A TOCOLYTIC THAT SHOULD NOT BE USED IN A PATIENT WITH PEPTIC ULCER DISEASE IS

A. Ritodrine
B. Terbutaline
C. Magnesium sulfate
D. A calcium channel blocker
E. Indomethacin ✓

Indomethacin is a tocolytic that should not be used in a patient with peptic ulcer disease. Indomethacin belongs to the class of nonsteroidal anti-inflammatory drugs (NSAIDs) and can exacerbate peptic ulcers due to its potential to inhibit prostaglandin synthesis, which plays a protective role in the gastrointestinal mucosa. Patients with peptic ulcer disease are at an increased risk of gastrointestinal bleeding, and the use of indomethacin can further irritate the stomach lining, leading to worsening of the ulcer or even perforation.

Explanation:

Ritodrine: Ritodrine is a beta-2 adrenergic agonist commonly used as a tocolytic agent to delay premature labor by relaxing the uterine smooth muscle. While it can cause side effects like tachycardia and hypotension, it is not specifically contraindicated in patients with peptic ulcer disease.
Terbutaline: Terbutaline is another beta-2 adrenergic agonist used as a tocolytic agent. Similar to ritodrine, terbutaline primarily acts on the uterus and does not have direct contraindications in patients with peptic ulcer disease.
Magnesium Sulfate: Magnesium sulfate is commonly used as a tocolytic agent due to its ability to reduce myometrial contractility. It is generally safe for use in patients with peptic ulcer disease and does not exacerbate gastrointestinal issues.
Calcium Channel Blockers: Calcium channel blockers are sometimes used off-label as tocolytic agents due to their smooth muscle relaxant properties. They are not known to worsen peptic ulcer disease and may even have some protective effects on the gastrointestinal tract.
Indomethacin: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, leading to decreased uterine contractions. However, NSAIDs like indomethacin can irritate the gastric mucosa and increase the risk of gastrointestinal complications, making them unsuitable for patients with peptic ulcer disease.

In conclusion, among the options provided, indomethacin stands out as the tocolytic that should be avoided in a patient with peptic ulcer disease due to its potential to exacerbate gastric issues.