Which tocolytic drug results in pulmonary oedema (adverse effect)-
The question is asking which of these causes pulmonary edema as an adverse effect. Let me think about each drug's side effects. Magnesium sulfate is known for causing hypotension and respiratory depression, but pulmonary edema? Maybe in overdose. Terbutaline is a beta-2 agonist; it can cause tachycardia and hypokalemia. Nifedipine, a calcium channel blocker, might lead to hypotension but not sure about pulmonary edema. Indomethacin is a NSAID, so it can cause renal issues and maybe fluid retention, but pulmonary edema? Wait, maybe magnesium sulfate is the one that can cause pulmonary edema, especially if there's magnesium toxicity.
Wait, magnesium sulfate's main adverse effects include hypermagnesemia, which can lead to respiratory depression, hypotension, and in severe cases, pulmonary edema. That makes sense. So if the correct answer is magnesium sulfate, then the explanation should focus on that. The other drugs don't typically cause pulmonary edema. Let me check each option again. If the options are A. Magnesium sulfate, B. Terbutaline, C. Nifedipine, D. Indomethacin, then the correct answer is A. The explanation would need to detail how magnesium affects the body and why it can lead to pulmonary edema. Also, why the other options aren't correct. For example, terbutaline's main side effects are cardiac, nifedipine's is hypotension, and indomethacin's are renal and GI. The clinical pearl here is that magnesium sulfate requires careful monitoring to avoid toxicity, which includes pulmonary edema. That should be the key takeaway.
**Core Concept**
Tocolytic drugs suppress uterine contractions in preterm labor. Pulmonary edema is a rare but serious adverse effect of **magnesium sulfate**, a first-line tocolytic, due to its direct myocardial and vascular effects at high concentrations.
**Why the Correct Answer is Right**
Magnesium sulfate acts as a calcium channel blocker and neuromuscular blocker. In therapeutic doses, it relaxes uterine smooth muscle. However, excess magnesium (hypermagnesemia) causes vasodilation, reduced myocardial contractility, and fluid transudation into the lungs. This manifests as pulmonary edema, particularly in patients with preexisting heart or kidney disease. Monitoring serum magnesium levels is critical to prevent toxicity.
**Why Each Wrong Option is Incorrect**
**Option B (Terbutaline):** Causes tachycardia and hypokalemia but not pulmonary edema.
**Option C (Nifedipine):** May cause hypotension but lacks direct pulmonary edema risk.
**Option D (Indomethacin):** Linked to oliguria and acute kidney injury, not pulmonary edema.
**Clinical Pearl / High-Yield Fact**
Remember the **"MAGNUS