-2992 Drug Treatment in Gynaecology Second edition Rodney S. Ledward, BSC, DA, MB, chb, LRCP, MRCS, MRSH, DM, FRCS, FRCOG, DHMSA, MRPharm Soc. Consultant Obstetrician and Gynaecologist, South East Kent Health Authority William Harvey Hospital, Ashford, Kent, UK TN2 4OL and Stephen Cruikshank, MD Chairman and Programme Director, Nicholas J Thompson Professor, Wright State University, Department of Obstetrics and Gynaecology, Miami Valley Hospital, Dayton, Ohio, USA. with a Foreword by Gedis Grudzinskas, MD, FRCOG Professor, Department of Obstetrics and Gynaecology, The Royal London Hospital (Whitechapel), 4th Floor, Holland Wing, London El IBB I S I S MEDICAL MEDIA Oxford
Abbreviations Foreword to first edition Foreword to second edition Preface to first edition Preface to second edition viii ix x xi xii 1 Vaginal discharge 1 Introduction 1 Physiological 1 Pathological 1 Candida albicans 2 Systemic preparations 3 Local preparations 6 Trichomonas vaginalis 9 Systemic preparations 9 Local preparations 10 Chlamydia trachomatis 11 Bacterial vaginosis 12 Genital herpes 13 Gonorrhoea 13 Syphilis 14 Tuberculosis 15 Atrophic vaginitis 18 Further reading 19 2 Infections 20 Introduction 20 Prophylaxis 20 Urinary-tract infections 22 Sulphonamides 22 Penicillins 24 Nitrofurans 26 Quinolones 27 Cephalosporins 30 Fosfomycin trometamol 30 iii
Hexamine derivatives 31 Bladder antiseptics 32 Intra-amniotic infections 32 Pelvic inflammatory disease 33 Penicillins 33 Macrolides 33 Cephalosporins 33 Sulphonamides 36 Tetracyclines 36 Lincosamide 37 Aminoglycosides 38 Nitroimidazoles 39 Carbapenems 40 Breast abscess 41 Disinfection 43 Further reading 44 3 Infertility 45 Introduction 45 Female infertility: induction of ovulation 45 Anti-oestrogens 46 Gonadotrophins (heterologous and homologous) 48 Gonadotrophin releasing hormone (GnRH) and analogues (GnRH-a) 51 Ovulation induction for in vivo fertilization and embryo transfer 52 Dopamine agonists 54 Oestrogens (estrogens) 55 Progestogens 57 Male infertility: improvement of spermatogenesis 58 Further reading 59 4 Dysmenorrhoea and endometriosis 60 Introduction 60 Primary dysmenorrhoea 60 Oestrogen-progestogen combinations 60 Progestogens 6l Non-steroidal anti-inflammatory drugs 6l Antispasmodics 63 Secondary dysmenorrhoea 64 Progestogens 64 iv
Combined oestrogen progestogen preparations 65 Danazol 66 Gonadotrophin releasing hormone (GnRH) and agonists 66 Further reading 68 5 Dysfunctional uterine haemorrhage 69 Introduction 69 Treatment 69 Non-steroidal anti-inflammatory drugs (NSAIDs) 69 Systemic haemostats 70 Fibrinolytic inhibitors 71 Hormones 72 Further reading 74 6 Premenstrual syndrome 75 Introduction 75 Hormone therapy 76 Progestogens 76 Oestrogens 76 Oestrogens-progestogen combinations 76 Danazol 76 Non-hormonal therapy 77 Antispasmodics: hyoscine-n-butyl bromide 77 Antidepressants 77 Antiprostaglandins: mefenamic acid, BP 77 Diuretics 77 Vitamins 78 Tranquillizers, e.g. diazepam 78 Choice of preparation 79 Further reading 79 7 The climacteric and menopause 80 Introduction 80 Non-hormonal preparations 81 Central a-agonists 81 Minor tranquillizers, (e.g diazepam and chlordiazepoxide) 82 Bone regulators 82
Hormonal therapy 83 Local atrophic vaginitis 83 General hormone-replacement therapy 85 Implants 85 Transdermal preparations 86 Oral preparations 86 Choice of preparation 89 Further reading 89 8 Pain relief and sedatives 91 Introduction 91 Premedication drugs 91 Local analgesia and anaesthesia 92 Regional analgesia 93 Parenteral analgesia 94 Newer analgesic preparations 98 Narcotic antagonist 98 Oral analgesia 99 Salicylates 99 Narcotic analgesics 101 Inhalational analgesia 102 Local preparations for analgesia 104 Perineal bruising 105 Sedatives 105 Further reading 107 9 The unstable bladder 108 Introduction 108 Anticholinergic drugs 108 Antispasmodic-musculotrophic drugs 111 Miscellaneous 112 Interstitial cystitus 112 Further reading 114 10 Miscellaneous topics 115 Introduction 115 Anticoagulation 115 Prophylactic therapy 116 vi
Active therapy 117 Anticoagulants 118 Miscellaneous 122 Large bowel disorders 122 Haemorrhoids soothing agents 122 Laxatives/enemas 122 Infusions 127 Radiological contrast media 128 Non-specific local agents 130 Further reading 133 Appendix I: Abortion, fertility control, hirsutism and lactation suppression 134 Introduction 134 Abortion 134 Threatened and recurrent abortions 134 First trimester abortions 134 Surgical termination of pregnancy 136 Gemeprost 136 Medical termination of pregnancy 139 Second trimester abortion 140 Control of fertility 145 Steroid contraceptives 145 Progestogen-only preparations 152 Long-acting contraception 153 Emergency contraception 155 Spermicidal preparations 155 Hirsutism 156 Lactation suppression 157 Dopamine agonists 158 Oestrogens (estrogens) 159 Further reading 160 Appendix II: Gynaecological malignancies and terminal-care therapy 161 Introduction 161 Cytotoxic drugs l6l Hormones 162 vu
Endometrial carcinoma 162 Hydatidiform mole/choriocarcinoma 164 Carcinoma of the ovary 166 Alkylating agents 166 New cytotoxic drugs.. 167 Carcinoma of the cervix 168 Terminal-care therapy 169 Further reading 172 Index 173 Abbreviations BNF = British National Formulary BP = British Pharmacopoeia BPC = British Pharmaceutical Codex Eur. P = European Pharmacopoeia USNF = United States National Formulary USP = United States Pharmacopeia CNS = Central Nervous System vm