classic gynecological drugs & contraindications

1️⃣ Combined Oral Contraceptive Pills (COCPs)

💊 Ethinyl estradiol + progestin

❌ Absolute Contraindications

• History of thromboembolism
• Migraine with aura
• Breast cancer
• Active liver disease
• Smoker >35 years
• Uncontrolled hypertension

📌 Classic exam line:

COCPs are contraindicated in migraine with aura due to increased stroke risk.

2️⃣ Progestin-only Pills / Injectables (DMPA)

❌ Contraindications

• Breast cancer
• Unexplained vaginal bleeding
• Severe liver disease

📌 Exam trap:

Progestins ARE SAFE in hypertension & lactation — unlike COCPs.

3️⃣ Oxytocin

❌ Contraindications

• Obstructed labor
• Cephalopelvic disproportion
• Previous classical cesarean section
• Grand multiparity (relative)

📌 Classic exam line:

Oxytocin is contraindicated in obstructed labor due to uterine rupture risk.

4️⃣ Misoprostol (PGE₁ analogue)

❌ Contraindications

• Previous uterine scar (C-section, myomectomy)
• Grand multiparity
• Placenta previa (for induction)

📌 Very high-yield:

Misoprostol increases risk of uterine rupture in scarred uterus.

5️⃣ Methotrexate (for Ectopic Pregnancy)

❌ Contraindications

• Intrauterine pregnancy
• Breastfeeding
• Liver disease
• Renal disease
• Blood dyscrasias
• Immunodeficiency

📌 Classic exam line:

Methotrexate is contraindicated in viable intrauterine pregnancy.

6️⃣ Clomiphene Citrate

❌ Contraindications

• Ovarian cysts (non-PCOS)
• Liver disease
• Pregnancy
• Pituitary tumors

📌 Exam pearl:

Clomiphene causes ovarian enlargement — avoid in existing cysts.

7️⃣ Ergometrine / Methylergometrine

❌ Contraindications

• Hypertension
• Pre-eclampsia / Eclampsia
• Cardiac disease
• Peripheral vascular disease

📌 Classic exam line:

Ergometrine is contraindicated in hypertension due to severe vasoconstriction.

8️⃣ Danazol (Endometriosis)

❌ Contraindications

• Pregnancy
• Liver disease
• Androgen-dependent tumors
• Cardiac disease

📌 Exam trap:

Danazol is teratogenic → contraindicated in pregnancy.

9️⃣ GnRH Agonists (Leuprolide, Goserelin)

❌ Contraindications

• Pregnancy
• Severe osteoporosis

📌 Exam pearl:

GnRH agonists cause hypoestrogenism → bone loss.

🔟 Antimuscarinics for Overactive Bladder (e.g., Oxybutynin)

❌ Contraindications

• Angle-closure glaucoma
• Urinary retention
• Gastric outlet obstruction

📌 Already discussed classic line:

Antimuscarinics precipitate acute angle-closure glaucoma.