Betnesol injection

Type of medicine: corticosteroid

Generic and:- Betamethasone sodium phosphate

Brand names: Betasone

Mode of Action

Corticosteroids diffuse across cell membranes and complex with specific cytoplasmic
receptors. These complexes then enter the cell nucleus, bind to DNA, and stimulate
transcription of mRNA and subsequent protein synthesis of enzymes ultimately responsible
for anti-inflammatory effects of topical application of corticosteroids to the eye. In high
concentrations, which may be achieved after topical application, corticosteroids may exert
direct membrane effects. Corticosteroids decrease cellular and fibrinous exudation and tissue
infiltration, inhibit fibroblastic and collagen-forming activity, retard epithelial regeneration,
diminish postinflammatory neovascularization, and reduce toward normal levels the
excessive permeability of inflamed capillaries.

BETAMETHASONE BENIFITS DURING PREGNANCY

Betamethasone leads to improvement in a babys lung function by speeding up maturational

changes in lung architecture (and other tissues) and by enhancing production of lung enzymes
involved in respiratory function. These changes improve lung compliance and lung volume
as well as gas exchange, meaning the baby can more easily take in oxygen and get rid of
carbon dioxide (CO2). Improved maturity of lung and other body tissues, improved
oxygenation and ventilation, and improved circulatory stability are the main effects of
betamethasone that help prevent serious injury in the baby, such as RDS, IVH, PVL and
sepsis.

Preparation

There are glcocorticoids. Hydrocortisone is a natural one. While dexamethasone is

synthetic preparation.
Important actions for Ob-Gy purpose are strong antiinflamatory, antiallergic and
antiimmunological actions
Hydrocortisone is available as hydrocortisone hemisuccinate injection for IM/ IV use.
133mg of salt contains 100mg of hydrocortisone.
Dexamethasone is available as dexamethasone sodium phosphate injection containing
4mg of the salt per ml. It is also given IM or IV route. It is available in 2ml ampoules or
bulbs.

Uses

This medicine may also be given to pregnant women at risk for preterm delivery. The
medicine helps mature the lungs of the infants and helps prevent breathing problems in
newborns.

To enhance lung maturity: in preterm pregnancies between 28 to 34 wks, injection dexona is

given 12mg I/M & repeated after 12-24 hrs to enhance lung maturity of the fetus, so that it
survives if preterm delivery occurs. Its effects start after 24. In past repeat doses were
practiced every 7 days but this is not done now as it leads to fetal IUGR & brain damage.

Inj. Dexona is given 6mg IM 6hrly 4 doses effect starts after 24 hrs of initiation of treatments
and reaches peak at 48 hrs.

Instead of inj. Dexona Inj. Betamethasone (betnesol) is commonly given in doses 12mg/ IM
twice, 24 hrs apart.

Contraindication

Cushing syndrome
TB
Infection
Peptic ulcer
DM
Hypertension

Side effects

Single large doses of short term therapies as required for OBG and gynec purpose are
harmless. Adverse reactions long term use include,

o Acute gastritis with hemorrhage,

o Peptic ulceration
o Osteoporosis and fracture
o Proximal myopathy
o Acute psychotic reaction
o Hypertension
o Precipitation of diabetes
o Spread or aggravation of infection

Nursing Implications

Assessment & Drug Effects

Monitor and report S&S of Cushing's syndrome or other systemic adverse effects.
Monitor neonates born to a mother who has been receiving a corticosteroid during
pregnancy for symptoms of hypoadrenocorticism.
Monitor for S&S of a hypersensitivity reaction. The acetate and sodium phosphate
formulations may contain bisulfites, parabens, or both; these inactive ingredients are
allergenic to some individuals.

Patient & Family Education

Take drug exactly as prescribed.

Report lack of response to medication or malaise, orthostatic hypotension, muscular
weakness and pain, nausea, vomiting, anorexia, hypoglycemic reactions , or mental
depression to physician. These symptoms may signal hypoadrenocorticism.
Report changes in appearance and easy bruising to physician. These symptoms may
signal hyperadrenocorticism.
Note: Hiccups that occur for several hours following each dose may be a complication
of high-dose oral dexamethasone.
 Keep appointments for checkups; make sure electrolytes and BP are evaluated during
therapy at regular intervals.
Add potassium-rich foods to diet; report signs of hypokalemia. Concomitant
potassium-depleting diuretic can enhance dexamethasone-induced potassium loss.
Note: Dexamethasone dose regimen may need to be altered during stress (e.g.,
surgery, infections, emotional stress, illness, acute bronchial attacks, and trauma).
Consult physician if change in living or working environment is anticipated.
Discontinue drug gradually under the guidance of the physician.
Note: It is important to prevent exposure to infection, trauma, and sudden changes in
environmental factors, as much as possible, because drug is an immunosuppressor.
Do not breast feed while taking this drug without consulting physician.

MUSCLE RELAXANT DRUGS

Hyoscine Butylbromide

Generic Name: Hyoscine Butylbromide

Brand Name: Amucin, Ascopen, Buscin, Buscomed, Buscopan, Busopin, Buston, Fucon,
Gascopan, Gastride, Losil, Rotomide, Scolmin, Spasmosan, Xspas

Classification: Antispasmodic, Muscle Relaxant

Mechanism of Action

Hyoscine works by relaxing the muscle that is found in the walls of the stomach,
intestines, bowel, bile duct and urinary tract. This type of muscle is called smooth
muscle or involuntary muscle. It normally contracts and relaxes in response to natural
body chemicals called neurotransmitters. The contractions are caused by a
neurotransmitter called acetylcholine. These contractions are not under our conscious
control and we are not normally aware of them. However, if the muscles go into
spasm this can cause pain.
Hyoscine stops the spasms in the smooth muscle by preventing acetylcholine from
acting on the muscle. It does this by blocking the receptors on the muscle cells that
the acetylcholine would normally act on.
The mechanism of action of Buscopan is that it blocks the muscarinic receptors found
on the smooth muscle walls. Which means its blocks the action of acetylcholine on
the receptors found within the smooth muscle of the gastrointestinal and urinary tract
and thus reduces the spasms and contractions. This relaxes the muscle and thus
reduced the pain from the cramps and spasms.

Doses

The usual dose of hyoscine tablets is 1 or 2 10 mg tablets per day. If you need to take this
medication regularly, the usual dose is 1 tablet 3 to 5 times a day. The maximum dose is 6
tablets per day.

For the injection, the usual dose is 10 mg to 20 mg given by intramuscular (into a muscle),
intravenous (into a vein), or subcutaneous (under the skin) injection. The maximum daily
dose is 100 mg.

Indications:
1. Spasms of the stomach, intestines or bile duct (gastro-intestinal tract), including those
associated with irritable bowel syndrome

2. This injectable form of hyoscine may also be used before certain medical procedures (e.g.,
endoscopy) to relax the smooth muscle of the stomach and intestines (gastrointestinal tract).

Buscopan tablets contain the active ingredient hyoscine butylbromide, which is a type of
medicine called an antispasmodic. It is used to relieve colicky abdominal pain that is caused
by painful spasms in the muscles of the gastro-intestinal (GI) or genito-urinary (GU) tract.

Contraindications

Abnormal muscle weakness

Abnormally large or dilated large intestine (megacolon)
Rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or
sucrase-isomaltase insufficiency (Buscopan tablets contain sucrose).
Children under 6 years of age
Narrow-angle glaucoma
Acute hemorrhage
Paralytic ileus
Tachycardia due to cardiac insufficiency
Myasthenia gravis

Side effects

Constipation
Reduced ability to sweat
Dry mouth
Allergic skin reactions and rashes
Flushing
light sensitivity.
Increase in heart rate (tachycardia).
Urinary retention (difficulty in passing urine)
Allergic reactions
Confusion
Nausea and vomiting ,Dizziness.

Nursing Responsibilities
Hyoscine may make a patient dizzy or cause vision problems; use caution engaging in
activities requiring alertness such as driving or using machinery.
Instruct the client to avoid or minimize drinking alcoholic beverages.
Caution is advised when using this drug in the elderly because they may be more
sensitive to the effects of the drug.
Inform the patient to consult the doctor immediately if he or she experiences any of the
following while using this medicine: red and painful eye, possibly with headache, loss of
vision, or seeing haloes around lights. These symptoms may be caused by an increase in
pressure inside the eyeball and require urgent investigation by the doctor.
If the patient missed a dose, inform him or her to use it as soon as you remember. If it is
near the time of the next dose, skip the missed dose and resume your usual
dosing schedule. Remind the patient not double the dose to catch up.
The medication should be stored at room temperature between 59 and 86 degrees F away
from light and moisture.
 Hyoscine should not be placed in the refrigerator.
Symptoms of overdose may include: irregular heartbeat, reddened skin, drowsiness.
Instruct the patient to immediately alert the physician once these are noticed or
experienced.
Drotaverine
Drotaverine is an antispasmodic drug, structurally related to papaverine. Drotaverine is a
selective inhibitor of phosphodiesterase 4, and has no anticholinergic effects.
A small 2003 study found drotaverine to be nearly 80% effective in treating renal colic. It has
also been used to accelerate labor.

Generic Name : Drotaverine

Classification : Antispasmodics

Brand name:- Biodrot, Abdrot Plus, Abdrot, Apodrot

Pharmacokinetics

Drotaverine has antispasmodic effect mediated via inhibition of phosphodiesterase-IV,

specific for smooth muscle. It has a rapid and direct action on the smooth muscle. It acts to
correct cyclic AMP and Ca imbalance at the spastic site, thereby relieving smooth muscle
spasm and pain.

Mechanism of Action

A novel non-Anticholinergic smooth muscle antispasmodic which acts by inhibiting

phosphodiesterase-4 (PDE-4) selective for smooth muscle. Elevation of intracellular
cAMP/cCMP attends smooth muscle relaxation

Indications

Used orally as well as parent rally in intestinal, biliary and renal colics, irritable bowel
syndrome, uterine spasms

Gallstones pain in the kidneys

Painful periods Join
Pain due to ulcers of the intestine
Chest pain Join 80 Pro Subscribers
Pain in stomach
Labor pain
Functional bowel disorders
Pain in renal colic

Contraindication

About to undergo surgery

Bedridden or immobile for a long time
Depression
Diabetes
Elevated levels of fat in the blood
Fits
Severe renal
 hepatic/cardiac dysfunction.
Porphyria.

Side Effects

Vertigo, nausea, vomiting, dry mouth,Headache, dizziness, constipation and flushing,

Hypotension when given I.V, Sweating , Sleep disorders , Allergic dermatitis

Nursing responsibility

Follow 10 rights of patient

Identify any side effects
Assess the vital sign
Maintain input out put

Epidocine
Generic name:- Valethamate

Classification:- Anticholinergic (antimuscarinic), a smooth muscle relaxant, Oxytocic,

antispasmodic

Brand name:- Diloton, Epidosin, Osdil, Valosin, valethamate

Mechanism of Action:- valethamate is an anticholinergic drug used as smooth muscle

relaxant. It has both central and peripheral action. It is a competitive inhibitor of
Acetylcholine. Valethamate blocks the muscarinic receptors and inhibits the action of
Acetylcholine and produces muscle relaxations.

Pharmacokinetics

It is well absorbed after parenteral administration. It is widely distributed in the body. It

crosses the placenta and excreted breast milk. It is metabolised in the liver. Drug and its
metabolites are excreted mainly in the urine. Onset of Action is 20-30 min. And half life is 4
hrs.

Indication

Cervical dilation in the first stage of labour

Symptomatic relief of GI colic
Biliary colic
Ureteric colic

Doses

Oral- 10-20 mg for 8-12 hrs in a day. Parenteral (IV/IM)- 4-8mg

Side effects

Increased heartbeat
Mild increase in the body temperature
Vomiting
 Dizziness
Dryness of mouth and skin
Blurred vision
Thirst
Mydriasis (dilation of the pupil of the eye.)
Reduced bronchial secretions
Cycloplegia (paralysis of the ciliary muscle of the eye, resulting in a loss of
accommodation.)
Palpitation
Constipation
Urinary retention

Contraindications
Hypersensitivity to Epidosin Injection is a contraindication. In addition, Epidosin Injection
should not be used if you have the following conditions:

Myasthenia gravis
Ulcerative colitis
Alcohol
Benign prostatic hyperplasia
Megacolon
Narrow angle glaucoma
Paralytic ileus
Pyloric stenosis

Nursing responsibility

Follow 10 rights of patient

Identify any side effects
Assess the vital sign
Maintain input out put