : oxytocin. Mechanism of action : stimulate the smooth muscle contraction of the uterus. Usage : 1-induction and augmintation of labor : 5IU in 500ml fluid. 2-third stage of labor : 5IU when the anterior shoulder is delivered 3-post-partum hemorrhage : 10 IU bolus then 40IU infusion maintain. Dosage : discussed above. Side effects : 1- tachycardia. 2- headache. 3-nause,vomitting.

Name of the drug : Methrgine Component : methylergonovine maleate. Mechanism of action : increases the tone, rate of uterine contraction. Usage : prevent PPH following delivery of the placenta, uterine atony. Dosage : IV 0.2 mg, administered slowly. Side effects : 1- abdominal pain. 2- hypertension. 3-seizure.

Name of the drug : Component : Enoxaparine : low molecular weight heparin (LMWH) Mechanism of action : activate anti-thrombin III , heigher anti-factor Xa to antifactor IIa activity ratio. Usage : prevention ,treatment of venous thromboembolic disease (DVT,PE) In prolong bedridden and surgical prophylaxis. Dosage : 1mg/kg twice daily SC injection for 10 days (60 mg Sc q 2). Side effects : 1- bleeding (epistaxis , gum bleed). 2- painful rash at the injection site.

With success