PRESENTATION ON LABOUR AND ABNORMALITY OF LABOUR, REVIEW

OF COMMON DRUGS USED IN ENDOCRINE SYSTEM

COURSE: PRE-COUNCIL COACHING CLASS

GROUP 18

INSTITUTION: LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY,

OGBOMOSHO, OYO STATE

TO BE SUBMITTED TO: COACHING LECTURERS

GROUP MEMBERS

IGBAYILOLA BOLUWATIFE VICTORIA – 2021004551

ADEOYE ADEYINKA AFOLABI – 2021004563

OLUSANYA DOYINSOLA MODUPE – 2021004588

ADEKOLA ADETOLANI MERCY – 2021004592

OYETUNJI AYOMIDE NOAH – 2021004631

OPALADE TEMITOPE ENDURANCE – 2021004688

BADMUS HABEEB OLUWASEMILORE – 2021004693

ABIOLA DANIEL OLAKUNLE – 2021004694

SHODUNKE OLALEKAN FESTUS – 2021004709

ADEBODUN OLUWAYIMIKA - 2021004743

DATE: 1/09/2025

Table Of Content
A. LABOUR AND ABNORMALITY OF LABOUR

 Introduction to Labour
 Stages & Mechanism
 Nursing Management
 Abnormalities of Labour
 Complications & Management

B. REVIEW OF COMMON DRUGS USED IN ENDOCRINE SYSTEM

 Drugs used for Diabetes

 Drugs used for hyperthyroidism and hypothyroidism - Abiola Daniel
Olakunle
 Drugs used in Adrenal insufficiency and Cushing's disease
 Drugs used for pituitary gland defect( growth hormone especially)
 Drugs used for the reproductive glands

1. INTRODUCTION TO LABOUR

Labour is a fundamental physiological process through which pregnancy

culminates in the delivery of the fetus, placenta, and membranes. According
to the World Health Organization (WHO, 2018), labour is defined as “the
onset of regular uterine contractions leading to progressive cervical
effacement, dilatation, and descent of the presenting part, resulting in the
expulsion of the fetus and placenta through the birth canal.” This process
typically occurs between 37 and 42 completed weeks of gestation and
involves intricate maternal and fetal physiological changes.

Labour is traditionally considered a normal physiological event, yet it is

inherently unpredictable. While many women experience labour within the
expected physiological parameters, deviations may occur, leading to what is
classified as abnormal labour. Abnormalities of labour, often termed dystocia,
are associated with increased maternal and neonatal morbidity and
mortality, making the understanding of labour dynamics crucial for safe
childbirth practices (American College of Obstetricians and Gynecologists \
[ACOG], 2020).

The study of labour encompasses both clinical and conceptual dimensions.

Clinically, it involves the monitoring and management of the mother and
fetus to ensure safe outcomes. Conceptually, labour can be understood as an
interaction between three key elements, often referred to as the “three Ps”:
1. Power – the force generated by uterine contractions and maternal pushing
efforts.

2. Passenger – the fetus, particularly its size, lie, presentation, and position.

3. Passage – the maternal pelvis and soft tissues through which the fetus
must pass.

Any imbalance or abnormality in one or more of these components can alter

the normal process of labour, potentially leading to complications such as
prolonged labour, obstructed labour, or fetal distress.

From a public health perspective, abnormal labour remains a major

contributor to maternal and neonatal morbidity in low- and middle-income
countries, where access to timely obstetric interventions may be limited (Say
et al., 2014). Globally, obstructed labour is a preventable cause of maternal
mortality, obstetric fistula, and perinatal loss. Conversely, in high-resource
settings, abnormalities of labour often lead to increased rates of operative
interventions, particularly cesarean sections, raising debates about the
balance between maternal safety and medical over-intervention.

Understanding the concepts of labour and abnormality of labour is therefore

significant for nursing and midwifery students, as it provides the theoretical
foundation for clinical practice. The knowledge equips practitioners to
recognize deviations from normal labour, utilize monitoring tools such as the
partograph, and implement appropriate interventions or timely referrals.
Thus, a conceptual exploration of labour and its abnormalities is not only
academic but also central to advancing safe motherhood initiatives and
achieving Sustainable Development Goal (SDG) 3: Good health and well-
being, particularly targets on reducing maternal and neonatal mortality.

2. STAGES AND MECHANISM OF LABOUR

Stages Of Labour
Stage 1 – Onset of labour to full cervical dilatation (10 cm)
Phases:
Latent phase: painful contractions with gradual cervical change
(effacement and dilatation up to about 4–6 cm depending on
guideline). Contractions may be irregular.
Active phase: starts once cervix is 4–6 cm dilated with regular
painful contractions. Progress is assessed by rate of dilatation,
descent, and contraction pattern.
Key points:
 Monitor maternal vitals, fetal heart rate, contractions, and
vaginal exams (usually every 4 hours in active labour).
 Use supportive care: hydration, pain relief, mobilization,
emotional support.
 Avoid unnecessary interventions (e.g., routine amniotomy or
oxytocin unless labour is delayed).
Stage 2 – Full cervical dilatation to birth of the baby
Two parts:
Passive second stage: cervix fully dilated but no active pushing
urge or visible presenting part.
Active second stage: maternal urge to push or visible presenting
part, with expulsive efforts.
Expected duration:
First-time mothers: up to 2–3 hours (longer if epidural).
Multiparas: usually within 1–2 hours.
Key points:
 Support positions of comfort (upright, side-lying, squatting).
 Encourage effective pushing once urge is present.
 Monitor fetal heart rate and maternal status closely.
Stage 3 – Birth of the baby to delivery of the placenta
Types of management:
Active management: administration of uterotonic (oxytocin 10 IU
IM/IV), controlled cord traction, and delayed cord clamping (30–60
seconds if baby stable). Reduces risk of postpartum haemorrhage.
Physiological management: placenta delivered spontaneously
with maternal effort and gravity.
Key points:
 Observe for signs of placental separation (gush of blood,
cord lengthening, fundal rise).
 Ensure uterus remains well contracted after delivery.
Stage 4 – Immediate postpartum period (1–4 hours after placenta)
Key points:
 Monitor maternal vital signs, uterine tone, vaginal bleeding
(lochia), and perineum.
 Perform fundal checks to ensure uterus is contracted.
 Encourage skin-to-skin contact and initiation of
breastfeeding.
 Observe for complications (e.g., postpartum haemorrhage,
retained placenta, uterine atony).
Mechanisms of Labour (Cardinal Movements)
In a normal vertex presentation, occiput anterior position, the
fetus undergoes the following movements to navigate the
maternal pelvis:
Engagement: biparietal diameter of fetal head passes the pelvic
brim.
Descent: downward movement of the head through the pelvis,
occurs throughout labour.
Flexion: fetal chin moves toward chest, presenting the smallest
diameter of the head.
Internal rotation: occiput rotates anteriorly to align with the
maternal anteroposterior diameter.
Extension: head extends as it passes under the pubic arch,
leading to crowning and birth of the head.
Restitution: head realigns with the fetal shoulders after birth of
the head.
External rotation: shoulders rotate into the anteroposterior
diameter of the pelvis.
Expulsion: anterior shoulder, then posterior shoulder, followed by
the rest of the body, is delivered.
Variations in Mechanisms
Occiput Posterior (OP): head may rotate anteriorly (long rotation)
or persist posteriorly, sometimes requiring assistance.
Face presentation: mentum (chin) is the leading point. Vaginal
birth possible if mentum anterior; usually obstructed if mentum
posterior.
Brow presentation: incomplete extension, often unstable; usually
requires caesarean if it persists.
Breech presentation: mechanisms differ (buttocks or feet present
first, followed by head last).

3. NURSING MANAGEMENT OF NORMAL LABOR

Nursing management of normal labor is a critical aspect of
obstetric care.
Initial Assessment
1. Maternal vital signs: Temperature, pulse, blood pressure, and
respiratory rate.
2. Fetal heart rate: Monitoring fetal well-being.
3. Labor status: Assessing cervical dilation, effacement, and fetal
station.
4. Pain management: Discussing pain relief options.
Ongoing Care
1. Monitoring: Regularly assessing maternal vital signs, fetal heart
rate, and labor progress.
2. Pain management: Offering support and interventions, such as
breathing techniques, positioning, and pharmacological options.
3. Hydration and nutrition: Encouraging oral intake or providing IV
fluids.
4. Positioning: Helping the woman find comfortable positions to
promote progress and comfort.
5. Emotional support: Providing reassurance, encouragement, and
support.
Supportive Interventions
1. Breathing techniques: Teaching and supporting breathing
exercises.
2. Massage and counter-pressured: Offering massage or counter-
pressure to alleviate back pain.
3. Hydrotherapy: Providing a warm bath or shower to promote
relaxation.
4. Position changes: Encouraging frequent position changes to
promote progress.
Preparation for Delivery
1. Preparing for pushing: Coaching the woman on pushing
techniques.
2. Perineal support: Providing support to the perineum during
delivery.
3. Neonatal care: Preparing for newborn care and resuscitation.
Post-Delivery Care
1. Maternal assessment: Monitoring vital signs and bleeding.
2. Newborn assessment: Evaluating the newborn's condition.
3. Bonding and breastfeeding: Supporting skin-to-skin contact and
breastfeeding.

4. ABNORMALITIES OF LABOUR (DYSTOCIA)

Introduction
Definition: Abnormalities of labour, also called dystocia, refer to
difficult, prolonged, or obstructed labour resulting from
abnormalities in the powers (uterine contractions), the passenger
(fetus), or the passage (birth canal).
It is a major cause of maternal and neonatal morbidity and
mortality, especially in low-resource settings.
Classification of Abnormalities of Labour
Abnormalities can be grouped into three main categories:
A. Abnormalities of Power (uterine activity)
Ineffective uterine contractions → failure of progress.
Types:
 Hypotonic uterine dysfunction → weak/infrequent
contractions, slow progress.
 Hypertonic uterine dysfunction → excessive, uncoordinated
contractions, painful but ineffective.
Incoordinate uterine action → irregular and unsynchronized
contractions.
Precipitate labour → abnormally rapid labour (<3 hours), risk of
trauma/hemorrhage.
B. Abnormalities of Passenger (fetus)
Malpresentation → fetal part other than vertex presents (breech,
shoulder, face, brow).
Malposition → abnormal position of occiput (e.g., occiput
posterior, occiput transverse).
Macrosomia → fetus >4–4.5 kg, difficult vaginal delivery.
Multiple pregnancy → risk of malpresentation, cord prolapse.
Fetal anomalies (e.g., hydrocephalus, conjoined twins).
Shoulder dystocia → impaction of fetal shoulder after head
delivery.
C. Abnormalities of Passage (maternal pelvis & soft
tissues)
Contracted pelvis → bony pelvis too small/narrow for fetus.
Cephalopelvic disproportion (CPD) → mismatch between fetal
head size and maternal pelvis.
Soft tissue obstruction → fibroids, ovarian tumor, bladder
distension, cervical stenosis, vaginal septum.
Clinical Features
 Prolonged or obstructed labour,
 Maternal exhaustion, dehydration, tachycardia
 Fetal distress (abnormal fetal heart rate, meconium-stained
liquor)
 Lack of progress on partograph (dilatation, descent)
 Abnormal contraction patterns (too weak, too strong, or
irregular)

5. MANAGEMENT OF NORMAL LABOUR

General Principles

 Provide a safe, supportive, and clean environment.

  Use of partograph to monitor labour progress.
 Ensure psychological support and continuous communication with the
woman and family.
 Follow the 10 Rights of Maternal Care: right patient, right environment,
right assessment, right monitoring, right intervention, right infection
prevention, right documentation, right referral, right support, right
outcome.

Stage-by-Stage Management

A. First Stage of Labour

 Admit and take full history, perform physical examination.

 Monitor maternal vital signs (every 30 min–hourly).
 Assess fetal heart rate (every 30 min, or after every contraction if risk
present).
 Monitor uterine contractions (frequency, duration, intensity).
 Vaginal examinations (4-hourly or when indicated).
 Use partograph to record progress (cervical dilatation, descent,
contractions, FHR, maternal condition).
 Ensure hydration and nutrition (oral fluids/light meals).
 Provide pain relief (breathing exercises, positioning, analgesics).
 Maintain asepsis in all procedures.

B. Second Stage of Labour

 Encourage woman to push with contractions.

 Maintain bladder emptying (catheterization if necessary).
 Monitor fetal heart rate after every contraction.
 Prepare delivery set and ensure asepsis.
 Assist delivery (episiotomy if indicated).
 Immediate care of newborn: clear airway, dry, keep warm, APGAR
scoring.
 Clamp and cut cord using sterile technique.

C. Third Stage of Labour

 Active management of third stage of labour (AMTSL):

 Administer uterotonic (e.g., oxytocin 10 IU IM).
 Controlled cord traction.
  Uterine massage after placental delivery.
 Inspect placenta and membranes for completeness.
 Monitor mother’s vital signs and bleeding.

D. Fourth Stage of Labour

 Observe for at least 1–2 hours postpartum.

 Monitor pulse, blood pressure, uterine contraction, and vaginal
bleeding every 15–30 min.
 Encourage skin-to-skin contact and initiate breastfeeding.
 Watch for complications (postpartum haemorrhage, shock).

2. Management of Abnormalities of Labour

A. Abnormalities of Power

- Uterine Inertia (weak contractions):

 Hydration, ambulation, and emotional support.

 Augmentation with oxytocin if no CPD.
 Artificial rupture of membranes (ARM) if indicated.
 Caesarean section if no progress despite measures.

- Hypertonic Contractions:

 Provide sedation and rest.

 Exclude obstruction before augmentation.
 Caesarean section if maternal/fetal distress.

- Precipitate Labour:

 Careful monitoring to prevent maternal/fetal injury.

 Control delivery of head to prevent perineal tears.
 Resuscitate baby if asphyxiated.

B. Abnormalities of Passenger

- Malpresentations (e.g., breech, face, shoulder):

 Breech: allow spontaneous delivery if favourable, or assisted breech

delivery; C-section if complications.
 Face/Brow: usually require caesarean section.
  Shoulder (transverse lie): caesarean section.

- Malpositions (Occipito-posterior):

 Continuous monitoring.
 Augmentation if contractions weak.
 Instrumental delivery (forceps/vacuum) or caesarean section if
persistent and prolonged.

- Macrosomia:

 Elective C-section if CPD suspected.

 Careful monitoring in vaginal delivery, anticipate shoulder dystocia.

- Fetal anomalies (e.g., hydrocephalus):

 May require cephalocentesis or C-section depending on case.

C. Abnormalities of Passage

- Contracted Pelvis / CPD:

 Confirm diagnosis with partograph.

 Immediate caesarean section.
 Avoid prolonged trial of labour.

- Soft tissue obstruction (fibroids, ovarian tumour):

 Surgical removal if feasible before pregnancy.

 Caesarean section if obstructing during labour.

D. Abnormal Progress

- Prolonged Labour:

 Identify cause (Power, Passenger, Passage).

 Supportive care (hydration, analgesia).
 Augmentation or operative delivery as indicated.

- Obstructed Labour:

 Resuscitate mother (IV fluids, oxygen, antibiotics).

 Caesarean section (gold standard).
 Symphysiotomy only in resource-limited settings.
 Prevent complications (fistula, sepsis, shock).
- Failed Induction:

 Stop oxytocin/induction agents.

 Reassess cervical favourability (Bishop score).
 Caesarean section if cervix unfavourable or mother/fetus
compromised.

3. Nursing Roles in Abnormal Labour

 Early Detection: Continuous monitoring using partograph.

 Supportive Care: Hydration, rest, pain relief, emotional support.
 Prevention of Complications: Maintain asepsis, monitor vital signs,
prepare for referral.
 Collaboration: Work with doctors for interventions (augmentation, C-
section, instrumental delivery).
 Emergency Response: Manage shock, resuscitate newborn, control
haemorrhage.
 Health Education: Antenatal education to reduce risks (nutrition,
hospital delivery, danger signs).

REVIEW OF COMMON DRUGS USED IN ENDOCRINE SYSTEM

 Drugs used for Diabetes

 Drugs used for hyperthyroidism and hypothyroidism - Abiola Daniel
Olakunle
 Drugs used in Adrenal insufficiency and Cushing's disease
 Drugs used for pituitary gland defect( growth hormone especially)
 Drugs used for the reproductive glands

6. DRUGS USED IN DIABETES MELLITUS

1. Insulin
 • Mode of Action: Replaces or supplements endogenous insulin →
increases glucose uptake by muscle & adipose tissue, inhibits
hepatic glucose output, and regulates fat/protein metabolism.
• Route: Subcutaneous injection (common), IV (in emergencies like
DKA), insulin pump.
• Dosage: Varies—commonly 0.5–1 unit/kg/day divided into basal
and bolus doses.
• Side Effects: Hypoglycemia, weight gain, lipodystrophy at
injection site.
• Indication: Type 1 DM (all patients), Type 2 DM when uncontrolled
by oral drugs, gestational diabetes if oral agents fail, DKA, HHS.
• Contraindications: Hypoglycemia episodes, allergy (rare).
• Examples: Regular insulin, NPH, insulin glargine, insulin lispro.
2. Biguanides (Metformin)
• Mode of Action: ↓ Hepatic glucose production, ↑ peripheral
insulin sensitivity, mild ↓ intestinal glucose absorption.
• Route: Oral.
• Dosage: Start 500 mg once/twice daily; titrate up to 2000
mg/day.
• Side Effects: GI upset (diarrhea, nausea), metallic taste, lactic
acidosis (rare).
• Indication: First-line for Type 2 DM, prediabetes, PCOS (insulin
resistance).
• Contraindications: Renal failure (eGFR <30), severe liver/heart
failure, alcoholism.
• Example: Metformin.
3. Sulfonylureas
• Mode of Action: Stimulates pancreatic β-cells → ↑ insulin
secretion (glucose-independent).
• Route: Oral.
• Dosage: Glibenclamide 2.5–20 mg/day; Glipizide 2.5–40 mg/day.
• Side Effects: Hypoglycemia, weight gain, nausea.
• Indication: Type 2 DM (when lifestyle + metformin insufficient).
• Contraindications: Type 1 DM, pregnancy, severe renal/hepatic
impairment.
• Examples: Glibenclamide, Glipizide, Glimepiride.
4. DPP-4 Inhibitors (Gliptins)
• Mode of Action: Inhibit DPP-4 enzyme → prolong incretin (GLP-1,
GIP) effect → ↑ insulin secretion (glucose-dependent), ↓
glucagon release.
 • Route: Oral.
• Dosage: Sitagliptin 100 mg once daily.
• Side Effects: Nasopharyngitis, headache, mild GI upset, rare
pancreatitis.
• Indication: Type 2 DM, often in combination with metformin.
• Contraindications: History of pancreatitis, Type 1 DM.
• Examples: Sitagliptin, Vildagliptin, Saxagliptin.
5. SGLT2 Inhibitors
• Mode of Action: Block renal glucose reabsorption in proximal
tubule → ↑ urinary glucose excretion.
• Route: Oral.
• Dosage: Empagliflozin 10–25 mg once daily.
• Side Effects: Genital/urinary tract infections, dehydration,
ketoacidosis (rare).
• Indication: Type 2 DM, especially with CV disease or heart failure.
• Contraindications: Renal failure, recurrent UTIs, hypotension.
• Examples: Dapagliflozin, Empagliflozin, Canagliflozin.
6. GLP-1 Receptor Agonists
• Mode of Action: Mimic incretin → ↑ insulin secretion (glucose-
dependent), ↓ glucagon, slow gastric emptying, promote satiety
→ weight loss.
• Route: Subcutaneous injection.
• Dosage: Exenatide 5–10 µg SC twice daily; Liraglutide 0.6–1.8 mg
SC daily.
• Side Effects: Nausea, vomiting, diarrhea, pancreatitis risk.
• Indication: Type 2 DM (esp. obese patients), CVD risk reduction.
• Contraindications: History of pancreatitis, medullary thyroid
cancer, Type 1 DM.
• Examples: Exenatide, Liraglutide, Semaglutide.

7. DRUGS USED FOR HYPERTHYROIDISM AND HYPOTHYROIDISM

Drugs for Hypothyroidism

1. Levothyroxine (T4)

Route of administration: Oral (tablets) and IV (in severe cases such as

myxoedema coma).
Mode of action: Synthetic form of thyroxine (T4) that is converted in the body
to the active T3, thereby restoring normal thyroid hormone levels and
metabolism.

Dosage:

 Adults: 50–100 mcg once daily (titrated based on TSH levels).

 Elderly/heart disease: start low (12.5–25 mcg daily).

Side effects: (mainly due to overdosage → hyperthyroid-like symptoms)

palpitations, insomnia, tremors, weight loss, diarrhoea, tachycardia.

Indication: Primary hypothyroidism, post-thyroidectomy hypothyroidism,

myxoedema coma (IV).

Contraindication: Untreated adrenal insufficiency, acute myocardial

infarction, thyrotoxicosis.

Common example in Nigeria: Eltroxin® (Levothyroxine sodium).

Drugs for Hyperthyroidism

1. Carbimazole (pro-drug of methimazole)

Route of administration: Oral.

Mode of action: Inhibits thyroid peroxidase enzyme → blocks iodination of

tyrosine residues in thyroglobulin → prevents thyroid hormone synthesis.

Dosage: 15–40 mg daily in divided doses; maintenance 5–15 mg daily.

Side effects: Agranulocytosis (rare but serious), skin rash, pruritus,

arthralgia, hepatotoxicity, nausea.

Indication: Graves’ disease, toxic multinodular goitre, thyroid storm (with

adjuncts).

Contraindication: Pregnancy (1st trimester), lactation, history of

agranulocytosis with antithyroid drugs.

Common example in Nigeria: Neo-Mercazole®.

2. Propylthiouracil (PTU)

Route of administration: Oral.

Mode of action: Inhibits thyroid peroxidase (like carbimazole) and also
inhibits peripheral conversion of T4 → T3.

Dosage: 50–150 mg every 8 hours initially; maintenance 50–150 mg daily.

Side effects: Hepatotoxicity, agranulocytosis, skin rash, vasculitis.

Indication: Hyperthyroidism (especially in 1st trimester of pregnancy or

thyroid storm).

Contraindication: Previous severe reaction to PTU, liver disease.

Common example in Nigeria: Propylthiouracil tablets (generic, not many

brands available compared to carbimazole).

3. Radioactive Iodine (I-131)

Route of administration: Oral capsule or solution.

Mode of action: Taken up by the thyroid gland, emits beta radiation that
destroys thyroid tissue → reduces hormone production.

Dosage: Typically 10–30 mCi (adjusted based on gland size and uptake).

Side effects: Permanent hypothyroidism, neck pain, sialadenitis (salivary

gland inflammation).

Indication: Graves’ disease, toxic multinodular goitre, thyroid carcinoma.

Contraindication: Pregnancy, breastfeeding, young children.

Common example in Nigeria: Available in specialist centres (e.g., University

College Hospital Ibadan, LUTH Lagos) as therapeutic sodium iodide-131.

8. DRUGS USED IN ADRENAL INSUFFICIENCY AND CUSHING’S

DISEASE

Drugs Used In Adrenal Insufficiency

Adrenal insufficiency is treated primarily with glucocorticoid and

mineralocorticoid replacement therapy.

1. Hydrocortisone

Class: Glucocorticoid (short-acting)

Mode of Action:
Hydrocortisone acts as a synthetic cortisol replacement. It binds to
intracellular glucocorticoid receptors, modulating gene transcription to
restore normal metabolic and anti-inflammatory functions.

Route of Administration: Oral, Intravenous (IV), Intramuscular (IM)

Dosage:

 Oral: 15–30 mg/day in divided doses (e.g., 10 mg morning, 5 mg

afternoon)
 Acute Adrenal Crisis: 100 mg IV stat, then 50–100 mg IV every 6–8 hrs

Side Effects: Weight gain, Hypertension, Hyperglycemia, Osteoporosis,

Increased infection risk.

Indications: Addison’s disease (primary adrenal insufficiency), Secondary

adrenal insufficiency, Acute adrenal crisis.

Contraindications: Systemic fungal infections, Hypersensitivity to

corticosteroids.

Examples: Hydrocortisone sodium succinate (IV), Hydrocortisone acetate

(oral)

2. Fludrocortisone

Class: Mineralocorticoid

Mode of Action: Binds to aldosterone receptors in the distal renal tubules,

enhancing Na⁺ reabsorption and K⁺ excretion, aiding fluid balance.

Route of Administration:Oral

Dosage: 0.05–0.2 mg/day

Side Effects: Hypertension, Hypokalemia, Fluid retention/edema, Headache.

Indications: Primary adrenal insufficiency (Addison’s disease), Congenital

adrenal hyperplasia.

Contraindications: Systemic fungal infections, Severe hypertension, Heart

failure.

Examples: Fludrocortisone acetate

3. Prednisolone

Class: Glucocorticoid (Intermediate-acting)

Mode of Action: Synthetic corticosteroid with anti-inflammatory and
immunosuppressive properties. It regulates gene transcription and inhibits
inflammatory cytokines.

Route of Administration: Oral, IV

Dosage: 5–15 mg/day (chronic therapy)

Side Effects: Hyperglycemia, Immunosuppression, Cushingoid features

Indications: Chronic adrenal insufficiency when hydrocortisone unavailable.

Contraindications: Active infections, Uncontrolled diabetes.

Examples: Prednisolone, Prednisone

Drugs Used in Cushing’s Disease

Cushing’s disease results from excess cortisol, commonly due to pituitary

ACTH-secreting adenoma. Drugs aim to reduce cortisol production or block
its effects.

1. Ketoconazole

Class: Antifungal (CYP450 inhibitor)

Mode of Action: Inhibits 17α-hydroxylase and 11β-hydroxylase enzymes in

adrenal steroid synthesis, reducing cortisol production.

Route of Administration: Oral

Dosage: 200–400 mg twice daily

Side Effects: Hepatotoxicity, Gynecomastia, GI disturbances

Indications: Medical management of Cushing’s syndrome (pre-surgery or

when surgery contraindicated)

Contraindications: Severe liver disease, Pregnancy

Examples: Ketoconazole (Nizoral)

2. Metyrapone

Mode of Action: Inhibits 11β-hydroxylase, blocking conversion of 11-

deoxycortisol to cortisol.

Route: Oral
Dosage: 250 mg every 4–6 hrs (up to 6 g/day)

Side Effects: Hypertension, Hirsutism, Nausea

Indications: Diagnosis of adrenal insufficiency (Metyrapone test), Cushing’s

syndrome

Contraindications: Adrenal cortical insufficiency

Examples: Metyrapone

3. Mitotane

Mode of Action: Adrenolytic drug causing adrenocortical cell necrosis,

reducing cortisol production.

Route: Oral

Dosage: 2–6 g/day

Side Effects: Nausea, vomiting, neurotoxicity

Indications: Adrenal carcinoma, Severe Cushing’s syndrome

Contraindications: Pregnancy

Examples: Mitotane (Lysodren)

4. Pasireotide

Mode of Action: Somatostatin analogue that inhibits ACTH secretion from

pituitary adenoma.

Route: Subcutaneous injection

Dosage: 0.6–0.9 mg twice daily

Side Effects: Hyperglycemia, GI symptoms

Indications: Pituitary-dependent Cushing’s disease (when surgery fails)

Contraindications: Uncontrolled diabetes

Examples: Pasireotide (Signifor)

5. Mifepristone

Mode of Action: Glucocorticoid receptor antagonist; blocks cortisol effects at

receptor level.

Route: Oral
Dosage: 300–1200 mg/day

Side Effects: Hypokalemia, Endometrial hyperplasia

Indications: Severe hypercortisolism with diabetes or hypertension

Contraindications: Pregnancy (abortifacient effect)

Examples: Mifepristone (Korlym)

9. DRUGS USED FOR PITUITARY GLAND DEFECTS

Drugs used for pituitary gland defects primarily aim to correct hormonal
imbalances, especially those involving growth hormone. These include
somatostatin analogues, GH receptor antagonists, and dopamine agonists.

1. Somatropin

Class: Recombinant human growth hormone (short-acting)

Mode of Action: Somatropin acts as a synthetic form of human growth

hormone. It binds to GH receptors in target tissues, especially the liver,
stimulating the production of insulin-like growth factor 1 (IGF-1). IGF-1
mediates many of GH’s effects, such as linear bone growth, protein
synthesis, lipolysis, and regulation of metabolism. It restores normal growth
patterns in children and improves muscle mass and metabolism in adults.

Route of Administration: Subcutaneous injection

Dosage: Children: 0.025–0.035 mg/kg/day; Adults: 0.15–0.3 mg/day (dose

titrated based on IGF-1 levels)

Side Effects: Edema, arthralgia, carpal tunnel syndrome, insulin resistance or

hyperglycemia, headache, intracranial hypertension (rare), slipped capital
femoral epiphysis in children

Indications: GH deficiency (children and adults), Turner syndrome, chronic

kidney disease (growth failure), Prader-Willi syndrome, idiopathic short
stature.

Contraindications: Active malignancy, acute critical illness (post-surgery or

trauma), hypersensitivity to somatropin or excipients, closed epiphyses (in
children)

Examples: Genotropin, Norditropin, Humatrope, Saizen, Omnitrope,

Zomacton
2. Mecasermin

Class: Recombinant human insulin-like growth factor 1 (IGF-1)

Mode of Action: Mecasermin directly stimulates IGF-1 receptors, promoting

anabolic effects and linear growth in patients who are unresponsive to
growth hormone due to GH receptor defects or severe IGF-1 deficiency.
Unlike somatropin, it bypasses GH and acts at the level of target tissues.

Route of Administration: Subcutaneous injection (twice daily)

Dosage: 0.04–0.12 mg/kg twice daily, 20 minutes before or after meals to

prevent hypoglycemia

Side Effects: Hypoglycemia, tonsillar/adenoidal hypertrophy, headache,

dizziness, jaw pain, scoliosis progression, injection site reactions

Indications: Severe primary IGF-1 deficiency, GH gene deletion with

neutralizing antibodies, Laron syndrome (GH receptor mutation)

Contraindications: Closed epiphyses, suspected or active malignancy,

hypersensitivity to IGF-1

Example: Increlex

3. Octreotide / Lanreotide

Class: Somatostatin analogues

Mode of Action: These drugs are synthetic analogues of somatostatin, a

natural hormone that inhibits GH secretion. They bind to somatostatin
receptors (primarily SSTR2 and SSTR5) on pituitary somatotroph cells,
suppressing excess GH and subsequently reducing IGF-1 levels.

Route of Administration:

- Octreotide: Subcutaneous (short-acting) or intramuscular (long-acting

release, every 4 weeks)

- Lanreotide: Deep subcutaneous injection every 4 weeks

Dosage: Octreotide LAR: 20–40 mg IM monthly; Lanreotide: 60–120 mg SC

monthly
Side Effects: Nausea, vomiting, abdominal cramps, gallstones (with long-
term use), bradycardia, altered glucose metabolism (hypo- or
hyperglycemia)

Indications: Acromegaly, GH-secreting pituitary adenomas, carcinoid tumors,

VIPomas

Contraindications: Hypersensitivity to somatostatin analogues, caution in

diabetes or gallbladder disease

Examples: Octreotide – Sandostatin; Lanreotide – Somatuline Autogel

4. Pegvisomant

Class: Growth hormone receptor antagonist

Mode of Action: Pegvisomant is a genetically engineered GH analog that

binds to GH receptors but prevents receptor dimerization, thereby blocking
GH signaling. This reduces hepatic IGF-1 production, helping to control the
symptoms and complications of GH excess.

Route of Administration: Subcutaneous injection (once daily)

Dosage: Starting dose: 10–20 mg/day SC; Maintenance: adjusted to

normalize IGF-1 levels (up to 30 mg/day)

Side Effects: Elevated liver enzymes, injection site lipodystrophy, nausea, flu-
like symptoms, possible tumor growth due to loss of negative feedback

Indications: Acromegaly not controlled by surgery, radiotherapy, or

somatostatin analogues

Contraindications: Hypersensitivity, caution in liver disease (monitor LFTs

regularly)

Example: Somavert

5. Cabergoline / Bromocriptine

Class: Dopamine D2 receptor agonists

Mode of Action: These drugs stimulate dopamine D2 receptors in the

pituitary gland, which suppresses GH and prolactin secretion. They are most
effective in pituitary adenomas that secrete both prolactin and GH.

Route of Administration: Oral

Dosage:
- Cabergoline: 0.25–1 mg twice weekly

- Bromocriptine: 2.5–7.5 mg/day in divided doses

Side Effects: Nausea, vomiting, orthostatic hypotension, headache, dizziness,

nasal congestion, cardiac valvulopathy (with long-term cabergoline use)

Indications: Acromegaly (mild or prolactin co-secreting tumors),

prolactinomas, hyperprolactinemia

Contraindications: Uncontrolled hypertension, cardiac valve disease, history

of fibrotic disorders, hypersensitivity to ergot derivatives

Examples: Cabergoline – Dostinex; Bromocriptine – Parlodel

10. DRUGS USED FOR THE ENDOCRINE DISORDER OF REPRODUCTIVE

GLANDS

1. Estrogens

Mode of action: Bind to estrogen receptors → regulate gene expression →

promote development of female secondary sexual characteristics,
endometrial growth, bone maintenance.

Route: Oral, transdermal patch, IM injection, vaginal cream/ring.

Dosage (common):

 Conjugated estrogens: 0.3–1.25 mg orally daily.

 Estradiol patch: 0.05 mg/day twice weekly.

Side effects: Nausea, breast tenderness, headache, fluid retention,

thromboembolism, endometrial hyperplasia (if unopposed).

Indications: Hormone replacement therapy (HRT), primary ovarian failure,

contraception (combined pills), menopausal symptoms.

Contraindications: Breast cancer, endometrial cancer, thromboembolic

disorders, liver disease, pregnancy.

Examples: Estradiol, Conjugated equine estrogens, Ethinyl estradiol.

2. Progestins

Mode of action: Bind to progesterone receptors → inhibit LH surge, suppress

ovulation, alter endometrium, increase cervical mucus viscosity.
Route: Oral, IM/SC injection, implant, intrauterine system (IUS).

Dosage (common):

 Medroxyprogesterone acetate (oral): 5–10 mg daily for 5–10 days.

 Depot medroxyprogesterone acetate (DMPA, injection): 150 mg IM
every 3 months.

Side effects: Weight gain, depression, bloating, irregular bleeding, acne,

decreased bone density (with long-term DMPA).

Indications: Contraception, HRT (with estrogen), endometriosis, dysfunctional

uterine bleeding.

Contraindications: Breast cancer, undiagnosed vaginal bleeding, severe liver

disease, thromboembolic disorders.

Examples: Medroxyprogesterone, Norethindrone, Levonorgestrel.

3. Androgens

Mode of action: Bind to androgen receptors → stimulate protein synthesis,

increase muscle mass, promote male secondary sexual characteristics.

Route: Oral, transdermal patch/gel, IM injection.

Dosage (common):

 Testosterone enanthate: 50–200 mg IM every 2–4 weeks.

 Transdermal gel: 5–10 g daily.

Side effects: Acne, gynecomastia, hepatotoxicity (oral), polycythemia,

infertility (due to suppression of spermatogenesis).

Indications: Male hypogonadism, delayed puberty, certain breast cancers

(palliative).

Contraindications: Prostate cancer, breast cancer (in men), pregnancy,

severe cardiac/hepatic disease.

Examples: Testosterone enanthate, Testosterone cypionate, Danazol.

4. Anti-estrogens & Selective Estrogen Receptor Modulators

(SERMs)
Mode of action: Bind estrogen receptors but act as agonist/antagonist
depending on tissue (e.g., antagonist in breast, agonist in bone).

Route: Oral.

Dosage (common):

 Tamoxifen: 20 mg orally daily.

 Clomiphene: 50–100 mg daily for 5 days (for ovulation induction).

Side effects: Hot flashes, nausea, endometrial cancer risk (tamoxifen),

ovarian hyperstimulation (clomiphene), thromboembolism.

Indications: Breast cancer (tamoxifen), infertility due to anovulation

(clomiphene), osteoporosis prevention (raloxifene).

Contraindications: Pregnancy, thromboembolic disease, liver disease.

Examples: Tamoxifen, Raloxifene, Clomiphene.

5. Anti-androgens

Mode of action: Block androgen receptors or inhibit 5-alpha reductase

(conversion of testosterone → DHT).

Route: Oral.

Dosage (common):

 Flutamide: 250 mg orally 3 times daily.

 Finasteride: 5 mg orally daily.

Side effects: Gynecomastia, decreased libido, hepatotoxicity (flutamide),

impotence.

Indications: Prostate cancer (flutamide), benign prostatic hyperplasia

(finasteride), hirsutism (spironolactone).

Contraindications: Liver disease, pregnancy (especially finasteride—

teratogenic to male fetus).

Examples: Flutamide, Bicalutamide, Finasteride, Spironolactone.

6. Gonadotropins & GnRH Analogues

Mode of action: Gonadotropins (FSH, LH, hCG): stimulate follicular growth &
ovulation in females; spermatogenesis in males. GnRH agonists (Leuprolide):
continuous use suppresses FSH/LH → medical castration. GnRH antagonists
(Ganirelix): directly block GnRH receptors.
Route: IM, SC injection, nasal spray.

Dosage (common):

 hCG: 5,000–10,000 units IM for ovulation induction.

 Leuprolide: 3.75 mg IM monthly.

Side effects: Ovarian hyperstimulation syndrome (OHSS), multiple pregnancy

(gonadotropins), hot flashes, osteoporosis (long-term GnRH agonist use).

Indications: Infertility, endometriosis, prostate cancer, precocious puberty.

Contraindications: Pregnancy, hormone-dependent cancers (when

inappropriate).

Examples: Human chorionic gonadotropin (hCG), FSH, LH, Leuprolide,

Nafarelin, Ganirelix.