Drugs Flashcards
How do you medically induce labour (include doses)
Prostaglandin E1 = misoprostol (25 micrograms PO 2hrly x 12)
Prostaglandin E2 = prandin gel (1mg PV 6hrly x 3)
How do you treat chorioamnionitis?
Ampicillin 2g IVI 6hrly
Gentamicin 240mg IVI daily
PLUS
Metronidazole if going for c/s
And delivery
Soft markers of Down syndrome on ultrasound
Nuchal translucency
Hypoplastic nasal bone
Sandal gap
Clinodactyly
Short femur
Short humerus
Single umbilical artery
Mild hydronephrosis
Scoring used in hyperemesis gravidarum and the boundaries
PUQE score
<6 = mild
7-12 = moderate
>13 = severe
Medical treatment of hyperemesis gravidarum
Vit B6
Antihistamines
Metoclopramide 10mg IVI 8hrly
Define hyperemesis gravidarum
Vomiting >/= 3 times per day with ketones in urine or acetone in blood
AND weight loss >3kg or 5 % original weight
Medical management of ectopic
Methotrexate
Treatment for PID
Inpatient
IV ceftriaxone 1g dly
IV Metronidazole 500mg 8hrly
Downscale once response
Amoxiclav 125mg PO 12hrly 10days
Azithromycin 1g PO single dose
Outpatient
Ceftriaxone 250mg IMI stat
Metronidazole 500mg PO BD x14days
Doxycycline 100mg PO BD x14days
Laparoscopy if no response in 48 hours
How do you determine how much extra anti-D is needed in an Rh incompatibility?
Kleihauer Bekte test
Each extra 4ml = +25micrograms anti-D
Medical treatment of polyhydramnios
Amnioreduction
Indomethacin 2-3mg/kg/day (NSAID) = stop at 34 weeks
Steroids
Medical treatment of PROM
Erythromycin 500mg 6hourly PO 10days
OR
Ampicillin 2g qid IVI 2 days
PLUS
Amoxicillin 500mg tds Po 5 days
Azithromycin 500mg dly PO 3 days
PLUS (if c/s)
Metronidazole 400mg tds PO 5 days
Steroids dose
Betamethasone 12mg IMI 24hrly x2
OR
Dexamethasone 8mg IMI 8hrly x3
(Deltoid muscle)
Tests for ROM
Nitrazine test
Microscopic = ferning
Ultrasound - oligohydramnios
Amniosure = pH sensitive pad
Ultrasound findings of placenta praevia
On u/s
>loss retroplacental soon lucena zone
>abnormal placental lacunae
>thinning of hyperechoic serosa bladder interface
Doppler
>turbulent flow
>hypervascularity over serotonin-bladder interface
>dilated vessels over peripheral sub placental zone
>diffuse/focal lacunae flow
RF preterm labour
Previous preterm birth
Behavioural (smoking, drugs, low pre pregnancy weight)
Cervical length <25mm before 24 weeks
History cervical cancer
Tocolysis drugs and doses
1) Nifedipine
> LOAD: 10mg PO every 15mins x4
>MAINT: 10-20mg PO 4-6hrly for 24 hours
2) Indomethacin
>LOAD: 50-100mg
>MAINT: 25-50mg PR/PO 6hrly x 24hours
3) Atosiban (oxytocin antagonist)
>LOAD: 6,75mg IVI over 1min
>MAINT: 300microgram/min over next 3 hours then 100micrograms/min for next 24hours
RF abruptio
Previous abruptio
Abdominal trauma
Pre-eclampsia
Polyhydramnios
Premature ROM
Intrauterine infection
Smoking and drug use
AMA
ECV
RF Placenta praevia
Previous placenta praevia
AMA
Smoking
Previous uterine surgery
Previous c/s
Previous TOP
Multiple gestation
Assisted conception
Endometrial deficiency
Leopold maneuvres
Fundal grip
Lateral grip
Pawliks Second pelvic grip
Leopolds First pelvic grip
Septic miscarriage treatment
2nd gen cephalosporin (Cefuroxime 750mg IVI 8hrly)
Metronidazole 400mg IVI 8hrly
Gentamycin 240mg IVI 8hrly
Miscarriage diagnosis on u/s
CRL >8mm with no fetal heart activity
Sac >25mm with no yolk sac/embryo
Absence of fetal heart activity 11days after ultrasound showing gestational sac
MVA requirements
GA<14weeks
Mom stable
Hb>9
Uterus is normal
MVA contraindications
GA>14weeks
Unstable mom
Hb<9
Uterine abnormalities
Severe maternal anxiety
Unsafe TOP
Active pelvic infection
MVA antibiotics
Doxycycline
Metronidazole
Glucose intervals when screening for GDM
Fasting 5,1<
1hr post prandial 10<
2hr post prandial 8,8<
RF GDM
Previous unexplained stillbirth
Previous congenital abnormalities
History GDM
AMA
Fam history
Obesity
Prepregnancy glucose goal for diabetic
Fasting <5,2
HbA1C <6
2hr post prandial <6,7
Intrapartum diabetes management
Actrapid 10IU in 1L 5% dextrose
100ml/hr (one NPO)
Test glucose hourly
If glucose >8 = actrapid 12-14IU in 1L 5% dextrose at 100ml/hr
If glucose <4% = actrapid 6-8IU in 1L 5% dextrose at 100ml/hr
Diabetes glucose goal during pregnancy
Fasting 3,3-5
Pre prandial 3,3-5,6
1 hour post prandial <7,8
2 hour post prandial <6,7
2h00 3,3-5
Glucose profile consists of
Pre prandial (30mins)
2hr post prandial
22h00
02h00
Contraception in HIV patients
Copper IUD
Progesterone IUD
Depot injection
high dose COC
Emergency contraception
High dose COC = 50mg ethinyl oestrodiol + 0,25mg levonorgesterol in one pill (take 2 pills at a time, 12 hours apart)
Progesterone only pill = 1,5mg levonolgesterol single dose
Copper IUD
Indications for hysterectomy in septic miscarriage
MODS
Septic shock
No improvement after evac
Pus in abdomen
Necrotic cervix
Uterine perforation
Severe PET
Platelets <100
Creatinine >100
RUQ pain and liver enzymes x2 normal
Altered mental status/visual disturbance
BP >160/110 on 2 occasions 4 hours apart
Pulmonary oedema
Acute hypertensive drugs
1) Nifedipine 10mg PO every 20-30mins until controlled (max x4)
2) Labetalol 20mg IVI bolus (bolus in increasing increments every 15mins until stable)
Chronic hypertensive meds
1) Methyldopa 250-500mg PO tds
2) Nifedipine 30-60mg PO bd
3) Labetalol 100-400mg bd/tds
Dose of TOP cervical ripening preop
Misoprostol 400micrograms PV 3 hours prior to procedure
Medical TOP
T1
>misoprostol 800micrograms sublingual every 3 hours (x2-3)
T2
> misoprostol 400micrograms 3hrly sublingual/vaginal/buccal (max 5 doses)
AB for puerperal sepsis
Carbapenim and clindamycin
