19 Miscellaneous
The student should be aware of
the non-pregnant physiology and adaptations during childbearing
the abnormal pathology of pre-existing medical conditions
the abnormal pathology of pregnancy-related disorders
The student is urged to examine Standard 37 of the Code (NMC, 2008) and Standard 23 from the Standards for Medicines Management (NMC, 2007, updated 2010) on complementary and alternative therapies. Specific consideration of these sources is vital before considering the use of alternative or complementary therapies in any aspect of practice.
BP
Zidovudine (azidothymidine, sometimes known as AZT – abbreviation to be used with caution as it is also used for another drug)
Proprietary
Zidovudine (Aurobindo Pharma Ltd)
Retrovir® (ViiV Healthcare UK Ltd)
Retrovir® (ViiV Healthcare UK Ltd)
Group
Antiviral
Uses/indications
Management of HIV, possibly in the prevention of maternofetal HIV transmission
Type of drug
POM
Presentation
Capsules (white/blue band and blue-white/dark blue band), syrup 100 mg/10 mL
Powder for reconstitution, vials 200 mg in 20 mL solution (10 mg/mL)
Powder for reconstitution, vials 200 mg in 20 mL solution (10 mg/mL)
Dosage
Prevention of maternofetal transmission (over 14 weeks’ gestation): oral – 100 mg 5 times a day until labour
Labour and delivery: IV infusion at 2 mg/kg over 1 h, then 1 mg per kg per h until the cord is clamped. If LSCS planned, commence the regimen 4 h prior to delivery
Labour and delivery: IV infusion at 2 mg/kg over 1 h, then 1 mg per kg per h until the cord is clamped. If LSCS planned, commence the regimen 4 h prior to delivery
Route of admin
Oral, IV infusion
Contraindications
Low haemoglobin or neutrophil counts, haematological toxicity: monitor blood levels
Vitamin B12 deficiency
Vitamin B12 deficiency
Side effects
Multiple, including gastrointestinal disturbances, headache, rash, fever, anaemia
Interactions
Analgesics – methadone increases the plasma concentration of this drug
Antiepileptics – plasma phenytoin concentrations can increase or decrease; valproate – there is a potential for toxicity as plasma levels are increased
Antiepileptics – plasma phenytoin concentrations can increase or decrease; valproate – there is a potential for toxicity as plasma levels are increased
Pharmacodynamic properties
Antiviral agent that acts as a virostatic by disrupting viral DNA to inhibit growth and reduce viral numbers
Fetal risk
Use only if clearly indicated – possible maternal and fetal anaemia
Breastfeeding
Not recommended as HIV infection can be transmitted vertically
BP
Aciclovir (acyclovir)
Proprietary
Zovirax® (GlaxoSmithKlein UK)
Aciclovir (Pharmacia Ltd) (non-proprietary, see BNF for details)
Aciclovir (Pharmacia Ltd) (non-proprietary, see BNF for details)
Group
Antiviral
Uses/indications
Treatment of varicella-zoster in pregnancy, herpes zoster, shingles and cold sores
Type of drug
POM
Presentation
Powder for reconstitution, tablets, cream, cold sore cream, suspension
Dosage
Slow IV infusion over 1 h – 5 mg/kg t.d.s.
Oral: 800 mg × 5/day for 7 days
Oral: 800 mg × 5/day for 7 days
Topical: apply to lesion 4-hrly 5 times/day for 5–10 days – prompt recognition and commencement of treatment is recommended
Route of admin
IV infusion, oral, topical
Contraindications
Renal impairment
Side effects
Multiple, including rash, gastrointestinal disturbances, on IV infusion – local inflammation
Interactions
Ciclosporin and tacrolimus – increased risk of nephrotoxicity
Mycophenolate and probenecid – increased plasma concentration of aciclovir and metabolites of mycophenolate
Mycophenolate and probenecid – increased plasma concentration of aciclovir and metabolites of mycophenolate
Pharmacodynamic properties
A virostatic that interferes with the DNA reproduction function of the virus, reducing production and inhibiting its growth
Fetal risk
Use only when the benefits outweigh the risks, as the number of exposures to the drug is too limited to assess the long-term prognosis
Breastfeeding
Significant amount secreted into breast milk
Oral: 5-day course – considered safe
IV: insufficient information to allow classification as safe
Oral: 5-day course – considered safe
IV: insufficient information to allow classification as safe
BP
Thyroxine (levothyroxine sodium)
Proprietary
Eltorxin™ (Goldshield Group UK Ltd)
Thyroxine (non-proprietary, see BNF for details)
Thyroxine (non-proprietary, see BNF for details)
Group
Thyroid hormone
Uses/indications
Hypothyroidism
Type of drug
POM
Presentation
Tablets (25 mcg, 50 mcg, 100 mcg)
Dosage
As indicated by laboratory monitoring and the physician
Route of admin
Oral
Contraindications
Thyrotoxicosis, hypersensitivity
Side effects
These usually occur with overdose – tachycardia, palpitations, muscle cramps and other indications of an increased metabolic rate
Interactions
Antidepressants – tricyclics, amitriptyline – the antidepressant response is increased by the concurrent use of thyroxine
Anticoagulants – the effect of warfarin is enhanced
Antiepileptics – phenobarbital and phenytoin accelerate the metabolism of thyroxine; phenytoin levels are increased by thyroxine
Cimetidine – reduces the absorption of thyroxine from the gut
Cholestyramine – the absorption of thyroxine is reduced
Iron – ferrous sulphate – reduced absorption of thyroxine
Hypoglycaemics – monitor insulin requirements because of increased metabolic rate
Oral contraceptives – may increase plasma levels of thyroxine
Anticoagulants – the effect of warfarin is enhanced
Antiepileptics – phenobarbital and phenytoin accelerate the metabolism of thyroxine; phenytoin levels are increased by thyroxine
Cimetidine – reduces the absorption of thyroxine from the gut
Cholestyramine – the absorption of thyroxine is reduced
Iron – ferrous sulphate – reduced absorption of thyroxine
Hypoglycaemics – monitor insulin requirements because of increased metabolic rate
Oral contraceptives – may increase plasma levels of thyroxine
Pharmacodynamic properties
A naturally occurring hormone that contains iodine and is produced by the thyroid gland – required for growth, development and the nervous system. It also increases the basal metabolic rate and has stimulatory effects on heart and skeletal muscle, liver and kidneys
Fetal risk
Monitor serum levels closely
Breastfeeding
Maternal dosage may interfere with neonatal screening for hypothyroidism
BP
Salbutamol
Proprietary
Ventolin™ Accuhaler™ (Allen & Hanburys Ltd)
Salbutamol (non-proprietary, see BNF for details)
Salbutamol (non-proprietary, see BNF for details)
Group
Selective β2-adrenoceptor agonist – bronchodilator
short acting
short acting
Uses/indications
Bronchodilator, immediate relief of asthma
Myometrial relaxant: see Chapter 18
Myometrial relaxant: see Chapter 18
Type of drug
POM
Presentation
Pressurized metered-dose inhaler
Dosage
100–200 mcg (1–2 puffs); for persistent symptoms up to 4 times daily; prophylaxis of allergen or exercise induced bronchospasm, 200 mcg (2 puffs)
duration of action 3–5 h
Premature labour: see Chapter 18 for regime if used as tocolytic
duration of action 3–5 h
Premature labour: see Chapter 18 for regime if used as tocolytic
Route of admin
Inhalation
Contraindications
Placenta praevia, antepartum haemorrhage, pre-eclampsia/eclampsia, threatened miscarriage, hypersensitivity
Side effects
Fine tremor (particularly in the hands), nervous tension, headache, muscle cramps
Palpitation, tachycardia, arrhythmias, peripheral vasodilatation, myocardial ischaemia, hypotension, and collapse
Disturbed sleep and behavioural changes
Paradoxical bronchospasm (occasionally severe)
Urticaria, angio-oedema
High doses associated with hypokalaemia
Palpitation, tachycardia, arrhythmias, peripheral vasodilatation, myocardial ischaemia, hypotension, and collapse
Disturbed sleep and behavioural changes
Paradoxical bronchospasm (occasionally severe)
Urticaria, angio-oedema
High doses associated with hypokalaemia
Interactions
β-blockers, e.g. propranolol
Pharmacodynamic properties
Acts on β2-adrenoceptors of bronchial muscle, with little or no action on β1-adrenoceptors of cardiac muscle
Fetal risk
Benefit should outweigh the risks; animal studies indicate toxicity at high doses
Breastfeeding
Likely to be secreted in breast milk, so benefits should outweigh risks
BP
Beclometasone dipropionate
Proprietary
Easyhaler® Beclometasone 200 mcg (Orion Pharma UK Ltd)
Beclometasone (non-proprietary, see BNF for details)
Beclometasone (non-proprietary, see BNF for details)
Group
Corticosteroid
Uses/indications
Management of chronic asthma
Type of drug
POM
Presentation
Inhalation powder administered from multidose powder inhaler
Dosage
Maintenance: 200 mcg b.d.
Severe: starting dose may need to increase to 600–800 mcg per day and reduced once stabilized
Total daily dose may be administered as 2, 3 or 4 divided doses
Severe: starting dose may need to increase to 600–800 mcg per day and reduced once stabilized
Total daily dose may be administered as 2, 3 or 4 divided doses
Route of admin
Oral inhalation
Contraindications
Hypersensitivity
NB: special care in clients with active or quiescent pulmonary tuberculosis
NB: special care in clients with active or quiescent pulmonary tuberculosis
Side effects
Candidiasis of the mouth and throat (clients are advised to rinse their mouth after using the inhaler)
Hoarseness/throat irritation, cough
Hoarseness/throat irritation, cough
Interactions
None reported
Pharmacodynamic properties
A pro-drug with weak glucocorticoid receptor binding activity, it is hydrolyzed via esterase enzymes to the active metabolite beclometasone-17-monopropionate (b-17-mp), which has high topical anti-inflammatory activity
NB: clients should be instructed in the correct use of the inhaler, and their technique checked, to ensure that the drug reaches the target areas within the lungs. The inhaler must be used regularly (even when asymptomatic for optimal benefit)
NB: clients should be instructed in the correct use of the inhaler, and their technique checked, to ensure that the drug reaches the target areas within the lungs. The inhaler must be used regularly (even when asymptomatic for optimal benefit)
Fetal risk
Corticosteroids given to pregnant animals can cause abnormalities of fetal development including cleft palate and intrauterine growth restriction, hence a possible risk to the fetus
Manufacturer recommends use only if benefits outweighs risk
Manufacturer recommends use only if benefits outweighs risk
Breastfeeding
Recommend only if benefits outweighs risk
BP
Loperamide hydrochloride
Proprietary
Imodium® (McNeil Products Ltd)
Loperamide hydrochloride (non-proprietary, see BNF for details)
Loperamide hydrochloride (non-proprietary, see BNF for details)
Group
Antidiarrhoeal
Uses/indications
Acute/chronic diarrhoea
Type of drug
POM
Presentation
Capsules/caplets, syrup, melts or instants
Dosage
Adjusted according to response: usually 4 mg initially and 2 mg after each loose stool thereafter to max dose of 12 mg in 24 h
Route of admin
< div class='tao-gold-member'>
Only gold members can continue reading. Log In or Register to continue
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
