UNIT 5 Drugs used for pregnant women during antenatal, labour and postnatal period
This guide covers essential medications used during pregnancy, labor, and postpartum to ensure maternal and fetal health. It includes Tetanus Prophylaxis, which is crucial for preventing maternal and neonatal tetanus.
During pregnancy, drugs are given to:
✔ Folic Acid (Vitamin B9)
✔ Iron (Ferrous Sulfate)
✔ Calcium + Vitamin D
✔ Iodine (Potassium Iodide)
✔ Omega-3 Fatty Acids (DHA)
🚨 Tetanus Toxoid (TT) Vaccine for Pregnant Women
| Dose | Timing | Protection |
|---|---|---|
| TT1 | Early pregnancy (First visit) | No protection |
| TT2 | 4 weeks after TT1 | 3 years |
| TT3 | 6 months after TT2 | 5 years |
| TT4 | 1 year after TT3 | 10 years |
| TT5 | 1 year after TT4 | Lifetime |
📢 For previously vaccinated mothers:
✔ Methyldopa (First-line, safe)
✔ Labetalol (Preferred in severe cases)
✔ Nifedipine (Calcium channel blocker, used in emergency)
🚫 Avoid ACE Inhibitors (Enalapril, Lisinopril) → Causes fetal kidney defects
✔ Given at 28-30 weeks & within 72 hours of delivery
✔ Prevents hemolytic disease of newborn
✔ Insulin (Preferred)
✔ Metformin (Used if insulin is not available)
🚫 Avoid Oral Hypoglycemics like Glibenclamide
During labor, drugs are used for induction, pain relief, and emergency management.
✔ Oxytocin (Induces contractions, prevents postpartum hemorrhage)
✔ Misoprostol/Dinoprostone (Cervical ripening)
🚫 Contraindicated in previous C-section due to risk of uterine rupture
✔ Epidural Analgesia (Bupivacaine + Fentanyl)
✔ Nitrous Oxide (Laughing gas) (Mild pain relief)
✔ Pethidine (Opioid Analgesic) (Use cautiously due to neonatal respiratory depression)
✔ Magnesium Sulfate (MgSO₄) (For Eclampsia – Prevents Seizures)
✔ Hydralazine/Labetalol/Nifedipine (For Severe Hypertension in Preeclampsia)
After delivery, drugs are given to:
✔ Oxytocin (First-line drug for uterine contraction)
✔ Methylergonovine (Ergometrine) (For severe PPH)
✔ Carboprost (PGF2α) (For refractory PPH)
✔ Misoprostol (For PPH in low-resource settings)
🚫 Methylergonovine is contraindicated in hypertension
✔ Paracetamol (Safe for breastfeeding)
✔ NSAIDs (Ibuprofen, Diclofenac) (Avoid in PPH risk patients)
🚫 Avoid Opioids unless necessary (e.g., Morphine, Pethidine)
✔ Ampicillin + Gentamicin + Metronidazole (For postpartum sepsis)
✔ Ceftriaxone + Metronidazole (For endometritis)
✔ Domperidone & Metoclopramide (Increase prolactin levels)
✔ Fenugreek, Shatavari (Herbal galactagogues)
🚫 Avoid Bromocriptine & Cabergoline unless stopping lactation
🚫 Avoid Estrogen-containing pills (COCs) in the first 6 weeks postpartum
| Stage | Drugs Used |
|---|---|
| Antenatal (Pregnancy) | Folic acid, Iron, Calcium, Iodine, Omega-3, TT vaccine, Anti-D, Methyldopa, Labetalol, Insulin |
| Labour | Oxytocin, Misoprostol, Epidural (Bupivacaine + Fentanyl), Pethidine, MgSO₄, Hydralazine |
| Postnatal | Oxytocin, Ergometrine, Carboprost, NSAIDs, Paracetamol, Antibiotics, Domperidone (for lactation), POPs (for contraception) |
👩⚕️ Antenatal Care:
✔ Give TT vaccination & Iron, Folic Acid supplements.
✔ Monitor BP (for Preeclampsia) & Blood Sugar (for Gestational Diabetes).
💊 During Labour:
✔ Monitor contractions & fetal heart rate.
✔ Administer Oxytocin, Pain relief drugs as per need.
🩺 Postnatal Care:
✔ Prevent PPH using Oxytocin, Methylergonovine.
✔ Support lactation with proper drugs & techniques.
✔ Educate about contraceptive options.
Iron supplements come in different formulations, including:
Iron is essential for:
Iron supplements increase hemoglobin levels, preventing or treating anemia.
| Form | Dose | Route | Use |
|---|---|---|---|
| Ferrous sulfate | 100-200 mg elemental iron/day | Oral | Pregnancy anemia |
| Ferrous fumarate | 106 mg elemental iron per 325 mg tablet | Oral | Mild-moderate anemia |
| IV Iron (Ferric Carboxymaltose, Iron Sucrose) | 100-200 mg per session | IV | Severe anemia, malabsorption |
| IM Iron Dextran | 50 mg/mL injection | IM | Iron-deficiency anemia (if oral iron is not tolerated) |
✔ Iron-deficiency anemia (Microcytic, Hypochromic anemia)
✔ Pregnancy & Lactation (Increased iron demand)
✔ Chronic blood loss (e.g., heavy menstruation, GI bleeding)
✔ Malabsorption syndromes (e.g., Celiac disease, Crohn’s disease)
✔ Post-surgical anemia (e.g., post-bariatric surgery)
❌ Hemochromatosis (Iron overload disorder)
❌ Hemosiderosis (Excess iron storage)
❌ Hemolytic anemia (Iron not required, as RBC destruction occurs)
❌ Peptic ulcer disease (Oral iron can worsen irritation)
🚫 Reduced Absorption with:
✔ Increased Absorption with:
⚠ Oral Iron:
⚠ IV Iron:
🚨 Iron Overdose Symptoms:
🔹 Treatment:
👩⚕️ Assessment:
✔ Monitor hemoglobin, serum ferritin, and iron levels.
✔ Check for GI side effects (Constipation, Nausea).
💊 Administration & Education:
✔ Give oral iron on an empty stomach for best absorption.
✔ Avoid milk, tea, and coffee around iron intake.
✔ Encourage Vitamin C-rich foods to enhance absorption.
🩺 Monitoring:
✔ Watch for iron overload in long-term supplementation.
✔ Educate about black stools as a normal effect.
Vitamin K exists in different forms:
Vitamin K1 is essential for:
| Indication | Dose | Route |
|---|---|---|
| Newborn prophylaxis | 0.5-1 mg within 1 hour of birth | IM |
| Vitamin K deficiency bleeding (VKDB) | 1-5 mg | IV/IM |
| Warfarin Overdose | 1-10 mg | IV/Oral |
| Malabsorption (Liver disease, Cystic fibrosis) | 2.5-10 mg weekly | Oral/SC |
✔ Prevention of Hemorrhagic Disease of the Newborn (HDN)
✔ Warfarin Overdose (Reverses Anticoagulation)
✔ Vitamin K Deficiency (e.g., in malabsorption syndromes, liver disease)
✔ Biliary disorders (Vitamin K requires bile for absorption)
❌ Hypersensitivity to Vitamin K
❌ Severe liver failure (IV form may not work effectively)
🚫 Reduced Effect with:
🚫 Increases Risk of Clots When Combined with:
⚠ Oral & IM Vitamin K:
⚠ IV Vitamin K (High dose rapid infusion):
🚨 Vitamin K Overdose Symptoms:
🔹 Management:
👩⚕️ Assessment:
✔ Check PT (Prothrombin Time), INR for clotting status.
✔ Assess newborns for bleeding disorders.
💊 Administration & Education:
✔ Give IM injection in the newborn within 1 hour of birth.
✔ Avoid rapid IV injection (Risk of anaphylaxis).
✔ Educate patients on foods rich in Vitamin K (Leafy greens, broccoli, liver).
🩺 Monitoring:
✔ Monitor for signs of bleeding (bruising, nosebleeds, hematuria).
✔ Watch for clotting issues in Vitamin K excess.
✅ Oxytocin binds to oxytocin receptors in the uterus → Stimulates rhythmic uterine contractions.
✅ Increases intracellular calcium levels → Enhances muscle contraction.
✅ Stimulates milk ejection from mammary glands → Facilitates lactation.
| Indication | Dose | Route |
|---|---|---|
| Induction/Augmentation of Labor | 0.5-1 mU/min (Increase by 1-2 mU/min every 30-60 min) | IV Infusion |
| Postpartum Hemorrhage (PPH) Prevention | 10 IU | IM/IV |
| Postpartum Hemorrhage (Treatment) | 20-40 IU in 1L NS/RL (Infused at 100-150 mL/hr) | IV Infusion |
| Incomplete/Missed Abortion | 10-20 IU in 500 mL NS/RL (Infused over 3 hours) | IV Infusion |
| Lactation Promotion (Milk Letdown Reflex) | 1-2 IU (If needed) | Nasal Spray (Rarely Used) |
🔹 Note: IV infusion is preferred for labor induction; IM injection is used for PPH prevention.
✔ Labor Induction & Augmentation (If spontaneous labor is not progressing)
✔ Postpartum Hemorrhage (PPH) Prevention & Treatment
✔ Incomplete or Missed Abortion (To expel retained products of conception)
✔ Lactation Assistance (Rarely used via nasal spray)
❌ Fetal distress (Non-reassuring FHR, late decelerations)
❌ Uterine hyperstimulation (Previous uterine rupture, Grand multiparity)
❌ Cephalopelvic disproportion (CPD)
❌ Malpresentation (Breech, Transverse lie)
❌ Placenta previa or vasa previa
❌ Cord prolapse
🚫 Increased Effect with:
🚫 Reduced Effect with:
⚠ Maternal Side Effects:
⚠ Fetal Side Effects:
🚨 Uterine Hyperstimulation (Tachysystole)
🚨 Uterine Rupture
🚨 Hyponatremia (Water Intoxication)
🚨 Signs of Oxytocin Overdose:
🔹 Management:
👩⚕️ Assessment Before Administration:
✔ Check fetal heart rate (FHR) pattern before starting infusion.
✔ Assess maternal vitals (BP, HR, contraction pattern).
💊 Administration Guidelines:
✔ Always use IV infusion pump for controlled delivery.
✔ Start with a low dose and titrate slowly to avoid hyperstimulation.
🩺 Monitoring During Infusion:
✔ Observe for tachysystole (>5 contractions in 10 min).
✔ Monitor fetal heart rate every 15-30 minutes.
✔ Check urine output (to prevent water intoxication).
📢 Patient Education:
✔ Inform the patient about possible pain and contractions.
✔ Teach signs of uterine rupture (sudden severe pain, fetal distress).
| Indication | Dose | Route | Notes |
|---|---|---|---|
| Medical Abortion (Early First Trimester) | 200-800 mcg total dose | Buccal, Vaginal, or Oral | Often combined with mifepristone |
| Management of Missed/Incomplete Abortion | 400-800 mcg | Vaginal or Oral | Can be repeated if necessary |
| Labor Induction/Cervical Ripening | 25-50 mcg every 4 hours (vaginal) | Vaginal or Buccal | Dose may vary per protocol |
| Prevention of Postpartum Hemorrhage (PPH) | 400-600 mcg | Oral or Sublingual | Alternative in low-resource settings |
| Gastroprotection (Peptic Ulcer Prevention) | 200 mcg four times daily | Oral | Taken with NSAIDs |
✔ Obstetrics & Gynecology:
✔ Gastroprotection:
❌ Pregnancy-Related Contraindications:
❌ Gastrointestinal Contraindications:
🚫 Other Uterotonics:
🚫 NSAIDs:
⚠ Common Side Effects:
🚨 Severe Uterine Hyperstimulation:
🚨 Excessive Bleeding:
🚨 Severe Gastrointestinal Reactions:
🚨 Overdose Symptoms:
🔹 Management:
👩⚕️ Pre-Administration Assessment:
✔ Confirm the indication (e.g., medical abortion, labor induction, PPH, or ulcer prevention).
✔ Review patient history for contraindications (e.g., ectopic pregnancy, hypersensitivity).
💊 Administration & Education:
✔ Educate the patient about the route (oral, buccal, vaginal) and timing of doses.
✔ Explain potential side effects, such as cramping and diarrhea, and advise when to seek help.
🩺 Monitoring:
✔ For Obstetric Use: Monitor uterine contractions, fetal heart rate, and vaginal bleeding.
✔ For Gastroprotection: Advise on monitoring for GI disturbances.
✔ Report any signs of uterine hyperstimulation or severe adverse reactions immediately.
📢 Post-Administration Care:
✔ Provide guidance on hydration, especially if GI side effects occur.
✔ Reinforce follow-up appointments to ensure therapeutic effectiveness and manage complications.
| Indication | Dose | Route | Notes |
|---|---|---|---|
| Postpartum Hemorrhage (PPH) Prevention | 0.2 mg | IM or IV (slowly) | Given after placental delivery |
| PPH Treatment | 0.2 mg every 2-4 hrs (max 5 doses) | IM or IV (slowly) | Used if oxytocin is not effective |
| Postpartum Uterine Atony | 0.2 mg every 6-12 hrs (max 5 doses) | Oral | Only for short-term use |
🔹 Note:
✔ Prevention & treatment of postpartum hemorrhage (PPH)
✔ Management of uterine atony (Failure of uterus to contract after delivery)
✔ Used after miscarriage/abortion to expel retained products
❌ Hypertension (Preeclampsia, Eclampsia, Gestational Hypertension) – Risk of severe hypertension and stroke
❌ Cardiovascular Disease (Heart Disease, Myocardial Infarction) – Can cause vasoconstriction and cardiac arrest
❌ Peripheral Vascular Disease (Raynaud’s Disease, Buerger’s Disease) – Risk of severe vasospasm
❌ Liver or Kidney Disease – Drug metabolism and clearance may be affected
❌ Sepsis or Severe Infection – Risk of vascular collapse
🚫 Not Used for Labor Induction – Causes sustained uterine contraction, leading to fetal distress and uterine rupture.
🚫 With Other Uterotonics (Oxytocin, Misoprostol, Carboprost):
🚫 With Vasoconstrictors (Epinephrine, Dopamine, Phenylephrine):
🚫 With Beta-blockers (Propranolol, Atenolol):
🚫 With Protease Inhibitors (Used for HIV/AIDS treatment):
⚠ Mild Side Effects:
🚨 Severe Hypertension (Most Common & Dangerous)
🚨 Uterine Hypertonicity (Strong, Prolonged Contractions)
🚨 Peripheral Vasoconstriction (Cold Hands/Feet, Cyanosis, Gangrene in Severe Cases)
🚨 Myocardial Infarction (Heart Attack) or Arrhythmias
🚨 Signs of Ergometrine Overdose (Ergotism):
🔹 Management:
👩⚕️ Before Administration:
✔ Check Blood Pressure – DO NOT give if BP >140/90 mmHg.
✔ Assess for cardiovascular disease, liver/kidney disease.
✔ Confirm placental delivery before administration (to prevent retained placenta).
💉 Administration Guidelines:
✔ IM route is preferred (IV is given slowly to avoid hypertensive crisis).
✔ Monitor uterine contractions & vaginal bleeding after administration.
✔ Ensure proper storage (Protect from light & store in a refrigerator).
🩺 Monitoring After Administration:
✔ Watch for signs of hypertension (Severe headache, visual disturbances, chest pain).
✔ Monitor for uterine rupture (Excessive, prolonged contractions).
✔ Check for signs of vasospasm (Cold, painful extremities, cyanosis).
📢 Patient Education:
✔ Inform the patient about possible nausea, vomiting, headache.
✔ Advise the patient to report severe headache, vision problems, or chest pain immediately.
| Category | Details |
|---|---|
| Class | Ergot Alkaloid |
| Uses | PPH prevention & treatment, Uterine atony |
| Dose | 0.2 mg IM/IV every 2-4 hrs (Max: 5 doses) |
| Onset of Action | 1-5 min (IM), 30 sec-1 min (IV) |
| Contraindications | Hypertension, Preeclampsia, Heart Disease, Peripheral Vascular Disease, Sepsis |
| Side Effects | Nausea, Vomiting, Headache, Abdominal pain |
| Adverse Effects | Severe Hypertension, Uterine Rupture, Peripheral Ischemia, MI |
| Toxicity | Ergotism (Severe Vasospasm, Gangrene, Stroke, Seizures, Hypertension) |
| Management | Stop the drug, Hydralazine (for BP), IV Fluids, Vasodilators, Magnesium Sulfate (for seizures) |
✅ Uterotonic Effect:
✅ Cervical & Uterine Effects:
✅ Luteolytic Effect:
✅ Bronchoconstriction & Gastrointestinal Effects:
| Indication | Dose | Route | Notes |
|---|---|---|---|
| Postpartum Hemorrhage (PPH) Treatment | 250 mcg every 15-90 min (Max 2 mg) | IM or Intramyometrial | Used when oxytocin & ergometrine fail |
| Induced Abortion (13-20 weeks gestation) | 250 mcg every 1.5-3 hrs | IM | Used if misoprostol fails |
| Incomplete or Missed Abortion | 250 mcg every 1.5-3 hrs | IM | Promotes uterine contractions for expulsion |
| Uterine Atony After Abortion | 250 mcg every 15-90 min (Max 2 mg) | IM | Prevents severe bleeding |
🔹 Note:
✔ Treatment of Postpartum Hemorrhage (PPH) when oxytocin and ergometrine fail.
✔ Induced abortion (2nd trimester, 13-20 weeks gestation).
✔ Management of incomplete abortion or miscarriage.
✔ Uterine atony post-abortion to prevent excessive bleeding.
❌ Severe Asthma or Respiratory Disorders → Can cause bronchospasm.
❌ Hypertension or Cardiovascular Disease → Risk of severe vasoconstriction & hypertension.
❌ Kidney or Liver Disease → Metabolism may be impaired, increasing toxicity risk.
❌ Pelvic Inflammatory Disease (PID) → Infection may worsen with uterine contractions.
❌ Allergy to Prostaglandins → Risk of severe hypersensitivity reactions.
🚫 With Oxytocin or Ergometrine:
🚫 With Bronchodilators (Salbutamol, Terbutaline):
🚫 With NSAIDs (Ibuprofen, Aspirin):
⚠ Common Side Effects:
⚠ Respiratory Effects (Due to Bronchoconstriction):
🚨 Severe Uterine Hyperstimulation:
🚨 Severe Hypertension:
🚨 Bronchospasm & Respiratory Distress:
🚨 Shock or Multi-Organ Failure (Rare but Severe Reaction):
🚨 Signs of Overdose:
🔹 Management:
👩⚕️ Before Administration:
✔ Check for contraindications (Asthma, Hypertension, Cardiovascular disease).
✔ Ensure oxytocin and ergometrine have failed before giving Carboprost.
✔ Assess uterine tone and vaginal bleeding before and after administration.
💉 Administration Guidelines:
✔ Give IM injection (Never IV due to risk of shock).
✔ Monitor uterine contractions and fetal heart rate (if applicable).
🩺 Monitoring After Administration:
✔ Observe for signs of bronchospasm (Wheezing, shortness of breath).
✔ Check BP frequently to prevent hypertensive crisis.
✔ Monitor for diarrhea, nausea, and vomiting (Provide IV fluids if needed).
📢 Patient Education:
✔ Explain potential pain, diarrhea, and fever as normal side effects.
✔ Instruct the patient to report severe cramping, shortness of breath, or chest pain immediately.
| Category | Details |
|---|---|
| Class | Prostaglandin F2α Analog |
| Uses | PPH treatment, Incomplete abortion, Induced abortion (13-20 weeks) |
| Dose | 250 mcg IM every 15-90 min (Max 2 mg) |
| Onset of Action | Within 15 minutes |
| Contraindications | Asthma, Hypertension, Cardiovascular Disease, Liver/Kidney Disease, Sepsis |
| Side Effects | Diarrhea, Nausea, Vomiting, Fever, Flushing |
| Adverse Effects | Severe Hypertension, Uterine Rupture, Bronchospasm, Shock |
| Toxicity | Respiratory Distress, Hyperstimulation, Multi-Organ Failure |
| Management | Stop Drug, Beta-agonists (for bronchospasm), Hydralazine (for BP), IV Fluids |
✅ Anticonvulsant Effect (For Preeclampsia & Eclampsia)
✅ Tocolytic Effect (Preterm Labor Prevention)
✅ Neuroprotective Effect (Preterm Birth Protection)
✅ Vasodilation & Smooth Muscle Relaxation
🔹 Loading Dose: 4-6 g IV over 15-20 minutes
🔹 Maintenance Dose: 1-2 g/hour IV infusion for 24 hours post-delivery
🔹 Loading Dose: 4 g IV over 15-20 minutes
🔹 Maintenance Dose: 1-2 g/hour IV infusion (Given for up to 48 hours)
🔹 Loading Dose: 4 g IV over 15 minutes
🔹 Maintenance Dose: 1 g/hour IV for 12 hours
🔹 Mild: 1-2 g IV over 1 hour
🔹 Severe: 4-6 g IV over 1 hour
🔹 Note:
✔ Obstetric Uses:
✔ Non-Obstetric Uses:
❌ Myasthenia Gravis (Causes muscle weakness, may lead to respiratory failure)
❌ Heart Block or Severe Bradycardia (Depresses cardiac function)
❌ Renal Failure (Risk of magnesium toxicity due to poor excretion)
❌ Hypocalcemia (Magnesium inhibits calcium release, worsening the condition)
🚫 With Calcium Channel Blockers (Nifedipine, Amlodipine):
🚫 With CNS Depressants (Benzodiazepines, Opioids, Anesthesia):
🚫 With Diuretics (Furosemide, Thiazides):
🚫 With Digitalis (Digoxin):
⚠ Maternal Side Effects:
⚠ Fetal Side Effects:
🚨 Respiratory Depression & Arrest
🚨 Severe Hypotension & Bradycardia
🚨 Loss of Deep Tendon Reflexes (DTRs)
🚨 Oliguria & Renal Failure
🚨 Signs of Magnesium Sulfate Toxicity:
🔹 Management:
1️⃣ STOP Magnesium Sulfate Immediately!
2️⃣ Administer Calcium Gluconate 10% IV (1 g over 10 minutes)
3️⃣ Provide Respiratory Support (Oxygen, Mechanical Ventilation if needed)
4️⃣ Monitor Urine Output (Must be >30 mL/hr to avoid accumulation)
👩⚕️ Before Administration:
✔ Check Baseline BP, Respiratory Rate, Reflexes, and Urine Output.
✔ Ensure Calcium Gluconate (Antidote) is available before infusion starts.
✔ Confirm IV Pump Setting (Slow Infusion is Necessary).
💉 Administration Guidelines:
✔ Give IV loading dose slowly over 15-20 minutes.
✔ Avoid rapid IV push (Risk of cardiac arrest!).
🩺 Monitoring During Infusion:
✔ Check deep tendon reflexes (DTRs) every 1-2 hours.
✔ Monitor respiratory rate (Must be ≥12 breaths/min).
✔ Assess urine output (Must be ≥30 mL/hr).
📢 Patient Education:
✔ Inform the patient about warmth, flushing, and drowsiness as normal effects.
✔ Advise the patient to report difficulty breathing, chest pain, or severe weakness immediately.
| Category | Details |
|---|---|
| Class | Electrolyte, Tocolytic, Anticonvulsant |
| Uses | Eclampsia, Preterm Labor, Neuroprotection, Hypomagnesemia, Arrhythmias |
| Dose | 4-6 g IV loading, then 1-2 g/hr IV maintenance |
| Onset of Action | Within 15 minutes |
| Contraindications | Myasthenia Gravis, Heart Block, Renal Failure, Hypocalcemia |
| Side Effects | Flushing, Nausea, Drowsiness, Weakness |
| Adverse Effects | Respiratory Depression, Hypotension, Loss of Reflexes, Cardiac Arrest |
| Toxicity Signs | Loss of DTRs, RR <12, Severe Hypotension, Cardiac Arrest |
| Antidote | Calcium Gluconate 10% (1 g IV over 10 min) |
✅ Restores Calcium Levels:
✅ Antidote for Magnesium Toxicity:
✅ Stabilizes Cardiac Membrane in Hyperkalemia:
✅ Promotes Bone & Muscle Function:
🔹 Dose: 1-2 g IV over 10-20 minutes
🔹 Route: Slow IV Injection (over 5-10 minutes) OR IV Infusion
🔹 Dose: 1 g IV over 5-10 minutes
🔹 Route: IV Push or Infusion
🔹 Dose: 1 g IV over 10 minutes (Can be repeated if necessary)
🔹 Route: Slow IV Injection
🔹 Dose: 1-3 g per day (Divided doses)
🔹 Route: Oral Tablets or Solution
🔹 Note:
✔ Hypocalcemia (Low blood calcium levels)
✔ Hyperkalemia (Prevention of arrhythmias)
✔ Hypermagnesemia (Magnesium Sulfate Toxicity)
✔ Calcium Channel Blocker Overdose (e.g., Amlodipine, Nifedipine overdose)
✔ Post-thyroidectomy (To prevent hypocalcemia-related tetany)
✔ Osteoporosis Prevention (Used with Vitamin D supplements)
❌ Hypercalcemia (High blood calcium levels)
❌ Severe Kidney Disease (Risk of calcium accumulation)
❌ Digitalis Toxicity (Can worsen cardiac arrhythmias)
❌ Sarcoidosis (Increases risk of high calcium levels)
🚫 With Digoxin (Digitalis):
🚫 With Calcium Channel Blockers (Verapamil, Nifedipine, Amlodipine):
🚫 With Tetracyclines & Fluoroquinolones:
🚫 With Biphosphonates (For Osteoporosis Treatment):
⚠ Mild Side Effects:
🚨 Cardiac Arrhythmias (If IV is given too fast)
🚨 Severe Hypercalcemia (If overdosed)
🚨 Tissue Necrosis (If IV calcium extravasates into surrounding tissue)
🚨 Signs of Calcium Overdose (Hypercalcemia Crisis):
🔹 Management:
1️⃣ Stop calcium administration immediately.
2️⃣ IV Fluids (Normal Saline) to flush out excess calcium.
3️⃣ Loop Diuretics (Furosemide) to increase calcium excretion.
4️⃣ Calcitonin (For severe cases) to lower blood calcium levels.
5️⃣ Monitor ECG and Serum Calcium Levels frequently.
👩⚕️ Before Administration:
✔ Check Serum Calcium, Magnesium, and Phosphate Levels.
✔ Assess for signs of hypercalcemia (confusion, nausea, frequent urination).
✔ Check kidney function before giving IV calcium.
💉 Administration Guidelines:
✔ Give IV calcium slowly (1 g over 10 minutes).
✔ NEVER give IV calcium rapidly (risk of cardiac arrest).
✔ Ensure IV line is patent (Avoid extravasation that can cause tissue necrosis).
✔ For oral calcium, give with Vitamin D for better absorption.
🩺 Monitoring During Infusion:
✔ Check ECG (For arrhythmias or bradycardia).
✔ Monitor serum calcium levels regularly.
✔ Watch for IV site reactions (Pain, redness, necrosis).
📢 Patient Education:
✔ Take oral calcium with meals to improve absorption.
✔ Avoid taking calcium with iron supplements, tetracyclines, or biphosphonates.
✔ Drink plenty of fluids to prevent kidney stones.
✔ Report symptoms of hypercalcemia (nausea, confusion, frequent urination).
| Category | Details |
|---|---|
| Class | Electrolyte supplement |
| Uses | Hypocalcemia, Hyperkalemia, Magnesium Sulfate Toxicity, Osteoporosis |
| Dose | 1-2 g IV over 10 min for emergency, 1-3 g/day orally for chronic use |
| Onset of Action | Within 10 minutes (IV), 1-2 hours (Oral) |
| Contraindications | Hypercalcemia, Kidney Disease, Digitalis Toxicity |
| Side Effects | Flushing, Nausea, Constipation, IV site pain |
| Adverse Effects | Arrhythmias, Hypercalcemia, Tissue Necrosis |
| Toxicity Signs | Severe Weakness, Confusion, Kidney Stones, Cardiac Arrest |
| Management | Stop Drug, IV Fluids, Furosemide, Calcitonin |