IMPORTANT OBSTRTICS MEDICINES.

• Labetalol :-

Group:- Alpha (alpha) and beta (beta) adrenergic antagonist

Dose :- 1ml -5mg, 20mg/4ml

Route :- intravenously (lv only), ORAL

Mode of action :-

Labetalol combines both selective competitive alpha one blocking and non-selective beta receptor blocking activity in a single substance.

Labeta Lol is a beta blocker medication that relaxes blood vessels and slows the heart rate, decreasing blood flow and blood pressure.

Use :- High blood pressure in pregnancy can cause complications for mother and baby.

Labetalol is a blood pressure medication used to lower blood pressure during pregnancy.

Indication:-

High blood pressure

preeclampsia

Eclampsia

Contraindications :-

Bronchial asthma

Cardiac failure

Cardiogenic shock

Severe bradycardia

Severe hypotension

Hypersensitivity

Side effects:-

Labetalol affects the growth of the baby in the womb.

Affects the baby’s blood sugar level.

Patient feels dizzy, sleepy and weak.

Head one

Cold fingers or toe

Nausea or vomiting.

diarrhea (diarrhoea)

Stomach pain

•√. Labetalol first line choice in pregnancy :-

Because reduces hypertension during pregnancy with every prescribed antihypertensive drug, but labetalol reduces hypertension, protein urea, and fetal/newborn death rates.

Nursing responsibility:-

To maintain the seven rights of the patient.

Right route

Right dose

Right client

Right time

Right drug

Right information to client

Right to refuse

Monitor blood pressure and pulse frequently during dose adjustment and periodically during therapy.

See the patient for complications.

Patient receiving i/v labetalol must be in supine position 5. Patient recommended supine position after three hours of drug administration.

Monitor patients intake and output chart and weight chart daily.

Watch for out come of drug administration.

Magnesium sulfate

Group Antique Conversion and Mineral Supplement
Route: Intravenous and intramuscular
Dose: Magnesium sulfate is given in an intravenous loading dose of four to six grams at an interval of 15 to 20 minutes and in a maintenance dose of 1 to 2 grams.

Repeat injections are given only if:

Knee jerks are present, urine output more than 30ml/hours

Respiration rate more than 12/ min.

Therapeutic serum magnesium sulphate is 4 to 7 meq /L.

MODE OF ACTION :-

Neuromuscular blockade –– Magnesium sulfate releases acetyl choline at the myoneural junction. This acetyl choline is responsible for muscle relaxation. This action can treat and prevent seizures.

Vasodilation –– Magnesium sulfate injection dilates the blood vessels due to which blood flow is improved, due to this effect the condition of pre-eclampsia and eclampsia is treated.

Central nervous system depression –– works as a central nervous system depression due to which the excitability of the nervous system of the brain is reduced. is

INDICATION : Primary use of magnesium sulphide injection is for the prevention and treatment of seizures in pregnant women with conditions such as eclampsia and preeclampsia, magnesium deficiency, certain cardiac arrhythmias and tocolysis (prevention of premature labour).

SIDE EFFECTS –— Respiratory depression, muscle weakness, nausea and vomiting, pain redness and swelling on injection site.

CONTRAINDICATIONS ––

Severe kidney impairment,
Myasthenia gravis,
Heart block
Hypersensitivity to magnesium sulfate

NURSING RESPONSIBILITY —

ASSESSMENT — a. Before giving magnesium sulfate, perform vital sign assays, take patient’s medical history, perform laboratory investigations.
b. Before administering magnesium sulphate drug check the contraindications of that drug like renal impairment, hyper-fecundity, etc.
2.Dosage calculation and preparation properly and according to physician’s order

Administration Administer the drug according to the prescribed route

Continuous monitoring of the injection side so that we can detect any complications

Maintain proper infection control practices while administering drugs to control infections

MONITORING — Continuous monitoring of patient’s vital signs like blood pressure heart rate respiration and oxygen saturation monitoring

To monitor the patient’s urine output and kidney function so that if there are signs of kidney impairment we can assist him.

Patients education –– explaining to the patient’s family members the purpose of magnesium sulfate injection, potential side effects and signs of complications

Documentation – Proper documentation after drug administration to the patient

Safety measures — ensuring availability of emergency treatment and assessment of patient for potential complications and availability of calcium gluconate for magnesium toxicity
ANTI DOTE : CALCIUM GLUCONATE

Tranexamic acid

There is a medication that is used to control excessive bleeding and to prevent bleeding.

Here are details related to tranexamic acid.

👉Drug class

Tranexamic acid belongs to a class of medication known as antifibrinolytics.

It works to inhibit the breakdown of blood clot, thereby reducing bleeding.

👉Dosage

The recommended dose of tranexamic acid injection varies depending on the indication.

Tablet dose – 500 mg
Injection dose – 5 ml

For treatment of bleeding disorders :- every 8 hours simple Dosage 1 to 1.5 gm for IV (intra venous) which should be adjusted based on the response of the patient.

For surgical prophylaxis :- A single dose of 1 gm IV can be administered before surgery or the dose is given according to the patient’s need.

For postpartum haemorrhage :- typical dose is 1 gm IV which is given as soon as possible after delivery, if the need of the patient is high then it should be given according to dose set.

👉Route:

For injection – Intra venous(IV)
For Tablet – Oral

👉Mode of action

It is an antifibrinolytic agent (inhibition of fibrinolysis).

Tranexamic acid prevents the conversion of plasminogen to plasmin, thus stopping the breakdown of the blood clot.

It blocks lysine binding sites on plasminogen molecules.

Hence it inhibits the activation of plasminogen into plasmin.

It therefore inhibits the ability of plasmin to form fibrin degradation products.

This inhibits the breakdown of the clot. (Fibrinolysis)

Then finally bleeding is reduced.

👉Indication

Tranexamic acid injection is indicated for the treatment and prevention of excessive bleeding in various medical and surgical conditions, including the following:

Menstrual bleeding disorders (e.g. menorrhagia)

Hemorrhage associated with surgery and trauma.

For dental procedures in patients with bleeding disorders.

Postpartum hemorrhage (excessive bleeding after child birth)

👉Contraindication

In patients with history of thrombolytic events (stroke, myocardial infraction)

Active intravascular clotting or hypersensitivity to Tranexamic acid

👉Side effects

Common side effects of Tranexamic acid injection

Nausea

Vomiting

Diarrhea

Dizziness

Fatigue

Serious adverse reaction such as,

Thrombolytic events

Seizures and allergic reactions are rare but may occur

particularly with high doses or prolonged treatment

Special precautions

Tranexamic acid should be used with caution in patients with renal impairment, because dose adjustment is necessary to prevent drug accumulation.

Tranexamic acid injection is an effective and widely used medication for the management of excessive bleeding in various clinical situations.

It should be used carefully and under guidance.

Work should be done keeping in mind its risks and benefits so that it cannot harm the patient.

Nursing responsibilities

A nurse has many responsibilities to ensure safe and effective patient care while giving tranexamic acid injection.

The nursing responsibilities associated with the administration of tranexamic acid are as follows,

👉1. Assessment

Assess the patient’s medical history including,

any allergies

bleeding disorders

any kidney problems

Evaluation of the current clinical status of the patient and giving Tranexamic acid therapy according to indication, such as…

Excessive bleeding or hemorrhage

👉2. Medication preparation

Verify for the following according to Physician’s order,

correct dose

route of administration

frequency of tranexamic acid

Preparation of medication with aseptic technique, preparation and administration following institutional policies and procedures.

👉3. Patient education

Explain the purpose of Tranexamic acid therapy to the patient, explain its role in reducing and preventing excessive bleeding.

After giving the injection, provide information to the patient about its potential side effects, precautions and signs of adverse reaction.

👉4. Injection administration

Selecting the appropriate injection site and needle size for administering Tranexamic acid.

Typically IV (intra venous) or IM (intra muscular) depending on the patient’s condition and clinical setting.

Administration of injection should be done after ensuring accurate dosage and with proper technique, and proper disposal of needle and syringe should be done.

👉5. Monitoring

Monitor the patient closely during and after the injection for signs of allergic reaction such as rash, itching, swelling or breathing difficulty.

Monitor vital signs

blood pressure

Pulse rate

Respiratory rate Special monitoring of patients who are at risk of cardiovascular or thrombolytic events.

👉6. Documentation

Document the administration of tranexamic acid.

including,

route

Site

Time of administration

✅️ Record…

_ any patient’s assessment

_ vital signs and observations related to the medication administration

_ patient’s response to treatment

👉7. Follow up

To assess the effectiveness of Tranexamic acid therapy to control bleeding or reduce symptoms.

Provide additional support, education, and resources and communicate with patients

If there is any kind of change in the patient’s condition, it should be reported to the health care team.

To fulfill the nursing responsibilities and to promote the positive outcome of the patient by administering the injection in a safe and effective manner.

When medication is administered, close monitoring, patient education and communication are essential components of nursing care.

👉 8. Storage

Up to 12 weeks at temperatures from 4 Celsius to 50 Celsius

And

Up to 4 weeks at -20 Celsius as determined by high performance liquid chromatography (HPLC)

Freezing should be avoided as cracks were observed in the ampoules within 1 week.

[Methergine]

➡️Introduction:-
➝ Methergine is a medication primarily used to control and prevent postpartum hemorrhage (excessive bleeding after childbirth). And it is also used to treat uterine bleeding disorders.
➝ The medication contains Methair-Gometrin, it works on the smooth muscles of the uterus and helps in controlling bleeding.

➡️FORM:– Injectable & Tablet available

➡️DOSE:– 0.2mg/ml
➝ Dose of this medication should be taken after meal and can be repeated in 2 to 4 hours period if necessary, maximum 5 doses can be taken in 24 hours period can be taken in 24 hours period.

➡️ GROUP NAME:– Ergot alkaloids

➡️ROUTE:- I/M & I/V

➡️ MAXIMUM DOSE:- 1gm/day

➡️ Other Name :- 1.Methylergovinon meleate

2. Methylergobasin meleat

➡️POPULAR BRAND NAME:–
➝ injection form :- MEM, Methrmed, utergin
➝ Tablet form: Metrin, Methergin, Metergo, Ergomin, Ergowell, Methrlin.

➡️MODE OF ACTION:-
➝ Methylergonovin maleate is an active ingredient that activates certain serotonin receptors, specifically the Alpha adrenergic receptor.
➝ By stimulating this receptor, Methergine causes the smooth muscles of the uterus to contract and lead to uterine involution (after childbirth the uterus returns to its normal size and position).
And reduces bleeding.
➝ Additionally, Methargin constricts blood vessels which further controls uterine bleeding.

➡️ INDICATION:-
➝ control bleeding after childbirth
➝ control bleeding after abortion
➝ To stop miscarriage bleeding
➝ To stop heavy bleeding of periods
➝ To control PPH (post partum hemorrhage)
➝ After taking MTP tablet to stop bleeding
➝ Reducing the risk of excessive bleeding & helping to contract uterus.

➡️CONTRAINDICATION:-
➝ During pregnancy
➝ Hypersensitivity to Ergot alkaloids
➝ preeclampsia
➝ eclampsia
➝ Hypertension
➝ Toxemia of pregnancy
➝ peripheral vascular disease
➝ liver & kidney disease
➝ Hiv patient

➡️SIDE EFFECT:-
➝ Nausea
➝ Vomiting
➝ Stomach upset
➝ Headache
➝ Change In BP
➝ Inj. site pain
➝ Dizziness
➝ Abdominal pain

☞ Serious side effects:
▪️ Seizures
▪️ Hallucinations & stroke like symptoms
Leg camps
▪️ Irregular heartbeat
▪️Chest pain

➡️ NURSING RESPONSIBILITY:-

☞ Perform patient’s medical history, current medication and vital sign assessment before administering Methergine.
☞ The nurse should educate the patient about the medication, its purpose, potential side effects and when to seek medical attention.
☞ Nurse closely monitor the patient for adverse reactions especially change in BP & sign of excessive uterine contractions.
☞ Verifying the correct dose and identifying the patient.
☞ To maintain record and report of accurately administration documents.
☞ The nurse should be ready to intervene immediately in case of any complications like hypertensive crisis or allergic reaction.

➡MONITORING:-
☞ During methergine therapy, the nurse should regularly monitor the patient’s BP in the first few hours after methergine administration.
☞ He should also observe the tone of the uterus without excessive bleeding.
☞ If the patient experiences severe persistent side effects during this time, the nurse should notify the health care provider immediately.
☞ And additionally you should assess the patient for the following symptoms like Headache, nausea, vomiting and allergic reaction.

inj. Epidosin

Other name :- It is also called valethmet bromide.

Group : antispasmodic, anticholinergic, & spasmolytic agent

Dose :- 16 mg /2 ml

Route :- deep Im or iv

Frequency :-od (1 time in day)

•√Mode of action :-

Epidosine inhibits the action of acetylcholine substance, which works to relax smooth muscle, which mainly contracts the muscle of intestine and cervix.
Induce strengthening uterine contraction
Relieves pain

Indications:

It is used in treating pain due to muscle spasm.

Reflex to smooth muscle

Cervical dilatation and prevent cervical dystocia

Treat Access Bleeding

Use for opening of cervix in first stage of labor

It is also used in the urinary tract and gall stone colic

REDUCE POST-OPERATIVE PEN

•√ Manly use in obstetrics :- episosine Manly use in shortened first stage of labor and minims cervical dystocia and prolonged labor

Side effects :-

Dry mouth

Flushing of face

Constipation

Dysphagia

Difficulty in passing urine

Tachycardia

Blurred vision

Glaucoma

Dizziness

Urine retensin

Difficulty in talking

√ Contraindications :-

1. Allergic reaction

Liver or kidney problem

Intenstinal blockage or obstruction inetenstine

Glaucoma

Pyloric Stenosis and Stomach Colitis

•√Available forms

Injection epidosine 8 mg/1 ml
16 mg /2 ml

Tablet epidosine which is available in 10 mg ma.

• Content :-

Velethmete bromide – 8 mg
Sodium chloride- 8 mg

•√Precautions :-

pregnancy :
Consult your doctor before using episosine during pregnancy

Breastfeeding:
Consult your doctor before using this injection while breastfeeding because of its many side effects.

Driving:
It is advised to avoid driving because injection that may experience blurred vision

alcohol :
Avoid alcohol consumption fearing this medication

•√ Nursing responsibility :-

• Check the intensity, duration and frequency of uterine contractions

•Monitor BP, pulse, temperature and respiration

• Menton Labor Progress Chart
• Check cervical dilation and effacement of cervix

•Notify physician if there are any complications or severe side effects

•Consider patient’s all right

Antara/DMPA-depot medroxyprogesterone acetate

Group: progestin
Dose: 150 mg/ml
Route: IM (upper arm and buttocks)

Mode of action:

It inhibits the production of gonadotrophin, preventing the follicle from maturing and forming an ovum. Thins the endometrium. It prevents monthly ovulation, and thickens the cervical mucus so that sperm stops.

Contains:

Medroxyprogesterone acetate

Pharmaceutical form:
Sterile aqueous suspension

Indications:

7 days during periods,
Breast feeding mother – after 6 weeks,
Non breast feeding mother – at the time of delivery,
Abortions- Seven days after abortion

Contraindication:

Unexplained vaginal bleeding,
breast cancer,
stroke,
severe diabetes,
liver disease,
Pregnant woman
BP – 160/150 mmHg
Genital cancer

Side effects:

Increases risk of cardiovascular disease by 40%,
Hypertension,
Irregular menstrual cycle,
Brest swelling,
Abdominal bloating,
Headache, body pain,
Dizziness,
weight gain,
body etching,
moodswing,
Decreases milk production

Benefits:

For a breastfeeding mother, after 7 days of good delivery,
Menstrual cramps and blood loss are reduced,
Safe in HIV AIDS,
One injection provides protection for up to 3 months

How to take:
To be taken every 3 months. And take MPA card as per given date.

Nursing Responsibilities:

Assessment of patients,
Explain about medical history, allergies, medication history, other contraceptive method,
Explain its advantages, disadvantages, side effects, BP and weight,
Ask for follow up, fill MPA card ma details and write date of stomach injection in that card, give that card to the client.

Chhaya tablet/ centchormen/ ormeloxifene

Group: Selective estrogen receptor modulators
Dose: 30mg each tablet

Mode of action: It works as a modulator of selective estrogen receptor. It avoids the hormonal action on the uterus and inhibits implantation. Blocks the estrogen receptor so that the endometrium does not grow and the implantation of the egg is prevented.

Indications:
Contraceptive pills,
In the treatment of abnormal uterine bleeding,
Anti-osteoporotic,
Palliative measures in advanced breast cancer

Contraindication:
Polycystic Ovarian Disease,
Cervical hyperplasia,
Past ma jaundice or liver
DCS,
Hypersensitivity, TB, kidney disease

Side effects:
In some women, those 3 month periods come late.
Bleeding is reduced.

How to take:
Take that pill on the first day of your period and then take another pill on the third day. So after taking it for 3 months, in the fourth month, take the pill on the day on which you have taken it.
Like.. If the day of periods is Sunday then take it on Wednesday then take it for 3 months and take one day on Sunday in the fourth month.

If you forget to take a pill:
If the pill is forgotten. Taking the valley rhythm as possible. But in less than seven days
Take and use a backup method (like condom). If missed for more than seven days, discard the packet of tablets and start a new packet again.

Nursing Responsibilities:
Explaining about contraceptive pills,
How to take it
Its effects, side effects,
Dose, time, follow up, telling to do it if you forget to take the tablet,
Documentation

💠Oxytocin

Oxytocin is synthesized by the supraoptic and paraventricular nuclei of the hypothalamus. Stored and released in posterior pituitary glands.
Oxytocin is stimulated by sucking of the vagina, cervix and breast.

➡️Mode of action It contracts the uterus fundus part and relaxes the lower part (cervix).
➝ It is stimulated by amnoitic and decidual prostaglandin production London
➝ It works on the oxytocin receptor in the smooth muscle of the myometrium and binds with it.
➝ It activates phospholipase c to release inositol triphosphate(ip3).
➝ which binds to the sacroplasnmic reticulum na receptor in the cell and stores calcium release in it. ➝ contractile protein (actin and myocin) is activated and increase in frequency and force of uterine contraction.

➡️Route

Intramuscular

• Intravenous infusion, but no iv bolus
  ➡️Dose
  Available in ampoule and vial.
  1ml ampoule = 5 IU
  10ml vial = 100IU
  Dissolve it in normal saline or ringer lactate.

➡️Indication
➝ Induction of labor
➝ Augmentation of labor process
➝ Uterine inertia
➝ Active management of third stage of labor
➝ Vesicular/ hydatidiform mole evacuation
➝ Post partum hemorrhage (PPH)
➝ For induction of abortion process along with prostaglandin
➝ to initiate milk let down in breast
➝ promotion of uterine involution
➡️Contraindication
➝Grand multiparous (<5)
➝ mal presentation
➝ Heart disease
➝ obstructed labour
➝ non reassuring fetal heart rate
➝ contracted pelvis or cephalo pelvic disproportion
➡️Side effects
➝Hyper stimulation of uterus (<60)
➝ tackysystole (<6 contractions in 10 minutes)
➝ rupture of uterus
➝ water intoxication
➝ Tachycardia
➝ confusion
➝ Non-reassuring fetal heart rate or fetal death
➝ difficulty in breathing
➝ headache
➡️Brand name
→ pitocin
→syntocinon
→syntocin
→oxyto
→labtocin
➡️Nurses Responsibility
☞ To check the dose route and infusion rate of rug.
☞ To check the progress of labor and its intensity, duration and frequency of uterine contraction.
☞ To monitor blood pressure, pulse and respiration.
☞ Partograph to maintain.
☞ Maintain intake output and monitor maternal electrolytes.
☞ To check fetal heart rate every 15 minutes.
☞ Monitor for symptoms of water intoxication like headache, drowsiness and confusion.
☞ Inform the physician if there is frequent contraction or absence of contraction, fetal distress.
☞ Explain to the patient and family if there is excessive blood loss.

Perinorm

The genetic name of perinorm is metoclopramide
Group:- Anti-emetics & prokinetic agents
Route:- Orally, IV, IM
Forms:- Tablet, Capsule, Syrup and Injection

Mode of Action :-

Metaclopramide antagonizes central medullary chemoreceptors and triggers peripheral D2 receptors. And reduces the sensitivity of vomiting.

Metaclopramide blocks the antiperistalsic effect of apomorphine.

Metaclopramide stimulates the anterior pituitary which causes the release of prolactin hormone which helps in lactation.

Indication:-

• Nosia
• Vomiting
• GERD
• Heart burn
• Dyspasia
• GI disorders
• Lactation failure

Contraindications:-

• Hypersensitivity
• GI bleeding
• Obstruction
• Depression
• Caesar
• Benign tumor

Side effects :-

• Sleepiness
• Stomach pen
• Diarrhea
• Dizziness
• Wickness
• Stephenish
• Take the feeling
• Low blood pressure
• Restlessness
• Shaking
• Slow heart rate
• Hallucinations

Nursing Responsibility :-

• Watch the patient for hypersensitivity effect.
• To observe patient’s vital signs.
• To maintain patient rights.
• To watch for side effects and other complications.
• Advising the patient to take the drug after meal and before bed.
• In case of drug overdose, give the patient anti-cholerge medication as per the doctor’s order.
• Inform the patient that the effect of overdose drug should subside within 24 hours.
• Maintaining patient intake and output chart.

Tablet Nifedipine

Group – calcium channel blockers
(Anti Hypertensive Drug)

Other name – Adalat, nifelat

Dose-1. Capsule-10mg, 20mg

2. Tablet-30mg,60mg,90mg

Route – orally

Frequency -BD/TDS

Action time -20 min to 2 hours

Mode of action

It inhibits the transmembrane flow of extracellular calcium ions across the vascular smooth muscle cell membrane without altering the serum calcium concentration.

This results in inhibition of cardiac and vascular smooth muscle contraction and dilatation of the main coronary and systemic arteries.

Indication

-Hyper tension

• Angina
• High blood pressure in pregnancy
  High pulmonary edema
  Rayons Phenomena
• Premature labor
  -Anna Fisher

Mainly used in obstetrics

• Niphi DP relaxes non-specific smooth muscles and may exert a tocolytic effect by inhibiting the influx of extracellular calcium into myometrial cells.
• This tablet is used to prevent pre-term labor
  Nifedipine Tablets are used to treat chronic hypertension in pregnancy and prevent preeclampsia.

Side effects

•Dizziness
•Flushing
•Nozia
•Head one

• Hypo tension
• Palpitation
  •In EDEMA
• Shortness of breath
  •Inhibition of labor
• MI

Contraindications

• Hypersensitivity
  •Cardiogenicshock
  •Hypo tension
  •Breast feeding mother
  •Alcoholic
• Heart block

Precautions

✓Caution in clients taking low BP, acute MI, and other anti-hypertensive medications
√Avoid grape fruit juice while taking this meditation
√ Do not crush, chew or breakdown Nifedipine capsules

Nursing considerations

•Assess and monitor for side effects
•Monitor blood pressure and heart rate
•Monitor vital signs

• Evaluate the therapy response
• Follow doctors instructions carefully

” HYOCINE BUTYLBROMIDE “

➡️ Group : Antimucarinic

➡️ Inj. : 20 mg/ml

➡️ Dose: for adults – 20 to 40 mg
for labor – 10 to 20 mg

➡️ Route : Intramuscularly
Intravenously

➡️ Mode of action:

Hyocine butylbromide works by blocking the action of acetylcholine, the neurotransmitter responsible for transmitting signals in the nervous system.

Specifically, it acts as a muscarinic receptor antagonist in smooth muscle. It includes the gastrointestinal tract.

Muscarinic receptors are part of the parasympathetic nervous system. Which plays a role in the regulation of smooth muscle contraction.

After blocking this receptor, hyoscine butylbromide inhibits the effects of smooth muscle ma acetylcholine. which relaxes the muscles of the gastrointestinal tract.

➡️ Indication:

Irritable bowel syndrome

Gastrointestinal spasms

Biliary colic

Diagnostic procedure

Symptomatic relief

Abdominal pain and cramping

Use in labor

Contraindication:

Hypersensitivity

Glaucoma

Obstructive disorder

Myasthenia gravis

Severe ulcerative colitis

Tachycardia

Certain medications

➡️ Side Effects:

Dry mouth

Blurred vision

Dizziness

Constipation

Urinary retention

Tachycardia

Nausea and vomiting

Allergic reaction

➡️ Nursing responsibility:

Assessment:
Nurses assess the patient’s medical history, allergies and vital signs.

Education:
Telling the patient about common side effects like dry mouth, blurred vision or dizziness

Administration:
Nurses should administer as per prescribed dosage, route and frequency.

Documentation:
Timely and accurate documentation of medication administration, dose, route etc.

Misoprostol

INTRODUCTION:
Misoprostol was discovered in 1973 as a prostaglandin E1 analogue.
Misoprostol was registered in 1986 for the prevention and treatment of peptic ulcers secondary to NSAIDS.

Trade name: cytotec.

Class of drug: SYNTHETIC PGE1 ANALOG

DOSE: To prevent peptic ulcer
-200 mcg; 100 mcg
:induced of labour

• 25 mcg
  : as prophylaxis of pph (post partum haemorrhage)
  -600 mcg PO

Route of administration:

Oral route
buccal
Sublingual
Vaginal
Rectal

Mode of action:

Misoprostol directly stimulates the prostaglandin E1 receptor located on the parietal cells of the stomach and thereby inhibits basal and nocturnal gastric acid secretion. And chances of peptic ulcer are reduced.

UTEROTONIC ACTION:
Misoprostol acid gets attached to its receptor
⬇️
Inhibition of adenyl cyclase
⬇️
Reduction of CAMP (central second messenger)
⬇️
Entry of Ca+2 through calcium dependent channels
(Intracellular & extracellular)
⬇️
Increase in intracellular calcium levels
⬇️
Uterine contractions

INDICATIONS:

As NSAIDS induced ulcer
pregnancy termination
Stress ulcer prophylaxis
induction of labour
NOTE: 25 microgram PV 4 hourly (max: 6)
Or
20 micrograms PO 2 hourly (max:12)
(Not to be used in patients with previous cesarean delivery or major uterine surgery)
PPH (post partum haemorrhage)
Treatment of incomplete abortion.

CONTRAINDICATIONS:

Pelvic infection or sepsis
Hemorrhage instability or shock
Allergy to misoprostol
bleeding disorder
Anticoagulant therapy is ongoing.
Suspected ectopic pregnancy.
To be taken during pregnancy without doctor’s concern.

ADVERSE EFFECTS:

Shivering/chills
Diarrhea
Abdominal pain
Hyperthermia
nausea
Vomiting
Menstrual irregularities
Breakthrough bleeding
dyspepsia (indigestion)
Constipation
headache

PRECAUTIONS/WARNING:

DO NOT USE THIS MEDICINE FOR PREGNANT WOMEN OR PLANNING TO BECOME PREGNANT.
Miscarriage, premature baby and birth defects are also seen from this medicine if taken during pregnancy.

NURSING RESPONSIBILITIES:

Misoprostol tablet is used to prevent ulcer caused by nsaids and also used in termination of pregnancy & induce uterine contractions.
Here the nursing responsibility associated with misoprostol administration.

Assessment:

Perform a through assessment of the patients medical history including any allergies, obstetric history and any cesarean surgery rated history.
Check patient’s vital signs, uterine tone and bleeding status before misoprostol administration to establish baseline.

Preparation:

Before giving misoprostol to patients, verify the doctor’s order e.g. correct dose, concentration, route of administration etc.

Patient education:
Tell the patient about misoprostol therapy and purpose, including its role in termination and preventing ulcer.
Providing information to the patient about its portal side effects, precautions, contraindications and adverse effects e.g shivering, nausea, vomiting.
To discuss about Importance of maintaining dosing and close monitoring after administration.

Monitoring:

To monitor patient’s vital signs, fetal heart sound and uterine activity for 1 hour after administration of misoprostol.

To assess signs of adverse effects or any complication.

Documentation:

Document the administration of misoprostol including the dose, route, site and time of administration in the patient’s medical records.

Follow up:

Ask the patient for follow up after misoprostol administration. To monitor treatment response and any bleeding or complications.

Storage:

Store the medicine in a closed container at room temperature. Keep away from heat, moisture and direct light.

Keep from freezing.

Keep out of reach of children.
Store in dry area.
It may have updated.

IRON FOLIC ACID

class: hematinic
USES:
iron folic acid medicine is an iron supplement which is used to treat or prevent low blood level of iron.
Iron is an important mineral that produces red blood cells.
Iron is best absorbed on empty stomach.

DOSAGE:

AGE GROUP:
▪️6 to 60 months
DOSAGE:
▪️ 1ml of IFA (iron folic acid) syrup containing
-20mg of elemental iron and
-100mcg of folic acid
AGE GROUP:
5 to 10 years
Dosage:
▪️ Tablet
-45 mg elemental iron and
-400 mcg of folic acid.
AGE GROUP:
10 To 19 years
Dosage:
Tablets:
-100mg elemental iron and
-500mcg of folic acid.
AGE GROUP:
▪️pre & lactating women
Dosage:
▪️ Tablets:
-100mg elemental iron and
-500 mcg of folic acid.
Regime:
1 tablet daily for 100 days, starting after the first trimester
▪️to be repeated for 200 days post partum.
AGE GROUP:
women reproductive age
Dosage:
Tablets:
-100mg elemental iron and
-500 mg of folic acid
Regime:
▪️weekly throughout the reproductive period.

INDICATION:

• Iron deficiency anemia

Prophylaxis of iron deficiency in low birth weight & breastfed babies.

CONTRAINDICATION:

Hypersensitivity

Hemochromatosis

Anemia not caused by iron deficiency

Untreated pyelonephritis

acute liver disease

ADVERSE EFFECT:

Nausea, diarrhea, constipation

epigastric pain

black stool

taste disturbance

dizziness, headache
INTERACTION:

Anatacid, milk, tetracycline, zinc: which reduces the absorption of oral iron.

ciprofloxacin, levofloxacin, ofloxacin
tetracycline, levodopa:
absorption is decreased by oral iron.
Drug food interaction

Do not take iron folic acid with alcohol daily product and eggs.

Enhance the absorption of iron:
▪️ascorbic acid

present in fruit juices

potatoes and other tubers and cabbage.

Dinoprostone gel

“Definition”
Dano Prostone Gel is used for preparation of cervix and induction of labor in pregnant women.
Group of drugs
-It is a prostaglandins class of drugs.

Prostaglandin E2 .FDA medication used for evacuation of uterine contents and induction of labor.

Administration of deniprostone gel
_ These drugs are inserted vaginally
_ adult ma is entered as 1 mg.

Dinoprostone gel use
_ Induction of Labor in Pregnant Women
To contract the uterus during labor to thin and dilate the cervix
_ deniprostone gel no use Relax and softness of cervix
_ It is used in labor and delivery
Apart from this, it is used in non metastatic trophoblast disease.

Indications of deniprostone gel
_ Denoprostone is inserted into the vagina at a dose of 10 mg
_ Indications for Initiation and Continuation of Cervical Repair in Pregnant Women Who Are Near the Tummy
Amniotic fluid embolism Termination of pregnancy

Contraindication of deniprostone gel
_ Due to this hyper-sensitivity is seen in the patient
Apart from this, fetal distress is seen
Bleeding from vagina is seen
_ acute pelvic inflammatory disease.
_ placenta previa.

Mechanism of action
_ Dano Prostone Gel stimulates the myometrium and contracts the uterus causing contractions.
_ Evacuation of the product of the conception from the uterus
_ It cellular membrane ne regulation of calcium transported intracellular contraction of cyclic
_ Local effect of this drug inducing softening effect and dilation.

Side effects of gel
_ Increases or decreases the heart rate causing pain in the uterus
_ Pale cool blotchy skin on arm or leg
_pressing or painful feeling of chest
Shortness of breath….

MALA-N TABLE

GROUP : oral contraceptive pill
DOSE: It consists of 21 days and 28 days package of pills, in which 21 active hormone pills, 7 inactive hormone pills.
If you have taken the pills on the first day, take the pills at the same time on the second day
Ex: If taken today at 8 o’clock, tomorrow also at 8 o’clock.
ROUTE : Orly
MODE OF ACTION: Its mode of action is to prevent the release of ovum from the ovary.
This blocks the secretion of pituitary gland and elicits gonadotropin which is responsible for ovulation.

INDICATIONS:

Contraceptive

Period pain

Abnormal uterine bleeding

Postmenopausal osteoporosis

Ovarian cyst

Endometriosis

Amenorrhea
Contraindication:

High blood pressure

Breast cancer

Heart disease

Liver diseases

NGO Edema

Kidney disease

Depression

Hypercalcemic

Pregnancy

Jaundice history

Genital track malignancy

Cycle cell diseases
SIDE EFFECTS:

Nozia

Vomiting

Weight gain

Dizziness

Head one

Tender breast
START Of MALA -N
It is started on the 5th day of menstruation.

NURSING RESPONSIBILITY OF MALA-N:

ASSESSMENT:
Check the medical history of the patient after giving Mala N Tablet.
Investigating the patient’s reproductive health history.

EDUCATION:
After giving Mala N Tablet, explain its dosage, mode of action, indication, contraindication, side effect, and administration.
Administration:
Teach the patient to take Mala N tablets in the correct method. In which the patient has taken the tablet at 7:00 pm today, asking to take the tablet tomorrow also at 7:00 pm.
MONITORING:
It should be monitored if the patient experiences any side effects or complications after taking Mala N tablets. Including, bleeding nausea and breast tenderness.
follow UP:
In which asking the patient to take regular follow up.
So that the patient’s no response can be known and he can ask if he has any question.
DOCUMENTATION:
Making Medical Record of Mala N Tablet and record whether the patient has any side effects or complications.

EMERGENCY CONTRACEPTIVE PILLS:

GROUP: oral contraceptive pills
DOSE: 1.5 milligrams of levonorgestrel
Emergency contraceptive pills should be taken as soon as possible without unprotected intercourse.

Its effectiveness lasts up to 120 hours after taking the pills.

ROUTE: Orly

MODE OF ACTION: Its main mechanism of action is inhibition of follicular development. So formation of corpus luteum does not take place after ovulation. It involves involvement of ulceration of cervical mucus.
Cervical mucus inhibits sperm penetration.

INDICATION:

When a contraceptive method fails

When the condom breaks and leaks

When ejaculation occurs in the external genitalia

When a woman does not use a contraceptive when sexually assaulted

Mistiment Fertility Awareness

When 2 or more birth control pills are missed
CONTRAINDICATION:

Pregnancy

Undiagnosed Abnormal Genital Bleeding

Hyper tension

Breast cancer

Endometrial cancer

Ischemic Heart Diseases

In hepatocellular adeno

Liver tumor

thrombophlebitis
SIDE EFFECTS:

Nozia

Head one

Ab normal cramping pan

Breast tenderness

Increased vaginal discharge

Decisive lemonade

Tyranny

Change of menstrual cycle

Spotting (light bleeding)

START OF EMERGENCY CONTRACEPTIVE PILLS:

Possible after unprotected sex.

It works after 5 days of unprotected sex.

Its first dose is taken 72 hours after unprotected sex.
NURSING RESPONSIBILITIES:
1- PATIENT ASSESSMENT:
In which the medical history of the patient is assessed. An assessment of any type of allergy or any complications is done
2- EDUCATION:
In it, education is given to the patient like how this tablet works, its side effects, indications, contra-indications, its dosage, education is given.
3- ADMINISTRATION :
Its first dose is taken 72 hours after unprotected sex.
And it works after 5 days of unprotected sex to explain all this to the patient.
4- MOTRING:
Monitor for any side effects or complications after taking the tablets.
5- FOLLOW UP:
Asking the patient to take regular follow up.
So that the response of the patient can be known and if he has any question he can ask.
6- DOCUMENTATION:
To record the medical record after taking this tablet and also to record if the patient has any complications.