What are the 4 main principles of quality use of medicines?

- judiciousness
- appropriateness
- safety
- effectiveness
2

Which regulatory body is respinsable for the regulation of medicines in Australia?

The therapeutic drugs administration (TGA)

3

What is a teratogen?

any substance that interferes with normal fetal development causing one or more developmental abnormalities
4

What is a mutagen?

a chemical or physical agent that causes a genetic mutation or increases the mutation rate
5

What is a carcinogen?

any agent that causes the development of cancer or increases its incidence
6

What is the role of the midwife in terms of pharmacology?

- education regarding indication, adverse effects, transfer to baby and safety in pregnancy/breastfeeding
- assistance in informed decision making
- appropriate administration
- assessing adverse drug effects
- interpreting and following standing orders
- working within local prescribing frameworks
7

What are the main antibiotics listed on the PBS for midwife prescribing?

- amoxycillin
- amoxycillin & clavulanic acid
- benzylpenicillin
- cephalexin
- clindamycin
- dicloxacillin
- flucloxacillin
- lincomycin
- nitrofurantoin
8
What is the name of the 2 eyedrops/eardrops listed on the PBS for midwife prescribing?

- chloramphenicol
- framycetin sulfate
9

What are the main anti-inflammatories that are listed on the PBS for midwife prescribing?

- diclofenac
- ibuprofen
10

What contraceptives are listed on the PBS for midwife prescribing?

- etonogestrel implant
- levonorgestrel
11

What is the main anti-emetic listed on the PBS for midwife prescribing?

- Metochlopramide
12

What opiod analgesic is listed on the PBS for midwife prescribing?

- morphine
13

What antacid is listed on the PBS for midwife prescribing?

- ranitidine
14

What are the main indications for giving antibiotics in the perinatal period?

- urinary tract infection

- GBS prophylaxis
- perineal infection
- caesarean wound infection
- endometritis
- neonatal skin infection
- mastitis
15

What is the usual indication for giving metochlopramide in the perinatal period?

relief of nausea and vomiting (particularly intrapartum)

16

What is the main anticonvulsant given in the perinatal period (particularly for preeclampsia)?
magnesium sulfate
17

What is the antidote to magnesium sulphate?

calcium gluconate
18

What are the 2 antidotes to metochlopramide?

- diphenhydramine
- benztropine
19

What are the 2 main antifungals that are usually given to treat vulvovaginal, nipple or neonatal oral thrush?

- iotrimazole
- nystatin
20

What is the generic name for the antiviral used to manage herpes simplex virus in late pregnancy?

Acyclovir
21

Which benzodiazepine is often given for rest and relaxation in early non-active labour?

Temazepam
22

Which 2 drugs act as dopamine-agonists and may be given to stimulate lactation postnatally?

- domperidone
- metochlopramide
23

What are the 2 key corticosteroids that may be given antenatally where there is threatened preterm labour?

- betamethosone
- dexamethasone
24

What is the immunoglobulin that is usually recommended to Rhesus (D) negative women with suspected rhesus positive pregnancies?

Human anti-D IgG

25

What is the antagonist given to women or infants to reverse the action of opiods in labour?

naloxone hydrochloride
26

What are the 2 most common NSAIDs given for postpartum analgesia?

- Diclofenac sodium
- Indomethacin
27

What prostaglandin may be indicated for management of PPH?

misoprostol
28

What drug may be used to manage anaphylaxis?

adrenaline hydrochloride
29

What antihypertensive is also used as a tocolytic?

Nifedipine
30

What are the main uterotonics given in the perinatal period? and what are their trade names?

- oxytocin (syntocinon)
- oxytocin/ergometrine (syntometrine)
- ergometrine maleate (ergometrine)
31

What are the main vaccines that may be indicated antenatally or postnatally?

- influenza vaccine
- Hep B vaccine
- MMR vaccine
32

What is the generic and trade name for drug given for prophylaxis of neonatal vitamin k deficiency bleeding?

- Phytomenadione (Vitamin K)
- Konakion
33

What are the three main schedule 8 medicines given for intrapartum or postnatal pain?

- pethidine
- morphine
- fentanyl
34

What are the 2 main intravenous fluids given in the perinatal period?
- 0.9% sodium chloride (normal saline)
- Compound sodium lactate/Hartmann's solution
35

What are the 4 main indications for giving IV fluids in the perinatal period?

- retain patency of IV line

- administration of medication
- rehydration in labour
- fluid replacement (particularly in PPH)
36

What is the definition of the term chemical drug name?

the unique precise description of the drugs chemical composition and molecular structure
37

What is the definition of the term generic drug name?

- the official drug name as suggested by the manufacturer and approved by the regulating authority
- shorter and more memorable than the chemical name
- usually has a lowercase letter at the start (whereas trade is usually capitalized)
38

What is the definition of the term trade drug name?

- the proprietary or brand name that a drug is advertised under

39

What is the definition of the therapeutic action of a drug?

therapeutic effect is the desirable or beneficial effect of a medical treatment

40

Describe the process of drug absorption for oral medications

orally administered drugs must undergo disintergration, and dissolution prior to crossing mucosal and epithelial layers of the GI tract to find their way into systemic
circulation
41

What is passive diffusion?

the transfer of a drug from an area of high concentration to an area of low concentration
42

What is carrier-mediated transport?

- movement across a membrane that requires the involvement of a membrane protein

- may be active (requiring energy) or facilitated
43

What variables influence how a drug is absorbed?

- nature of the absorbing surface (number of membrane layers, surface area, blood supply)
- chemical structure of the drug (lipid solubility, charge, molecular weight, dissolution rate, pH)

Front Back

cytotec Classification: Gastric antisecretoryUse:

Stimulation of uterus resulting in
contractionAction: Dug is converted in body into
Prostaglandin E analogs, which inhibit gastric acid,
Increases mucus, and bicarbonate production in
stomachDosage/Route: 200 mcg qid with meals
POSide Effects: Headache, cramps, menstrual
disorders, spotting, polyuria, dysuria. Warning-can
cause miscarriage and uterine
ruptureContraindications: Hypersensitivity to
drug/prostaglandins, pregnancy. Nursing
Implications:Avoid breastfeeding, monitor VS esp
BP, discontinue if possible pregnancy.

Depo Provera Classification: Progestational

hormoneUse: Prevention of Pregnancy, also used
for amenorrhea, abnormal abdominal
bleedingAction: Inhibit pituitary gonadotropin,
resulting in ovarian suppression; vaginal mucosa
exhibits increased mucificationDose/Route: 150
mg q3mos IM injectionSide Effects:edema,
breakthrough bleeding, spotting, menstrual flow
change, acne, depression,
thrombophlebitisContraindications:
hypersensitivity with hx of thrombophlebitis,
suspects breast malignancy, undiagnosed vaginal
bleeding, High risk of developing problems with
dementia in postmenopausal > or equal to 65 y/o
during treatment Nursing Implications: Avoid
breastfeeding and pregnancy, menstrual changes
may occur, teach procedure for breast self-exam

Dilaudid Classification: Analgesics-narcoticUse: Relief of

severe pain, also preanesthetic
sedationAction:Interference with pain impulses at
subcortical level of brain, alter psychologic
response to painDose/Route: 2-4mg q4-6h
POSide Effects: lightheadedness, sedation,
sweating, urinary retention, ureteral spasm,
 respiratory depressionContraindications:
Hypersensitivity. Caution if pregnant,
breastfeedingNursing
Implications: Monitor VS, respiration, circulatory
status, safety precautions, check for CNS
depressent effect

Dulocolax suppository Classification: LaxativeUse:produce a BM with a

soft, formed stoolAction: Directly stimulates
peristaltic activity of the intestinal tract, increase
fluid level that results in defecation. Used for
general constipationDose/Route: 5-15mg single
dose dailySide effects:diarrhea, fatigue,
risk impaired skin integrity, risk for deficient fluid
volumeContraindications:Acute surgical abdomen,
undiagnosed pain, appendicitis, fecal impaction,
obstruction of intestinal tractNursing Implications:
Use caution when pregnant, avoid breast-feeding,
encourage fluid intake and increased activity

Erythromycin eye ointment Classification: antiinfectiveUse: treatment of

susceptible bacterial ocular infections, prophylaxis
of gonococcal ophthalmic neonatorumAction:
Inhibition of ribosomal protein
synthesisDose/Route: Apply ribbon to eyes of
neonates after birthSide Effects: burning,
inflammation, itching, lacrimation,
redness, Contrindications:hypersensitivity,
fungal/viral ocular infectionsNursing
Implications:Asses skin integrity and
sensory perception

Ibuprofen Classification: Antiinflammatory-analgesic,

antipyreticUse: Relief of mild/moderate pain,
reduce inflammation and feverAction:Inhibition of
prostaglandin synthesisDose/Route: 200-400-mg
q4-6h POSide Effects: dizziness, abdominal
pain,rash,
thirstContraindications:aspirin hypersensitivity,
treatment of perioperative pain, can increase risk
of GI bleeding, ulcersNursing
Implications: Administer with food to reduce GI
irritation, encourage upright position for 15-30
minutes, avoid if breast-feeding

Toradol (Ketorolac tromethamine) Classification: Analgesic,

antiinflammatory Use: Short-term relief of pain for
up to 5 daysAction: Analgesic activity appears
related to inhibition of prostaglandin
 synthesisDose/Route:Im/IV: 15,30 mg/ml
doseTablets: 10mg q4-6hSide
Effects:dizziness, drowsiness, hypertension,
impaired
comfortContraindications:hypersensitivity,
labor/delivery, nursing mothers,
epidural/intraecal administrationNursing
Implications:administer with food/milk, monitor
for side effects

Magnesium Sulfate Classification: AnticonvulsantUse: prevent

seizures in severe pre-eclampsia, eclampsia, or
toxemia of pregnancy.Action:Inhibition of
peropheral neuromuscular
transmissionDose/Route: 4g(1-5g) IM q4h
prn Side Effects: dressed reflexes, flushing,
drowsiness, hypotensionContraindications: do not
administer within 2h before delivery in toxemic
pregnant womenNursing Implications: Monitor
signs for seizure activity, emotional support,
patellar reflex positive before dose given

Methergine Classification:
oxytoxicUse:Treatment/prevention of
postpartum hemorrhage due to uterine atony, may
be given second stage of labor following delivery of
anterior shoulderAction: increases uterine
contraction force and frequencyDose/Route: 0.2
mg PO tid-qid up to 1wk OR 0.2 mg IM q2-4h prn up
to 5 dosesSide Effects: headache, hypertension,
possible symptoms of ergot
poisoningContraindications:hypersensitivity,
threatened spontaneous abortionNursing
Implications: Caution with use, not
routinely used before delivery, have emergency
equipment available animal studies show adverse
fetal effects

Morphine injection Classification: AnalgesicUse: Relief on moderate

to severe painAction: interacts w/ various opioid
receptors, producing analgesia and sedation
(opioid agonist)Dose/Route: 10-15 mg epidural one
timeSide Effects:oxygen saturation decrease,
hypotension, urinary retention,
constipation.Contraindications:hypersensitivity,
respiratory depression asthma, upper airway
obstruction, head trauma, labor and
deliveryNursing Implications:Safe with lactation,
monitor for possible adverse fetal effects
Nubain (Nalbuphine hydrochloride) Classification: AnalgesicUse:Reliefe of
moderate/severe pain, preop sedationAction: not
determined, possible activity in subcortical areas
in brainDose/Route: 10mg/70kg weight q3-6h
IM/Iv/SC, do not exceed 20mg per doseSide
Effects: sedation, dizziness, vertigo, autonomic
responses, possible
rashContraindications:hypersensitivity, use
caution in breast-feeding mothers due to small
amount of drug in the milkNursing
Implications: caution with lactation

Phenergan injection Classification: AntihistamineUse:Symptomatic

treatment of allergic disorders medicated by
histamine, pain caused by childbirthAction: non-
selectively antagonizes central and peripheral
histamine H1 receptors; possesses anticholinergic
properties, resulting in antiemetic and sedative
effects Dose/Route: 25-50 mg PO/IM/IV x1Side
Effects:drowsiness, confusion, sedation, blurred
vision,
disorientationCOntraindications:hypersensitvity,
neonates,nursing mothers, lower respiratory tract
symptomsNursing Implications:Avoid breast-
feeding; caution, results show adverse fetal effects

Pitocin Classification: OxytocicsUse:to induce labor,

strengthen labor contractions during childbirth,
control bleeding after childbirth, or to induce an
abortion.Action: binds to oxytocin receptors in
myometrium, increasing intracellular Ca and
stimulating uterine contractionsDose/Route:
Postpartum: IV 10-40unit in 100ml ; Im 3-10unit
after delivery of placentaAntepartum: Start IM/IV
at 1-2mU/m slowly increase until contractions
reach desired rateSide Effects: Cardiac
arrhythmia,hypertensive episodes, postpartum
hemorrhage, fetal
brachycardia Contraindication:pregnancy, vaginal
delivery, unfavorable fetal position, cephalopelvic
disproportion fetal distress when delivery not
imminentNursing Implications:Caution with fetal
position and maturity, monitor mother and fetal VS,
Safety precautions(uterine rupture/fetal distress)

Rhogam (Rh-D immune globulin) Classification: ImmunosuppresantUse: used to

suppress antibody formation in women with Rh
blood after abortion/pregnancy termination up to
and including week 12 of gestation unless father
has Rh- blood. Also used to suppress antibody
formation in woman with Rh- blood after delivery,
abdominal trauma during pregnancyAction: exact
mechanism of action unknown; suppresses immune
response of Rh-negative pts to Rh-positive
RBCsDose/ Route: Antepartum:300 mcg IM x1 at
28 wk gestation, then 300 mcg IM x1 w/in 72h of
deliveryPostpartum: 300 mcg IM x1 w/in 72h of
deliverySide Effects: Headache, lethargy, myalgia,
localized
stiffnessContraindications:hypersensitivity, Ph
positive patients, Iv administration, antepartum
prophylaxis at week 28Nursing Implications: Do
not administer to infant, proceed with caution with
lactation.
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