Drugs in Obstetrics & Gynecology Ashok Kumar, Krishna Agarwal, Sudha Prasad
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fm1DRUGS IN OBSTETRICS AND GYNECOLOGYfm2
fm3DRUGS IN OBSTETRICS AND GYNECOLOGY
Editor Ashok Kumar MD PhD FAMS FICOG FICMCH Director-Professor Department of Obstetrics and Gynecology Maulana Azad Medical College and Lok Nayak Jai Prakash Narayan Hospital New Delhi, India Krishna Agarwal MS Professor Department of Obstetrics and Gynecology Maulana Azad Medical College and Lok Nayak Jai Prakash Narayan Hospital New Delhi, India Sudha Prasad MS Director-Professor and Head Department of Obstetrics and Gynecology Maulana Azad Medical College and Lok Nayak Jai Prakash Narayan Hospital New Delhi, India
fm4
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Drugs in Obstetrics and Gynecology
First Edition: Digital Version 2017
9789352501687
fm5Dedicated to
All patients who provide us the opportunities to learn
fm6Contributors Preface
Drugs are the integral part of medicine. The rational use of drugs has saved enumerable lives, prevented epidemics and promoted health in general. Accessibility to essential medicines is an essential element of a health system. However, to accrue the optimum benefits, the drugs have to be used optimally—the right indication, right drug, right dose, right duration, minimal toxicity, and at the lowest cost, denoted as “rational drug therapy”.
Unfortunately, despite knowing the benefits of rational drug therapy, irrationality in the use of drugs is rather rampant to the extent that it has been identified as a major public health problem. Apart from causing harm to the health of people, it is responsible for high cost of health care impoverishing people and communities. As per a recent estimate, over 53 million people get impoverished due to health care cost and cost of drugs constitutes a major part of it. Irrational use of antimicrobial drugs resulting in high level of antimicrobial resistance has almost pushed us to preantibiotics era.
The specialty of obstetrics and gynecology is different from other specialties of medicine in many different ways. A practitioner of this specialty has to have artistic skills of a surgeon as well as wisdom of a physician. Unfortunately, this does not happen in reality and we tend to falter on the very basic principles of pharmacotherapy. Despite being a physician for a significant part of our routines, we keep getting confused when confronted with names of drugs—new or old, as well as pharmacological terms associated with it. One of the reasons is the unavailability of ‘resource book’ that is concise yet provides optimum amount of details to help us make well-informed decisions about the use of drugs.
We have attempted to fill this void through this modest attempt. The book includes description of commonly used drugs in obstetrics and gynecology. In the beginning of a chapter, common-related drugs are given in a table for quick-reference followed by other required details in the text. There are a total of 35 chapters, each one being concise enough to be read over a short time. We have tried to maintain uniformity throughout the book to make it more predictive and easy to understand. Enough number of tables are provided on essential information. The section on antimicrobials provides optimum choice of antibiotics in different clinical conditions. A table has been provided on classification of commonly used antibiotics, which will help the reader in choosing the right agent in different situations.
We hope that the book would serve its purpose and help practicing physicians as well as postgraduate students to practice rational drug therapy in their day-to-day practice. It was a great learning experience for us to go through the nuances of the subject. Despite of observing due diligence, we are sure that there would be mistakes and errors, which we hope that the generous readers would overlook and provide us feedback for improvement in the future editions.
We thank the contributors for painstakingly compiling their chapters. Mr Jai Mohan deserves special thanks for coordinating with the contributors and the publisher. We also thank M/s Jaypee Brothers Medical Publishers, New Delhi, India, for bringing out this work wonderfully.
Ashok Kumar
Krishna Agarwal
Sudha Prasadfm11
FDA PREGNANCY DRUG CATEGORIES
FDA Category
Type of Studies Available
A
Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities in any trimester of pregnancy
B
Well-controlled studies in animals have revealed no evidence of harm to the fetus
C
No animal studies or the one's reported have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in pregnant women
D
Risk to the fetus demonstrated in well-controlled or observational studies in pregnant women, however, the benefits of therapy could outweigh the potential risk. Acceptable for use in a life-threatening situation only
X
Positive evidence of harm to the fetus seen in well-controlled or observational studies in both animals and pregnant women. The use of the drug is contraindicated in women who are or might become pregnant
N
Not classified by FDA
LACTATION DRUG CATEGORIES
Category
Safety
Type of Studies Available
L1
Safest
Controlled studies in breastfeeding women have not shown any risk to the breastfeeding infant and possibility of harm is remote
L2
Safer
Drugs which have been studied in limited number of breastfeeding women without any increase in adverse effects in the breastfeeding infant
L3
Moderately safe
There are no controlled studies, but risk of untoward effects on breast-fed infant is possible
OR
Controlled studies show minimal nonlife-threatening adverse effects.
These drugs are given when potential benefit outweighs potential risk to the mother
L4
Possibly hazardous
There is evidence of risk to the breastfed infant or to the breast milk production. But these drugs can be used in life-threatening situation and when safer drugs cannot be used
L5
Contraindicated
Human studies showed significant risk to the infant, the risk of using drug clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated during lactation