Pharmacology
Reproductive Pharmacology
Reproductive drugs for MBBS and NEET-PG: contraceptives, oxytocics, tocolytics, drugs for abortion and benign prostatic hyperplasia, mapped to NMC codes.
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Reproductive Pharmacology
Reproductive drugs for MBBS and NEET-PG: contraceptives, oxytocics, tocolytics, drugs for abortion and benign prostatic hyperplasia, mapped to NMC codes.
This chapter covers the drugs that act on the reproductive system, including contraceptives, uterine stimulants and relaxants, drugs used in labour and abortion, and agents for male reproductive health. It links sex hormone physiology to contraception, obstetric emergencies and infertility.
High-yield: Reproductive Pharmacology
- Combined oral contraceptives contain oestrogen and progestogen and mainly work by suppressing ovulation.
- The main serious risk of combined oral contraceptives is venous thromboembolism, higher in smokers over the age of 35.
- Progestogen-only pills are preferred when oestrogen is contraindicated, such as during breastfeeding.
- Oxytocin is used to induce and augment labour and to control postpartum haemorrhage by contracting the uterus.
- Ergometrine causes sustained uterine contraction for postpartum haemorrhage but is avoided in hypertension.
- Misoprostol, a prostaglandin analogue, is used for medical abortion, cervical ripening and postpartum haemorrhage.
- Mifepristone is an antiprogestogen used with a prostaglandin for medical termination of pregnancy.
- Tocolytics such as nifedipine and the beta agonist salbutamol relax the uterus to delay preterm labour.
- Magnesium sulphate prevents and treats eclamptic seizures and provides fetal neuroprotection in preterm labour.
- Clomiphene induces ovulation by blocking oestrogen feedback, raising gonadotrophin release, and increases the chance of twins.
- Testosterone and anabolic steroids are misused for muscle building and cause infertility, aggression and hepatotoxicity.
- Sildenafil, a phosphodiesterase-5 inhibitor, treats erectile dysfunction and is contraindicated with nitrates.
- Tamsulosin, an alpha-1 blocker, relaxes prostatic smooth muscle in benign prostatic hyperplasia.
- Finasteride, a 5-alpha reductase inhibitor, shrinks the prostate and is used in benign prostatic hyperplasia and male pattern baldness.
Reproductive drug essentials
- **Combined pill:** Suppresses ovulation; main risk is venous thromboembolism; avoid in smokers over 35.
- **Uterine stimulants:** Oxytocin, ergometrine and prostaglandins for labour and postpartum haemorrhage.
- **Medical abortion:** Mifepristone followed by misoprostol under supervision.
- **Prostate:** Tamsulosin relaxes smooth muscle; finasteride shrinks the gland over months.
NMC competencies in this chapter
- **PH1.39:** Drugs acting on the uterus: oxytocics and tocolytics
- **PH1.40:** Sex hormones, contraceptives and drugs for infertility
- **PH1.41:** Drugs for erectile dysfunction and benign prostatic hyperplasia
Frequently Asked Questions
How do combined oral contraceptives prevent pregnancy?
Chiefly by suppressing ovulation through negative feedback, with added effects on cervical mucus and the endometrium that reduce fertilisation and implantation.
Why is sildenafil dangerous with nitrates?
Both increase nitric oxide signalling, so together they cause profound vasodilatation and a dangerous fall in blood pressure.
Which drugs control postpartum haemorrhage?
Oxytocin is first-line, with ergometrine and the prostaglandin misoprostol as further uterotonics to contract the uterus and stop bleeding.
Why choose the progestogen-only pill in breastfeeding?
Oestrogen can reduce milk supply and adds thrombotic risk after delivery, so the progestogen-only pill is preferred while breastfeeding.
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