This document discusses antihypertensive drugs used during pregnancy. It provides an overview of how drugs cross the placenta and categories drugs by the FDA for safety in pregnancy. Common antihypertensive drugs discussed include methyldopa, labetalol, nifedipine, hydralazine, and sodium nitroprusside. For each drug, the document covers mechanism of action, dosing, indications, contraindications, side effects, and important nursing considerations. The goal of antihypertensive treatment during pregnancy is to lower blood pressure and protect the health of the mother and fetus.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
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This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
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This topic contains anticonvulsants used in obstetrics such as magnasium sulphate, diazepam, phenytoin and anticoagulants such as heparin and warfarin.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
This topic contains anticonvulsants used in obstetrics such as magnasium sulphate, diazepam, phenytoin and anticoagulants such as heparin and warfarin.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
ABSTRACT- Valeriana jatamansii Linn (Valerianaceae) is a medicinal herb used in the traditional health care system of
Uttarakhand (India). The present study reports the anticonvulsant activities in the aqueous and ethanolic extracts of the
roots of Valeriana jatamansii on the rats, induced both chemically and electrically. The models chosen for the activity
were Maximal Electroshock (MES) and Pentylenetetrazole (PTZ) induced convulsions in rats. The test dose studied were
400 and 600 mg/kg body weight orally of the extracts. Acute toxicity studies show that the extracts were non toxic up to
the recommended dose 2000mg/kg body weight orally as per OECD guideline no 423. In PTZ induced seizures, onset of
clonic convulsions were studied while in MES model, reduction in the mean duration of extensor phase was noted. Both
the extracts showed anticonvulsant activities against MES and PTZ animal models.
Key Words: Anticonvulsant activity, MES, PTZ, Herbal drug
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
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7. How Drugs Cross the Placenta
Fetus's blood vessels are contained in tiny
hair like projections (villi) of the placenta that
extend into the wall of the uterus.
The mother's blood passes through the space
surrounding the villi (intervillous space).
Only a thin membrane (placental membrane)
separates the mother's blood in the
intervillous space from the fetus's blood in
the villi.
8. Drugs in the mother's blood can cross this
membrane into blood vessels in the villi and
pass through the umbilical cord to the fetus
9. HYPERTENSION
Hypertension is defined as having a
blood pressure greater than 140/90 mm
Hg
Normal blood pressure is 120/80 mm/hg.
10. GESTATIONAL HYPERTENSION
is the development of new
hypertension in a pregnant woman
after 20 weeks.
Rise of blood pressure to
140/90mm/hg.
12. INTRODUCTION
ANTIHYPERTENSIVE- Work against the
hypertension.
Antihypertensive drugs are essential when
the BP is 160/110 mm of Hg to protect mother
from
Eclampsia.
Cerebral hemorrhage.
Cardiac failure.
Placental abruption.
13. Risk of large organ damage ( kidney)
antihypertensives are given to maintain BP <-
140 mm of Hg.
First line therapy is either methyldopa or
labetalol.
Second line drug is nifedipine.
ACH inhibitors/ ARB are avoided in
pregnancy.
14. These drugs are used in two clinical conditions.
Pre- eclampsia and eclampsia.
Chronic hypertension.
15. PRE-ECLAMPSIA AND ECLAMPSIA
Rise of blood pressure specially where the
diastolic pressure is above 110mm Hg.The
use is more urgent with proteinuria.
Severe pre- eclampsia to bring down the
blood pressure during continued pregnancy
and during the period of induction of labour.
16. DRUGS MODE OF
ACTION
DOSE
METHYLDOPA Central and
peripheral anti
adrenergic action.
250-500 mgTID or
QID.
LABETATOL Adrenoceptor
antagonist (alpha or
beta blocker).
100 mgTID or QID
NIFEDIPINE Calcium channel
blocker.
10-20 mg BID
HYDRALIZINE Vascular smooth
muscle relaxant.
10-20 mg BID.
17. CHRONIC HYPERTENSION
Routine use of antihypertensive drugs is not
favoured.
Antihypertensive drugs should be used only
when the pressure is raised beyond 160/100
mm Hg.
To prevent target organ damage.
18. HYPERTENSIVE CRISIS
Drugs can be used when the BP is _>160/110
mm Hg or the mean arterial pressure (MAP)
is _> 125 mm Hg.
MAP is the average arterial pressure during a
single cardiac cycle.
Avoid labetalol I woman having asthma or
cardiac failure.
19. DRUG ONSET OF
ACTION
DOSE
SCHEDULE
MAXIMUM
DOSE
MAINTENANCE
DOSE
LABETALOL 5 MIN 12-20 mg IV
every 10 min.
300 mg IV 40 mg/hr
HYDRALAZINE 10 MIN 5 mg IV every
30 min
30 mg IV 10mg/hr
NIFEDIPINE 10 MIN 10-20 mg
ORAL, can
repeat 30 min
240
mg/24hr
4-6 hour interval
NITROGLYCERI-
NE.
0.5- 5 MIN 5ug /min IV Other drugs
have failed.
Other drugs
failed
SODIUM
NITROPRUSSID-
E.
0.5- 5 MIN 0.25-5
ug/kg/min IV
Other drugs
have failed.
Other drugs
failed.
20. COMMONLY USED DRUGS
CATEGORY C
Sympatholytics
Methyl-dopa
Reserpine
Calcium channel blocker
Nifedipine
Nicardipine
22. CATEGORY D
5. ACE inhibitors/ ARB.
Captopril
Trlmisartan
Avoided during pregnancy because it can cause
various kind of deformities in fetus.
23. PHARMACOKINETICS
These drugs transported actively by intestinal
amino acid carrier, less than 1/3 of an oral
dose absorbed.
It is partly excreted unchanged in urine.
Antihypertensive effect develop over 4-6
hours and lasts for 12-24 hours.
24. METHYLDOPA
Mechanism of action/ Pharmacodynamics:
Central or peripheral antiadrenergic action as false
transmitter, resulting in reduction of arterial pressure.
Effective and safe for mother and the fetus.
Indication:
Hypertension.
Dose:
Orally- 250mg TID - may be increased to 1 g QID
depending upon the response. IV infusion – 250-
500mg.
Contraindications and precautions:
Hepatic disorders, psychic patients, congestive
cardiac failure, Postpartum ( risk of depression.
26. Nursing consideration
Assess
Blood values: Neutrophils, platelets.
Renal studies: Protein, creatinine.
Blood pressure before beginning treatment and
periodically thereafter.
Perform/ Provide
Storage of tablets in tight containers.
Evaluate
Decrease in blood pressure .
Allergic reaction: Rash, fever.
27. Teach client/ Family
To avoid hazardous activities.
Administer one hour before meals.
To rise slowly to sitting or standing
position to minimize orthostatic
hypotension.
Not to skip or stop drug unless directed by
physician.
Notify physician of untoward signs and
symptoms.
28. HYDRALAZINE
Mechanism of action:
Acts by peripheral vasodilators as it relaxes the
arterial smooth muscle. Orally it is weak and
should be combined with methyldopa or
beta- blockers. It increases the cardiac output
and renal blood flow.
Preparations:
Aspresoline, Hydralyn, Rolazine.
Dose:
Orally: 100mg/day in four hours divided doses
IV: 5-10 mg every 20 minute maximum 20 mg.
29. Indication:
Essential hypertension.
Contraindications and precautions
Coronary artery diseases, mitral valvular
rheumatic heart disease.
Because of variable sodium retention,
diuretics should be used.To control
arrhythmias, propranolol may be
administered intravenously.
31. Nursing Consideration
Assess
BP every 15 minutes initially for 2 hours then
every hour for 2 hours, and then q4h, pulse
q4h.
Blood studies: Electrolytes, CBC and serum
glucose.
Intake: Output and weight daily.
Administer
To patient in recumbent position, keep in that
position for one hour after administration.
32. Evaluate
Edema in feet and legs daily.
Skin and mucosa membrane for hydration.
Dyspnea, orthopnea.
Joint pain, tachycardia, palpitation, headache
and nausea.
Teach Client/ Family
To take with food to increase bio- avail-ability.
To notify physician if chest pain, severe fatigue,
muscle or joint pain occurs.
33. LABETALOL
Mechanism of action: Combined with alfa and
beta adrenergic blocking agent.
Preparations:Trandate, Normodyne.
Dose: Orally – 100mg TID may be increased up
to 2400 mg daily.
IV- infusion ( Hypertensive crisis) 20-40 mg
every 10-15 min until desired effect,
maximum up to 220 mg.
Indication: Hypertension
34. Contraindications and precautions- Hepatic
disorders, Asthma, congestive cardiac failure.
Side effects -Tremors, headache, asthma,
congestive cardiac failure. Efficacy and safety
with short term use appear equal to
methyldopa.
35. Nursing Considerations:
Assess
Intake output and weight daily.
Blood pressure and pulse check q4h.
Apical or radial pulse before administration.
Administer
PO, before food and h.s.
IV, keep client recumbent for 3 hours.
36. Perform/ provide
Storage in dry area at room temperature.
Evaluate
Therapeutic response: Decreased BP after 1
to 2 weeks.
Edema in feet, legs daily.
Skin turgor and dryness of mucus membranes
for hydration status.
37. Teach Client/ Family
Not to discontinue drug abruptly, taper over 2
weeks.
To report bradycardia, dizziness, confusion or
depression.
To avoid alcohol, smoking and excess sodium
intake.
Take medication at bedtime to prevent the
effect of orthostatic hypotension.
38. NIFEDIPINE
Preparations - Adalat, Procardia.
Mechanism of action: Direct arteriolar
vasodilation by inhibition of slow inward calcium
channels in vascular smooth muscle.
Dose: Orally- 5-10 mg tid maximum dose 60-120
mg/ day.
Indication – Hypertension, angina pectoris.
Contraindications and precautions:
Simultaneously use of magnesium sulfate could
be hazardous due to synergistic effect.
Side effects- Flushing, hypotension, headache,
tachycardia, inhibition of labour, fatigue,
drowsiness, nausea, vomiting.
39. Nursing Considerations
Assess
Blood levels of the drug, therapeutic levels 0.025 to
0.1ug/ml.
Administer
Before meals and night.
Evaluate
Therapeutic response, cardiac status, BP, pulse,
respiration and ECG.
Teach Client/ Family
To limit caffeine consumption.
Stress patient compliance to all aspects of drug use.
40. SODIUM NITROPRUSSIDE
Preparations – Nipride, Nitropress.
Mechanism of action: Direct vasodilator (
arterial and venous), directly relaxes
arteriolar, venous smooth muscle, resulting in
reduction of cardiac preload and afterload.
Indications
Hypertension crisis.
To decrease bleeding by creating
hypotension during pregnancy
41. Contraindication and precaution: Drug of last
resort for acute hypertension. Should be used
in critical care unit for very short time ( 10
minutes)
Dose: IV infusion 0.25-8 ug/kg/min.
Side effects: Maternal- Nausea, vomiting,
severe hypotension, restlessness, decreased
reflexes, loss of consciousness.
Fetal toxicity due to metabolites- cyanide
and thiocyanate
42. Nursing Considerations
Assess
Serum electrolyte, BUN and creatinine.
Hepatic function.
BP and ECG.
Weight and intake output.
Administer
Using and infusion pump only.
Wrap bottle with aluminum foil to protect
from light.
44. NITROGLYCERINE
Mechanism of action: Relaxes mainly the
venous but also arterial smooth muscle.
Dose- Given as IV infusion 5 ug/ min to be
increased at every 3-5 min up to 100ug /min.
Side effect: Tachycardia, headache,
methaemoglobinaemia.
Contraindication and precautions: Used in
hypertensive crisis for short time only.
Contraindicated in hypertensive
encephalopathy as it increases blood flow
and intracranial pressure
45. Nursing Consideration
Assessment
Monitor patient closely for change in levels of
consciousness and for dysrhythmias.
Assess for headaches. Approximately 50% of all
patients experience mild to severe headaches
following nitroglycerin.
Take base line BP and heart rate.
Assess for and report blurred vision and dry mouth.
Patient and Family Education
Take care of the adverse effect of headache.
Report blurred vision if present.
Change position slowly and avoid prolonged
standing.
46. PROPRANOLOL
Action
Beta adrenergic blocker: Decreases preload,
afterload, which is responsible for decreasing
left ventricular end diastolic pressure and
systemic vascular resistance.
Indication – Hypertension, prophylaxis of
angina pain.
Contraindication – Bronchial asthma, renal
insufficiency, diabetes mellitus, cardiac
failure.
47. Side effect/ Adverse Reactions
Maternal
Sever hypotension, sodium retention,
bradycardia, bronchospasm, cardiac failure.
Fetal
Bradycardia and impaired fetal responses to
hypoxia, IUGR with prolonged therapy.
Doses and routes of administration
Orally 80 to 240 mg divided doases.
48. Nursing Consideration
Assess
BP, pulse and respirations during therapy.
Weight daily and report excess weight gain.
Intake output ratio.
Administer
Administer with 240 ml of water on empty stomach.
Evaluate
Tolerance if taken for long period.
Headache, light- headedness, decreased BP.
Teach Client/ Family
There may be stinging sensation when the drug
comes in contact with mucus membranes.
To make position changes slowly to prevent fainting.
49. DIAZOXIDE
Preparation – Hyperstat.
Action –Vasodilator.
Indication – Hypertensive crisis when urgent
decrease of diastolic pressure is required.
Contraindications – Diabetes, heart disease,
diuretics should be used simultaneously.
50. Side effect
Maternal
Fluid and sodium retention.
Inhibition of uterine contraction.
Hyperglycemia.
Severe hypotension.
Palpitations.
Fetal
Hypoxia.
Dosage and routes of administration
IV- 30 to 50 mg, may be repeated every 10 to 15
minutes or continuous infusion.
51. Nursing Consideration
Assess
BP q5min for 2 hours, then q1hr for 2 hours and
then q4h.
Pulse, jugular venous distention q4h.
Serum electrolytes, CBC, serum glucose.
Weight daily and intake output.
Administer
To patient in recumbent position, keep in that
position for one hour after administration.
Perform/ provide
Protection from light.
52. Evaluate
Therapeutic responses: Primarily decreased diastolic
pressure.
Edema in feet and legs.
Hydration status.
Dyspnea and orthopnea.
Postural hypotension:Take BP sitting and standing.
Teach Patient/ Family
To limit caffeine consumption.
To report side effects if present.
To comply with the regimen.
53. ACE inhibitors/ Angiotensin-
II receptor blocker (ARB
Mechanism of action - ACE inhibitors, inhibits
formation of angiotensin- II from
angiotensin- I. ARB blocks angiotensin- II
receptors.
Dose- Captopril orally 6.25 mg bid
Telmisartan orally 20-40 mg a day.
54. Side effect - Maternal- Hypotension, headache,
asthma, arrhymias.
Fetal- Oligohydraminios, IUGR, fetal tubular
dysgenesis, neonatal renal failure, pulmonary
hypoplasia.
Contraindication and precaution: Should for
chronic hypertension in non- pregnant state
or postpartum.
55. TITLE-
The effect of calcium channel blockers on
prevention of preeclampsia in pregnant
women with chronic hypertension.
AUTHOR –
Jiang N, Liu Q, Liu L,YangWW, ZengY.
56. BACKGROUND:
This study aims to investigate whether
calcium channel blockers plus low dosage
aspirin therapy can reduce the incidence of
complications during pregnancy with chronic
hypertension and improve the prognosis of
neonates.
57. MATERIALS AND METHODS:
From March 2011 to June 2013, 33 patients were
selected to join this trial according to the chronic
hypertension criteria set by the Preface Bulletin
of American College of Obstetricians and
Gynecologists.
Patients were administrated calcium channel
blockers plus low-dosage aspirin and vitamin C.
The statistic data of baseline and prognosis from
the patients were retrospectively reviewed and
compared.
58. RESULTS:
Blood pressure of patients was controlled by
these medicines.
39.4% patients complicated mild
preeclampsia; however, none of them
developed severe preeclampsia or eclampsia,
or complicate placental abruption. 30.3%
patients delivered at preterm labour; 84.8%
patients underwent cesarean section.
59. The neonatal average weight was 3,008 ±
629.6 g, in which seven neonatal weights
were less than 2,500 g. All of the neonatal
Apgar scores were 9 to 10 at one to five
minutes. Small for gestational age (SGA)
occurred in five (15%).
60. CONCLUSIONS:
Calcium channel blockers can improve the
outcome of pregnancy women with chronic
hypertension to avoid the occurrence of
severe pregnancy complication or neonatal
morbidity.
65. INTRODUCTION
Due to eclampsia. Other causes are –
epilepsy, meningitis, cerebral malaria
and cerebral tumours.
Proved by history, examination and
investigations.
66. Commonly used anticonvulsant is
magnesium sulfate.
Diazepam, Phenytoin and
Phenobarbitone are also used.
67. IN 2013 ACCORDINGTO FDA
FROM CATEGORY A
TO CATOGORY D
BECAUSE OFTHE RISK OF FETAL
DEMINERALIZATION.
68. PHARMACOKINETICS
Absorption by oral route is slow, mainly
because of its poor aqueous solubility.
Widely distributed in the body and is 80-
90% bound to plasma proteins.
Metabolized in liver.
Excreted by the kidney.
69. MAGNESIUM SULFATE
Action –
Decrease acetylcholine in motor
nerve terminals, which is responsible
for anticonvulsant properties, thereby
reduces neuromuscular irritability.
70. It also decreases intracranial edema
and helps in diuresis.
Its peripheral vasodilatation effect
improves the uterine blood supply.
71. Use –
It is a valuable drug lowering seizure
threshold in women with pregnancy –
induced hypertension.
The drug is used in preterm labor to
decrease uterine activity.
72. Dosage and Route
For control of seizures, 20 ml of 20%
solution IV slowly in 3 to 4 minutes and
10ml of 50 percent solution IM, and
continued 4 hourly for 24 hours
postpartum.
73. Repeat injections are given only if the
knee jerks are present, urine output
exceeds 100ml in previous 4 hours
and the respirations are more than
10/minute.
74. The therapeutic levels of serum
magnesium is 4 to 7 mEq/L.
4 gm IV slowly over 10 min, followed
by 2 gm/ hr and then 1 gm/hr in drip of
5 percent dextrose for tocolytic
effect.
75. Side effects
Maternal – Severe CNS depression (
respiratory depression and circulatory
collapse), evidence of muscular
paresis ( diminished knee jerks).
Fetal –Tachycardia, hypoglycemia.
Antidote – Injection calcium gluconate
10% 10 ml IV.
76. Nursing Considerations
Assess
Vital signs 15 min after IV dose.
Monitor magnesium levels.
If using during labour, time contractions,
determine intensity.
Urine output should remain 30 ml/hr or
more, if less notify physician.
77. Administer
Only after calcium gluconate is
available for treating magnesium
toxicity.
Using infusion pump or monitor
carefully IV at less then 150 mg/min,
circulatory collapse may occur.
Only dilution.
78. Perform/Provide
Seizer precautions, place client in
single room with decreased stimuli,
padded side rails.
Positioning of the client in left lateral
recumbent position to decrease
hypotension and increase renal blood
flow.
79. Evaluate
Mental status, sensorium, memory.
Discontinue infusion if respirations
are below 12/min or fetal distress.
80. Teach Client/ Family
On all aspects of the drug: action, side
effects and symptoms of
hypermagnesemia.
To remain in bed during infusion.
81. DIAZEPAM ( VALIUM)
Action -
Depresses subcortical levels of CNS,
anticonvulsant, and antianxiety.
Dosage and Route of Administration
PO, 2 to 10 mg tid – qid.
82. IV, 5 to 20 mg ( bolus), 2mg/min, may
repeat q5 – 10 min, not to exceed 60
mg, may repeat in 30 min if seizures
reappear.
83. Side effect
Mother – Hypotension, dizziness,
drowsiness, headache.
Fetus - Respiratory depressant effect,
which may last for even three weeks
after birth.
84. Nursing Consideration
Assess
BP in lying and standing positions, if
systolic pressure falls 20 mmHg, hold
drug and inform physician.
Blood studies: CBC.
Hepatic studies.
85. Administer
IV into large vein to decrease chance
of extravasation.
PO with milk or food to avoid GI
symptoms.
86. Provide
Assistance with ambulation during
beginning therapy since drowsiness and
dizziness may occur.
Safety measures include side rails.
88. Teach Patient/ Family
Drug may be taken with food.
To avoid alcohol ingestion.
Not to discontinue medication
abruptly.
To rise slowly as fainting may occur.
89. PHENYTOIN ( DILANTIN)
Action – Inhibits spread of seizure
activity in motor cortex.
Dosage and route of administration
Eclampsia: 10 mg/kg IV at the rate not
more than 50mg/minute, followed 2
hours later by 5 mg/kg.
91. Fetal
Prolonged use by epileptic patients
may cause craniofocal abnormalities,
mental retardation, microcephaly and
growth deficiency.
92. Nursing Consideration
Blood studies: CBC, Platelets every 2
weeks until stabilized.
Discontinue drug if neutrophils<
1600/mm2
Administer
After diluting with normal saline, never
water.
93. Evaluate
Mental status, memory.
Respiratory depression.
Sore throat, brushing.
Teach Patient/ Family
All aspect of drug administration,
when to notify physician.
94. PHENOBARBITONE ( LUMINAL)
Action - Decreases impulse
transmission and increases seizure
thresholds at cerebral cortex level.
Dose and Route of Administration –
120 to 240mg/day in divided doses.
97. Evaluate
Mental status, mood affect and
memory.
Respiratory depression.
Fever, sore throat bruising, rash.
Teach Patient/ Family
All aspects of drug administration and
when to notify physician.
98. Effect of magnesium sulphate on
fetal heart rate parameters : a
systematic review.
AUTHOR –
Nensi A, De Silva DA, von Dadelszen P,
Sawchuck D, Synnes AR, Crane J, Magee LA
99. ABSTRACT
To examine the potential effects of
intravenous magnesium sulphate
(MgSO4) administration on
antepartum and intrapartum fetal
heart rate (FHR) parameters
measured by cardiotocography (CTG)
or electronic fetal monitoring (EFM).
100. They took a systematic review of
randomized controlled trials,
observational studies, and case series,
by qualitatively analyzed. Result of 18
included studies, all changes were
small and not associated with adverse
clinical outcomes
101. Maternal administration of MgSO4
for eclampsia have a small negative
effect on FHR, variability, and
accelerative pattern, but is not
sufficient clinically to warrant medical
intervention.