Makindo Medical Notes"One small step for man, one large step for Makindo" |
|
---|---|
Download all this content in the Apps now Android App and Apple iPhone/Pad App | |
MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd. |
Related Subjects: |Emergency Drugs |Emergency Drug Antidotes |Emergency Cardiac Drugs |Emergency Endocrine Drugs |Emergency Gastrointestinal Drugs |Emergency Haematology Drugs |Emergency Neuropsychiatric drugs |Emergency Pain drugs |Emergency Respiratory drugs |Emergency Obstetric and Gynaecology Drugs |Emergency Paediatric Drugs
DRUG (UK Name) | MOA | DOSE IV | DOSE PO | INDICATION | CONTRAINDICATION |
---|---|---|---|---|---|
Oxytocin (Syntocinon) | Stimulates uterine smooth muscle contraction by acting on oxytocin receptors |
PPH (Postpartum Haemorrhage): Commonly 10-40 units in 1 L IV infusion, rate per protocol
Induction of Labour: Typically start at 0.5-2 milliunits/min IV, titrated to contractions |
N/A | Induction/augmentation of labour, prevention and treatment of PPH | Risk of fetal distress if hyperstimulation, uterine rupture (rare), caution in malpresentation |
Methylergometrine (Methylergonovine)* | Ergot alkaloid that causes sustained uterine contraction |
Typically 200 micrograms IM (may repeat every 2-4 hours)
IV route generally avoided unless no alternative (given slowly if used) |
N/A | PPH due to uterine atony | Hypertension (can exacerbate), pre-eclampsia, cardiovascular disease
*Note: Methylergometrine is not licensed in the UK; refer to local guidance. |
Carboprost (Hemabate) | Prostaglandin F2α analogue causing strong uterine contractions | 250 micrograms IM, may repeat every 15-90 min (max 2 mg total) | N/A | Refractory PPH due to uterine atony not responding to first-line agents | Asthma (risk of bronchoconstriction), significant cardiac, renal or hepatic disease |
Misoprostol | Prostaglandin E1 analogue causing uterine contractions and cervical ripening | N/A (Rectal use in PPH: 600-1000 micrograms PR if indicated) | 100-800 micrograms PO/SL/PR for labour induction or PPH management
(Check BNF for specific regimens) |
Labour induction, cervical ripening, PPH | Previous uterine surgery (risk of rupture), known hypersensitivity; caution in asthma |
Magnesium Sulfate | Reduces neuromuscular excitability, cerebral vasodilation, stabilises membranes |
Eclampsia: 4 g IV load over ~20 min, then 1-2 g/hour infusion as maintenance
(Doses vary: verify with local protocol) |
N/A | Seizure prophylaxis and treatment in pre-eclampsia/eclampsia | Myasthenia gravis, heart block, severe renal impairment; monitor for toxicity (reflexes, RR, urine output) |
Terbutaline | Beta-2 agonist that relaxes uterine smooth muscle (tocolysis) | 250 micrograms SC every 20-30 min, up to 3 doses | N/A | Short-term tocolysis in preterm labour | Tachycardia, uncontrolled hypertension, significant cardiac disease, uncontrolled hyperthyroidism |
Nifedipine | Calcium channel blocker, relaxes uterine smooth muscle (tocolysis) | N/A |
Initially 10-20 mg PO, then 10-20 mg PO every 4-6 hours
(Modified-release forms and exact dosing as per local protocol) |
Tocolysis in preterm labour | Hypotension, caution in cardiac disease; avoid concomitant IV magnesium sulfate (risk of severe hypotension) |
Labetalol | Combined alpha and beta adrenergic blockade to lower BP |
Severe hypertension in pre-eclampsia: 20 mg IV bolus initially, may repeat or increase dose every 10-15 min until target BP
Maintenance infusion or repeated boluses as per protocol |
N/A | Acute severe hypertension in pre-eclampsia/eclampsia | Asthma, heart block, bradycardia, heart failure; monitor BP and HR closely |
Hydralazine | Direct arteriolar vasodilator, reduces afterload | 5-10 mg IV bolus every 20-40 min as needed, titrate to BP response | N/A | Acute severe hypertension in pre-eclampsia/eclampsia | Hypersensitivity; caution with hypotension or reflex tachycardia; monitor BP closely |
Anti-D (Rho(D) Immune Globulin) | Prevents maternal sensitisation to fetal Rh+ RBCs |
250-500 international units (usually 250 IU per 2.5 mL fetal blood) IM or as per protocol
Common standard postpartum dose: 500 IU IM within 72 hours of delivery or sensitising event (doses may vary, some use 1500 IU) |
N/A | Prevention of Rh sensitisation in Rh- mother after Rh+ fetal blood exposure (birth, miscarriage, invasive procedures) | Rh+ mother, known hypersensitivity; verify dose with Kleihauer test if needed |