Pharma Flashcards
Nifedipine + Mg sulphate ?
Retrospective studies show no harm to combine nifedipine and Mg sulphate on pregnant mother and Ca level but remember to monitor heart rate during that
Methotrexate anti-dote
Folinic acid
treatment option for trichomonal vaginal infection
Single oral dose (2g) Metronidazole and Tinidazole are effective treatment options for women who have trichomonal vaginal infection and their partner
Cetrotide® (cetrorelix acetate) 0.25 mg
GnRH antagonist
The most common cause of erythema nodusum
OCP
What is “Mirabegron”, uses, S.E., contraindications?
Beta 3 agonist
Indication:
-for Pt with OAB Who can’t tolerate anti-musculanic or have dry mouth or constipation due to other medical conditions
S.E.: may increase BP
CI: in uncontrolled Hypertension
SGLT2 inhibitors
side effect
Increase viscosity > increase the risk of thrombosis
Oxytocin (Syntocinon )dose:
10-20 IU IM (with 3 mins) or in 500 ml of NS IV infusion @ 1 hr [@40-60 drops /min] ( IV Bolus risk of marked transient fall in BP, Abrupt increase in CO, MI, chest pain)
in William’s obs: 20U in 1000 ml crystalloid Solution IV at rate of 10 ml/min for a dose of 200 mU/min
Max: 96 units
CI of methylergometrine:
Mnemonic: TOPER
Twin pregnancy
Organic heart disease
Preeclampsia
Eclampsia
Rh negative female
Cabertocin (uterotonic more effective than oxytocin) its dose:
100 mcg IV
15-methyl PGF2α (Carboprost) dose:
250 mcg (0.25 mg) IM or intramyometrially (repeated every 15-90 min for max 8 doses)
Carboprost PGF2α (Hemabate) side effects:
Diarrhoea and vomiting
Hypertension
Pyrexia and Flushing
Tachycardia
CI in BA, Suspected pt of Amniotic fluid embolism
Relative CI: Renal and liver and cardiac dis
Misoprostol - cytotec- (PGE1) dose for prevention /treatment of PPH:
600-1000 mcg (rectally or sublingual or orally)
SE:
- hyperpyrexia
- safe in asthma
Source: William ACOG17
Dinoprostone (PGE2) off- label PPH dose:
20 mg per rectum or per vagina every 2 hrs
SE:
Diarrhoea
CI in hypotension
Sulprostone is an Intravenous form of PGE2
Tranexamic acid dose:
500 mg IV or IM
The most potent drug to control PPH:
Carboprost
Misoprostol dose in abortion:
5-13 wks:
800 mcg vaginally or orally
Max dose: 400/ 3-4 hrs
14-24 wks:
400 mcg vaginally or sublingual
Max: 5 doses < 1/2 dose in prev C/S
In cervical preparation before surgical evacuation:
Up to 14 wks:
400 mcg vaginally 3 hrs prior or sublingual 2-3 hr
- if didn’t pass tissue give 600 or 800 single dose
- if actively bleeding give ASAP
Opioids anti-dote
Naloxone ( except pethidine it’s respiratory depression cann’t be reversed by it)
Syntometrine dose:
5IU
Oxytocin is structurally similar to anti-diuretic hormone (ADH, vasopressin) and both are released from the posterior pituitary, Commonest side effects:
The most common side effect is hypotension
Prolonged infusions can result in water retention and hyponatremia due to cross reactivity with the vasopressin receptor, giving rise to water intoxication.
PROPESS
containing 10 mg dinoprostone (Prostaglandin E2)
Actinomycin-D side effects:
- serious myelosuppression
- black stool discolouration
Mgso4 S.E.
Uterine atony > examine if uterus contracted post- delivery
ACOG 2009 Abx recommendation Preoperative Abx
Single Preoperative dose of 1 gm IV injection cefazolin half-an-hour prior to CS or 3 doses 8 hourly can be given for high risk cases or suspected infection x 24 hrs
IOL regimen by prosten and propess:
Prosten (PGE2 tab or gel): one dose followed by 2nd dose after 6-8 hrs (Max: 3 doses)
Propess (controlled release pessary): one dose over 24 hrs.< for PG, singleton, cephalic, normal CTG
If Bishop’s score < 6, IOL started at Antenatal ward
Terbutaline/ Ritodrine MOA
Bind to B-adrenoreceptors that increase Adenylyl Cyclase, elevated levels of cAMP, and myometrial cell relaxation.
How does mifesprostone prevent pregnancy?
Prevents ovulation (progesterone agonist)
Syntometrine is combination of
Oxytocin/ergometrine
Why the use of nitrofurantoin is contraindicated near term (38 to 42 weeks’ gestation)
because of the potential for the induction of hemolytic anemia in the neonate, which is caused by low levels of red blood cell glutathione
should not be used at term because of the risk of neonatal haemolysis - during the last few weeks may precipitate haemolytic anaemia due to glucose-6-phosphate dehydrogenase deficiency in the newborn.
Hemolytic reactions to nitrofurantoin in patients with glucose-6-phosphate dehydrogenase deficiency.
This drug may rarely cause an acute pulmonary reaction that dissipates on its withdrawal
Ondansetron withdrawal S.E.
Prolonged QT interval and serotonin syndrome
Cabergoline dose (dopamine agonist D2 specific ligand)
For hyperptolactinemia cessation. 0.25 mg twice weekly
For breastfeeding cessation 1mg ORALLY given within 24 to 27 h of delivery
Methergine (methylergonovine) dose In PPH
0.2 mg IM/IV Q2-4hrs for 24-48 hrs (Not to exceed 5 doses maximum)
IV Labetalol initial dose:
20 mg bolus over 2 min
If BP > 160/110, then repeat 10 min later with 40 mg IV, and 10 min later 80mg IV (the maximum IV daily dose is 300 mg)
if BP remain >160/110 shift to hydralazine.
(labetalol not given to asthmatic women)
MgSo4 dose in severe PET or eclampsia
4-6 g IV loading dose of Mgso4 diluted in 100ml IV fluid over 15-20 min followed by maintenance cont. infusion of 2 g/hr in 100 ml IV fluid
MgSo4 antidote
Calcium gluconate or calcium chloride 1gm IV over 3 min
Implanon
etonogestrel
SSRIs for Premenstrual Dysphoric Disorder, SSRI Effective Doses:
Fluoxetine hydrochloride:
20 mg/day
Sertraline hydrochloride
50-150 mg/day
Paroxetine hydrochloride
20-30 mg/day
Paroxetine controlled release (CR)
25 mg/day
Citalopram
20-30 mg/day
Escitalopram
10-20 mg/day
toxic complication of NSAID use
is nonoliguric renal failure. Because it is more likely to occur with NSAID use associated with severe dehydration, the agent should be discontinued if severe diarrhea is present and should not be used with diuretics.
Hydralazine initial dose and maintenance?
Initial dose: 5-10 mg IV over 2 min
After 20 min if BP remain >160/110, repeat with 10 mg IV
In PET: Nifedipine dose
10-20 mg PO repeat every 30 min if BP> 160/110,
Also you may give 10-20 mg PO Q2-6 hrs for management.
(Nifedipine given sublingually is no longer recommended. This route is associated with dangerously rapid and extensive effects.)
Oxytocin is never given as an undiluted
bolus dose because
serious hypotension or cardiac arrhythmias can develop
Tranexamic Acid serious association
Its use has been associated with a higher incidence of renal cortical necrosis (Frimat, 2016)
Anti-D dose
50μg given IM for pregnancies ≤12 weeks and 300 μg for ≥13 weeks.
This is administered immediately following surgical evacuation. For planned medical or expectant management, the injection is given within 72 hours of pregnancy failure diagnosis.
the most widely accepted regimen for medical abortion
regimen is mifepristone, 200 mg given orally on day 0 and followed in 24 to 48 hours by misoprostol 800 μg, administered by a vaginal, buccal, or sublingual route
(Acog, 2016c).
During medical abortion, the uterine rupture rate is
0.4 percent with one prior cesarean delivery.
the rate may reach 2.5 percent with two or more prior cesarean deliveries.
methotrexate precautions:
bound primarily to albumin, and its displacement by
other medications such as phenytoin, tetracyclines, salicylates, and sulfonamides can increase MTX serum drug levels.
renal clearance of MTX may be impaired by nonsteroidal antiinflammatory drugs including aspirin, probenecid, orpenicillins. Last, vitamins containing folic acid may lower MTX efficacy.
the most common side effects of methotrexate
The most common were liver involvement—12 percent; stomatitis—6 percent; and gastroenteritis—1 percent.
Mgso4 monitoring:
measure serum mg+ level at 4-6 hrs and adjust infusion to maintain levels btw 4-7 mEq/L (4.8 -8.4mg/dL)
Patellar reflexes disappear when the plasma magnesium level reaches
10 mEq/L—about 12 mg/dL—presumably because of a curariform action.
NSAIDS contraindicated in 3rd trimester it may cause:
- early closure of PDA.
- oligohydramnious
- fetal pulmonary HTN
medications may predispose to QT prolongation
such as azithromycin, erythromycin, and clarithromycin
to treat hypertension in pregnancy methyldopa (adrenergic-blocking drugs act centrally by reducing sympathetic outflow to effect a generalized decreased vascular tone) or (α-/ β-receptor blocking agent) labetalol.doses
methyldopa: 250mg BID max 1 gm
Labetalol: 200
thiazide diuretics are considered safe in
pregnancy. But for preeclampsia treatment, they are considered to be ineffective
Webster and colleagues (2017) found labetalol and nifedipine to be equally effective for chronic hypertension in pregnant women.
vasodilator treatment (hydralazine) not that effective alone for chronically hypertensive women was associated with a twofold rise in rates of low-birthweight and growth-restricted neonates
T
Angiotensin-Converting Enzyme Inhibitors fetal side effects: ( ARBs are presumed to have the same fetal effects as ACEi and thus are also contraindicated)
can cause severe fetal malformations when given in the second and third trimesters. These include oligohydramnios, hypocalvaria, and
renal dysfunction
nitrofurantoin side effect in 1st trimester of pregnancy
-associated in first trimester with two fold risk of cleft lip
- threefold greater risk of hypoplastic Lt heart syndrome (systematic review)
ACOG 2017 concluded that nitrofurantoin use in 1st trimester is appropriate if no alternatives are available
side effects of erythropoietin:
-hypertension, which is already prevalent in women with renal disease.
-Red cell aplasia and anti-erythropoietin antibodies have also been reported
Methimazole embryopathy characterised by
Esophageal or choanal atresia, and aplasia cutis congenita
Propylthiouracil side effects
Hepatotoxicity -
transient leukopenia (doesn’t require drug cessation)
- agranulocytosis (if women developed fever or sore throat mandate drug discontinue and report for CBC)
Methimazole dose
Initial: 10 -20 mg orally followed by lower maintenance dose of 5 -10 mg
PTU dose for hyperthyroidism in pregnancy
50- 150 mg orally TID
Dose of letrozole
2.5-7 mg
The serotonin 5-HT3 inhibitor (eg, ondansetron) when used with phenothiazine medications (such as chlorpromazine) may result in
a potential cardiac risk of QT interval prolongation.
what are the common laboratory abnormalities found in hyperemesis ?
Increase liver enzymes»_space; usually less than 300 units/L.
Serum bilirubin»_space; less than 4 mg/dL.
Serum amylase or lipase»_space; up to five times greater than normal levels.
Urinanalysis»_space; ketonurea .
It is recommended that after serum PRL levels have remained normal for 6 months, cabergoline be discontinued to determine whether the PRL levels will stay low without therapy. A potential concern with cabergoline and is
the development of cardiac valvular lesions. However, this has only been observed with large doses, as used for Parkinson disease, and has not been reported with lower doses. It has been suggested that cardiac ultrasound be performed every 2 years in patients on chronic therapy of cabergoline at doses of less than 2 mg per week.
Side effects of high-dose MPA medroxyprogesterone acetate included
acne, edema, weight gain, and irregular menstrual bleeding.
GnRH Agonists FDA- approved management to endometriosis
Leuprolide acetate (Lupron Depot) is available in a 3.75-mg monthly dose or an 11.25-mg 3-month dose, both given IM. Less frequently used GnRH agonists include goserelin (Zoladex) administered as a 3.6-mg monthly or a 10.8-mg 3-month SC depot implant; triptorelin (Trelstar) given as a 3.75-mg monthly IM injection; and nafurelin (Synarel) used in a 200-mg twice-daily nasal spray regimen. All of these except triptorelin carry specific FDA approval for endometriosis treatment.
Because of the greater osteoporosis risk and vasomotor symptoms, hormone therapy usually is added. Daily progestins or a low-dose estrogen plus progestin regimen is suitable and is termed add-back therapy. With this therapy, a GnRH agonist may be used longer than 6 months.
Unlike GnRH agonists, GnRH antagonists do not produce an initial release or j/Are of gonadotropins. Thus, suppression of gonado-tropins and of sex steroid hormones is immediate. Examples approved for endometriosis
Elagolix is a nonapeptide, orally bioactive GnRH antagonist taken daily.
Als aromatase inhibitors clinically include
anastrozole (Arimidex) and letrozole (Femara).
A serious concern is ovarian cyst formation. by blocking the conversion of androgens to estrogens in ovarian granulosa cells, Als reduce the nega-tive feedback at the pituitary-hypothalamus level. This leads to increased GnRH secretion. Concomitant elevations in lutein-izing hormone (LH) and follicle-stimulating hormone promote increased ovarian follicular development. Therefore, Als always are combined with a progestins, COCs, or GnRH agonist to help blunt this significant side effect.
mifepristone’s antiprogestational side effects
expose the endometrium to chronic unopposed estrogen. The resulting endometrial changes range from endo-metrial hyperplasia to a new category described as progesterone-receptor-modulator-associated endometrial changes (PAECs), Of SPRMs, ulipristal acetate is available in the United States for emergency contraception as single-dose Ella. PAEC developed in 40 to 80 percent of the participants that were treated with extended-use ulipristal acetate.
Selective Estrogen-Receptor Modulators Bazedoxifene {BZA) is a third-generation selective estrogen-receptor modulator (SERM).
Either alone or with a GnRH antagonist, BZA/ CEE also was effective in a small case series for symptom suppression in patients with confirmed endometriosis
Danazol (Danocrine) is a
synthetic l 7a-ethinyl testosterone derivative. Regarding efficacy, danazol given orally at dosages of 200 mg three times daily is superior to placebo to diminish endometri-otic implant size and pelvic pain symptoms after 6 months of therapy. The recommended dosage of danazol is 600 to 800 mg orally daily. Unfortunately, significant androgenic side dfccts develop and include acne, hot flashes, hirsutism, adverse serum Upid profiles, voice deepening (possibly irreversible), elevation of liver enzyme levels, and mood changes. Moreover, due to possible teratogenicity, this medication should be taken in con-junction with effective contraception.
Methylene blue S.E.
rarely may induce acute methemoglobinemia, particularly in patient with glucose-6-phosphate dehydrogenase deficiency.
Clomiphene citrate mechanism of action
(SERM) interacting with estrogen-receptor-containing tissues, including the hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. It may compete with estrogen for estrogen-receptor-binding sites and may delay replenishment of intracellular estrogen receptors. Clomiphene citrate initiates a series of endocrine events culminating in a preovulatory gonadotropin surge and subsequent follicular rupture. The first endocrine event in response to a course of clomiphene therapy is an increase in the release of pituitary gonadotropins. This initiates steroidogenesis and folliculogenesis, resulting in growth of the ovarian follicle and an increase in the circulating level of estradiol. Following ovulation, plasma progesterone and estradiol rise and fall as they would in a normal ovulatory cycle.
Available data suggest that both the estrogenic and antiestrogenic properties of clomiphene may participate in the initiation of ovulation.
Why tocolytics entails higher risks than in singleton pregnancy ?
This stems in part from augmented pregnancy-induced hypervolemia, which arise cardiac demands and increases the susceptibility to iatrogenic pulmonary Edema.
Clomiphene citrate side effects
Symptoms of hypoestrogenemia
- mood swings
- hot flushes
- night sweats
- blurry vision (most serious)
Scotoma
- nausea, vomiting,
- ovarian enlargement, pelvic and abdominal pain. It is also nephrotoxic after prolonged use.
Clomiphene citrate dose
50-150 mg
hMG urinary FSH(menopur, merional)
Recombinant (Gonal F, puregon)
Dose
75 IU
HCG (ovulation induction) available Med names and doses
Choriomon 5000 IU
Profasi 10000 IU
Ovitrelle 250 mcg
CLOMID Contraindications:
Primary ovarian failure. Ovarian cysts. Uterine leiomyomas. Abnormal vaginal bleeding. Thrombophlebitis. Liver disease. Depression. Uncontrolled thyroid or adrenal dysfunction. Organic intracranial lesions (eg, pituitary tumor). Pregnancy
Trimethoprim-sulphamethoxazole associated teratogenic effects with periconecption use
Fivefold risk of Esophageal atresia and diaphragmatic hernia
ACOG 2017 concluded that sulphonamide use in 1st trimester is appropriate if no alternatives are available
Tetracycline and pregnancy
No longer commonly used due to association with yellowish brown discolouration of deciduous teeth when used after 25 wks
(Systematic review in 2016 showed that doxycycline no higher rates of either birth defects or staining of deciduous teeth)
Mycophenolate mofetil (used to prevent GVHD in renal transplant, and autoimmune diseases ) what is drug related congenital anomalies?
Mycophenolate embryopathy includes microtia, auditory canal atresia, clefts, Coloboma and other eye anomalies, short fingers with hypoplastic nails, and cardiac defects.
Risk of Ebstien anomaly with lithium
3%
What is the findings of Neonatal lithium toxicity from exposure near delivery (advices to decrease or stop the dose 2-3 days per-delivery)
Neonatal hypothyroidism
Diabetes insipidus
Cardiomegly
Bradycardia
Electrocardiogram abnormalities
Cyanosis
Hypotonia and reduce suckling
All SSRI and SNRI are not considered teratogenic except
Paroxetine associated with 1.5-2 folds higher risk of cardiac anomalies particularly A/VSDs following 1st trimester exposure
Neonatal effects associated with perinatal exposure to SSRI and SNRI
Neonatal behaviour syndrome includes jitteriness, irritability, hyper- or hypotonia, feeding abnormalities, vomiting, hypoglycaemia, thermoregulatory instability and respiratory abnormalities.
Another possible association is persistent pulmonary hypertension of the newborn.
Retinoic acid embryopathy
CNS, face, heart, and thymus.
Specific anomalies may include ventriculomegaly, maldevelopment of facial bones or cranium, microtia or Anotia, micrognathia, cleft palate, conotruncal heart defects, thymic aplasia or hypoplasia.
Warfarin embryopathy (AKa fetal warfarin syndrome or di sala syndrome) characterised by
Nasal hypoplasia ( the most consistent feature)
Stippled epiphysis
Choanal atresia
Dandy walker syndrome
Ritordine and terbutaline mechanism of action
Binding to B-adrenergic receptors that mediate G-Alfa s stimulated increases in adenylyl Cyclase expression
Dinogest (vissan) Mechanism of action
Progesteronic compound Dose: 2mg
Dinogest (vissan) Mechanism of action & Dose
Progesteronic compound Dose: 2mg
Methyldopa side effects
Drug-induced hyperpyrexia
Serious
Cardiovascular:Congestive heart failure, Heart block
Gastrointestinal:Colitis, Pancreatitis
Hematologic:Aplastic anemia, Bone marrow depression, Hemolytic anemia (less than 1% to 5%), Leukopenia, Malignant lymphoma, Neutropenia, Thrombocytopenia
Hepatic:Hepatotoxicity, Jaundice, Liver function tests abnormal
Immunologic:Systemic lupus erythematosus
Neurologic:Parkinsonism
Postpartum depression
Primolout N (norethisterone) - derived from nortestosterone. This means that it has some androgenic activity-
AUB: 5 mg BID for 21 days for 6 months (From day 5 to day 25?)
Dysfunctional uterine bleeding, polymenorrhoea, menorrhagia, dysmenorrhoea and metropathia haemorrhagia: 1 tablet three times daily for 10 days; bleeding usually stops within 48 hours. Withdrawal bleeding resembling true menstruation occurs a few days after the end of treatment. One tablet twice daily, from days 19 to 26 of the two subsequent cycles, should be given to prevent recurrence of the condition
-Postponement of menstruation: not longer than 10 to 14 days. A normal period should occur 2-3 days after the patient has stopped taking tablets. This method should be restricted to users who are not at risk of pregnancy during the treatment cycle. The dosage is 1 tablet of Primolut N three times daily, starting 3 days before the expected onset
Miconazole 400 vaginal suppository
For 3 days
Dienogest (Visanne)
1 tab oral x 6 mon
Dienogest (Visanne)
1 tab oral x 6 mon
Duphastone regimen for AUB
1 tab PO BID Day 11 to day 26
Side effects and contraindications of vasopressin local injection in uterus
Local vasopressin lnjection can lead to inadvertant intravasvular infiltration and transient increases in blood pressure, bradycardia, atrioventricular block, and pulmonary edema (D~ps. 2005; Tulandi, 1996). Thus, patients with a history of cardiovascular disease, uncontrolled hypertension, migraine, asthma. and severe chronic obstructive pulmonary disease may not be candidate for vasopressin use. Other less-robust evidence supports vaginal misoprostoL intravenous (IV) tranexamic acid, and IV oxytocin infusion for this indication (Asian, 2019; Atashkhoei, 2017; Fusa. 2018; Kongnyuy, 2014).
Chemotherapy that works on M-phase
Taxanes: Paclitaxel Docetaxel
Vinca Alkaloids
Chemotherapy that works on G1-phase
Hormonal agents:
-Tamoxifen
-Megestrol acetate
Antitumor antibiotics:
- Dactinomycin
- Doxorubicin
- Doxorubicin liposome
Chemotherapy that works on S-phase
Antimetabolite:
- Methotrexate
- Gamcitabine
- 5-Auorouracil
Chemotherapy that works on G2-phase
Topoisomerase inhibitors: Etolposide, Topotecan.
Antitumor: antlbiotics: - Bleomycin
What are the CYCLE NONSPECIFIC chemotherapy?
Alkylating agents: Cyclophosphamide, Ifosfamide.
Platinum agents: Carboplalin, Clsplatln.
induction chemotherapy is defined as
primary treatment for patients with an advanced malignancy when no feasible alternative treatment exists .
bevacizumab is a monoclonal antibody metabolized and eliminated via
the reticuloendothelial system. It is dosed only by patient weight (mg/kg).
For renally excreted drugs, such as carboplatin, dosing may be based on
an estimate of the glomerular filtration rate (Calven formula).
The amount of drug administered over time is known as
the dose intensity. Its primary imponance is in highly responsive tumors, in which cure can be achieved with chemotherapy.
Limitations of Hyperthermic intraperitoneal chemotherapy (HIPEC) or local intraperitoneal chemotherapy
intraabdominal adhesions, poor fluid circulation, fibrotic tumor encapsulation, and coexisting ascites. Because of these limitations in drug penetration, IP chemotherapy is typically administered postoperatively to women with minimal residual disease.
Anaphylaxis epinephrine dose
epinephrine (1 to 5 mL of a 0.1/mL solution [1:1000 solution])
In Evaluating Response to Chemotherapy the most important indicator is the compkte response rate. In ovarian cancer can be assessed by
normal CA125 levels (usually <35 U/mL), physical examination findings, and imaging test results.
Methotrexate (MTX) tightly binds to
dihydrofolate reductase, blocking the reduction of dihydrofolate to tetrahydrofolate (the active form of folic acid)
As a result, thymidylate synthetase and various steps in de novo purine synthesis are halted. This leads to arrest of DNA, RNA, and protein synthesis.
topical estrogen cream (e.g.,
Premarin or Estrace cream)
GnRHa medications such as
nafarelin, triptorelin, buserelin, and leuprolide.
Water intoxication happen when the rate of oxytocin exceeds
30-40 mu/ min
Water intoxication symptoms triad
- coma
- collapse
- convulsion
Mechanism of action of tranexamic acid
Inhibits of activation of plasminogen to plasmin
protamine sulfate dose
protamine sulfate—1 mg per 100 units heparin with a maximum dose of 50 mg
Postpartum venous thrombosis is usually treated with
The initial dose of warfarin is 5 to 10 mg for the first 2 days. Subsequent doses are titrated to achieve an international normalized ratio (INR) of 2 to 3. To avoid paradoxical thrombosis and skin necrosis from the early antiprotein C effect of warfarin, these women are maintained on therapeutic doses of UFH or LMWH for 5 days and until the INR is in a therapeutic range for 2 consecutive days (American College of Obstetricians and Gynecologists, 2020b).
Anti-hypertensive meds in pre-eclampsia
Oxybutynin Chloride
Antimuscarinic agents remain the mainstay of treatment of overactive bladder.
Once daily
Oxybutynin is
tertiary amine with M3 affinity, but it has some M1 affinity, which can result in central nervous system adverse effects. Oxybutynin also has direct myotropic relaxation and some local anesthesia.
Trospium chloride is a quaternary amine that has limited penetration across the blood–brain barrier and, therefore, has the potential for fewer central nervous system effects.
Tolterodine, fesoterodine fumarate, and solifenacin succinate are
all tertiary amines that have M3 affinity. Fesoterodine is converted to its metabolite 5-hydroxymethyl toltero- dine, potentially having fewer adverse effects.
Anticholinergic agents are contraindicated in patients with
narrow angle glaucoma because these medications may precipitate an acute angleclosure attack.
Mirabegron is a
β3-agonist that relaxes the bladder by mimicking norepinephrine. Because β3-receptors are predominant in the bladder, when norepinephrine is released by the sympathetic nervous system, it binds to the β3-receptor, which causes bladder relaxation.
Adverse effects of mirabegron include
hypertension, nasopharyngitis, urinary tract infection, headache, and dry mouth, although to a much lower degree than anticholinergic agents. The only contraindication is uncontrolled hypertension, which may be exacerbated with mirabegron.
Management lines For patients with refractory overactive bladder syndrome (ie, who have failed conservative therapy or medical or anticholinergic therapy)
botulinum-A neurotoxin, peripheral tibial nerve stimulation, and sacral neuromodulation are treatment options.
Gentamycin Dosage is based on
Dosage is based on patient’s actual body weight. If patient’s actual weight is >20% over ideal body weight (IBW) then the “dosing weight” (DW) can be calculated as follows: DW = IBW + 0.4 (actual weight-IBW).
Otherwise you may give 5 mg/ kg IV
nitrofurantoin carries a rare but real risk of
chronic interstitial lung disease in older adults and, therefore, would not be ideal in a patient with chronic obstructive pulmonary disease.
Oxytocin should not be started for .. hours following administration of vaginal prostaglandins.
Oxytocin should not be started for 6 hours following administration of vaginal prostaglandins. The initial infusion rate should be set at 1 to 4 milliunits/minute (2 to 8 drops/minute). It may be gradually increased at intervals not shorter than 20 minutes and increments of not more than 1-2 milliunits/minute, until a contraction pattern similar to that of normal labour is established. In pregnancy near term this can often be achieved with an infusion of less than 10 milliunits/minute (20 drops/minute), and the recommended maximum rate is 20 milliunits/minute (40 drops/minute).
Betamethasone administration is associated with ——- fetal movement for 24 to 72 hours, and the diurnal pattern is lost (Koenen, 2005; Mulder, 2009). The effect is less clear with dexamethasone.
Betamethasone administration is associated with decreased fetal movement for 24 to 72 hours, and the diurnal pattern is lost (Koenen, 2005; Mulder, 2009). The effect is less clear with dexamethasone.
Solifenacin (Vesicare)
used to treat overactive bladder and neurogenic detrusor overactivity. It may help with incontinence, urinary frequency, and urinary urgency.
Dose: 5-10 mg / day
Navidoxine a combination of doxylamine (10 mg) plus pyridoxine (10 mg).
The usual dose is two tablets orally at bedtime, and it appears safe and effective, If relief is insufficient, one additional first-morning tablet is added to the bedtime dose. This can be further escalated to include one first-morning, one midafternoon, and two bedtime tablets.
Other formula is one half of a 25-mg Unisom (doxylamine) tablet plus a 25-mg vitamin B6 (pyridoxine) tablet. The same graduated dosing is used but does not exceed three total daily doses.
spironolactone (Aldactone) It is a competitive inhibitor of androgen binding to the androgen receptor. This drug also directly inhibits 5 alfa reductase. It dose ?
The typical dosage is 50 to 100 mg orally twice daily.
letrozole dosage
the starting dosage is 2.5 mg/d for 5 days, typically starting on day 3, day 4, or day 5 after a spontaneous or progestin-induced menses. If ovulation does not occur, the dosage can be increased to 5 mg/d for 5 days with a maximum dosage of 7.5 mg/d. Dosages greater than 7.5 mg/d have been associated with thinning of the endometrium as seen with clomiphene citrate.
