Common Medications in Midwifery

Question 1

Flucloxacillin

Answer 1

Antibiotic for CS wound infection, PO, 500mg 4 x a day for mild infection and 1g 4 x a day for moderate infection. Safe in breastfeeding and pregnancy. Not suitable if allergic to penicillin. Side effects: Diarrhoea, nausea, skin reactions, vomiting.

Question 2

Co-amoxiclav

Answer 2

Antibiotic for CS wound infection, PO, 625mg 3 x a day for serious infection. Not suitable for penicillin allergy. Safe in breastfeeding. Side effects: diarrhoea, hypersensitivity, nausea, skin reactions, vomiting.

Question 3

Vancomycin

Answer 3

Antibiotic for CS wound when allergic to penicillin. 125mg every 6 hours for 10 days. Side effects: Dizziness, very low white cells, nausea, drug fever, hypersensitivity.

Question 4

Paracetamol

Answer 4

Relief of mild-moderate pain and pyrexia. PO. 500mg x 2. 4 times a day. Side effects: Hypersensitivity reactions

Question 5

Diamorphine

Answer 5

Analgesia for moderate to severe pain. Given IM, 5-10mg every 4 hours. Side effects: nausea/vomiting, bradycardia, drowsiness, dizziness, respiratory depression.

Question 6

Diclofenac Tabs

Answer 6

Analgesia for moderate to severe pain for up to 48 hours, especially following C/S. PO 50mg T.D.S. Side effects: Abdominal pain, dyspepsia, nausea, headaches, diarrhoea/constipation, allergic reactions, rash.

Question 7

Diclofenac Suppositories

Answer 7

Analgesia and anti-inflammatory post perineal suturing. PR 100mg once only. Side effects: Abdominal pain, dyspepsia, nausea, headaches, diarrhoea/constipation, allergic reactions, rash.

Question 8

Prochlorperazine

Answer 8

Antiemetic to go with opioid analgesia or excessive emesis. IM 12.5mg once only or 6-8hrly. Side effects: Tremor, dystonia, akathisia, drowsiness, dizziness, gastrointestinal disturbance, constipation, pallor, hypothermia. Can cause prolonged labour so withhold until 3-4cm dilated.

Question 9

Ibuprofen

Answer 9

Analgesia for mild to moderate pain, particularly perineal. 400mg up to 3 times a day. Side effects: gastrointestinal discomfort, diarrhoea, rash, headache dizziness.

Question 10

Folic Acid

Answer 10

Prevention of neural tube defects. 400mcg PO once a day until 12 weeks gestation. Side effects: rarely gastrointestinal disturbance.

Question 11

Lactulose

Answer 11

Treatment for constipation. 5ml starting dose, then 15ml B.D PO. Side effects: flatulence, abdominal cramps, discomfort.

Question 12

Micralax Enema (Sodium Citrate)

Answer 12

Treatment for constipation. One 5ml enema PR. Side effects: Diarrhoea and excessive fluid loss

Question 13

Peptac

Answer 13

For reflux. PO 10-20ml after meals and at bedtime.

Question 14

Peppermint water

Answer 14

Relief of abdominal colic and distention, IBS. PO 1-2 capsules 3 x a day. Side effects: Ataxia, bradycardia, gastro discomfort, reflux disease, headache, nausea. Not to broken or chewed as peppermint oil can irritate the mouth.

Question 15

Phytomenadione (Vitamin K for neonate)

Answer 15

Prophylaxis and treatment for VKDB. 1mg IM at birth or 2mg orally. a further 2mg dose at 4-7 days. BF babies should be given a 3rd dose at 1 month.

Question 16

Clotrimazole 1% cream

Answer 16

Treatment of vaginal and vulval candidiasis. Use 2-3 times a day. Side effects: local irriation, rash, burning, pruritus.

Question 17

Clotrimazole 500mg pessary

Answer 17

Treatment of vaginal candidiasis. One pessary inserted at night PV. Side effects: local irritation, rash, pruritus.

Question 18

Adrenaline (1mg/ml)

Answer 18

Treatment for acute anaphylaxis. IM. 500mcg (0.5ml). Can be repeated after 5-15 mins according to BP,pulse and resp function. Side effects: anxiety, temor, tachycardia, arrythmias, headache, cold extremities, hypertension, pulmonary oedema, nausea, vomiting, sweating, weakness, dizziness, hyperglycaemia.

Question 19

Anti-D immunoglobulin

Answer 19

Routine antenatal prophylaxis of haemolytic disease of the newborn caused by Rh D antibodies in Rh D negative mothers, where fetus is known to be RhD positive or status is unknown. 1500 units stat as single dose at 28 weeks or 29-30 weeks gestation.

Sensitising event in Rh D negative mothers - 1500 units

Postnatally - 1500 units IM, plus additional depending on FMH result (foeto-maternal haemorrhage/kelihauer test)

Side effects: local pain at site of injection. Sometimes fever,headache, cutaneous reactions, chills.

Question 20

Anusol cream

Answer 20

Symptomatic relief of haemorrhoids and anal pruritus. Use am and pm, and following BO until symptoms resolved. Side effects: rarely localised burning at site.

Question 21

Diprobase cream

Answer 21

Symtomatic relief of red inflamed, damaged or dry skin. Use as required (PRN). Side effects: local irritation, pruritus, rash.

Question 22

Entonox

Answer 22

Pain relief in labour, inhalational, as required self administered. Side effects: euphoric effects. No longer than 24 hours use.

Question 23

Ergometrine

Answer 23

Emergency treatment of PPH associated with uterine atony. IM or slow IV, 500mcg single dose. Side effects: nausea, vomiting, abdominal pain, chest pain, arrythmias

Question 24

Ferrous sulphate 200mg tabs

Answer 24

treatment of iron deficiency anaemia. PO. 200mg once or twice a day. Can cause nausea, dyspepsia, constipation, black stools

Question 25

Fybogel orange sachets

Answer 25

Relief of constipation. PO, one sachet a day. Side effects: bloating and flatulence.

Question 26

Gaviscon advance.

Answer 26

Treatment of reflux, indigestion, heartburn. PO 5-10ml after meals and bedtime. Side effects: hypersensitivity rare.

Question 27

Hartmann's solution

Answer 27

IV infusion. Used in maternal resuscitation, expanding circulatory volume and fluid/electrolyte replenisher and prior to epidural. 1000ml once only.

Question 28

Hepatitis B vaccine.

Answer 28

For immunity to Hep B infection in neonates born to Hep B surface antigen positive mothers. IM - anterolateral thigh 10mcg at birth. Side effects: pain, redness at site, irritability, fever, diarrhoea and vomiting.

Question 29

Hepatitis Immunoglobulin

Answer 29

Prevention of transmission of Hep B at birth. IM into upper outer quadrant of buttock in neonates. 200 units asap after birth simultaneous to vaccine but in different site. Side effects: red, redness at site of injection

Question 30

Lidocaine 1%

Answer 30

For perineal infiltration prior to episiotomy or perineal suturing. 5-20ml once only. Side effects: drowsiness, restlessness, dizziness, blurred vision, nausea, vomiting, muscle twitching, tremor, convulsions.

Question 31

Nystatin

Answer 31

Treatment of oral and intestinal thrush in adults and infants. PO, 1ml 4 x a day. Side effects: Oral irritation, gastro disturbance in overdose.

Question 32

Oxytocin (Syntocinon)

Answer 32

To expedite 3rd stage of labour in hypertensive patients, IM, 10 units once only. For emergency treatment for PPH up to max of 4 hrs post delivery. IV infusion, 50mls in 500mls hartmanns solution at a rate of 125ml/hr. Side effects: nausea, vomiting, arrythmia, headache

Question 33

Pethidine Hydrochloride

Answer 33

Pain relief in labour. IM 50-100mg repeated 3/4hours later if necessary. Max 200mg in 24 hours. Side effects: nausea, vomiting, constipation, dry mouth and more

Question 34

Sodium Chloride 0.9%

Answer 34

Following IV cannulation, IV flush, 5ml

Question 35

Syntometrine (ergometrine/oxytocin)

Answer 35

To expedite 3rd stage of labour. IM injection. 1ml amp once only. Side effects: nausea, vomiting, abdo pain, uterine spasm, uterine hyperstimulation, chest pain, arrythmias

Question 36

Intramuscular Injection

Answer 36

90 degree angle

Question 37

Subcutaneous injection

Answer 37

45 degree angle

Question 38

Intravenous injection

Answer 38

25 degree angle

Question 39

intradermal injection

Answer 39

10-15 degree angle