TASK 1

1. Fevers during pregnancy

2. Amoxicillin pharmacokinetics are quite good especially when given orally. Bioavailability can
reach 95% orally.
Absorption
Amoxicillin is absorbed quickly and well in the digestive tract, and does not depend on food.
Bioavailability ranges from 74 to 92%, and can reach 95% orally. Peak concentration in serum
occurs within 1─2 hours. The peak time in blood plasma depends on the dosage form, where the
peak time will be reached in 2 days for capsules, 3 days for extended release tablets, and 1 day
for suspension drugs. Because amoxicillin is excreted mainly in the kidneys, the concentration in
the serum will increase in patients with kidney disorders. Oral absorption in neonates is slower
than in older children. Peak serum concentrations in neonates, obtained in 3─4.5 hours.

Distribution
Amoxicillin distribution is highest in body fluids and bones, including the lungs, bronchial
secretions, maxillary sinus secretions, bile, pleural fluid, sputum, and middle ear fluid. In
cerebrospinal fluid amoxicillin can be found in concentrations <1%. In plasma protein bonds,
17─20%. In pregnant women, amoxicillin can cross the placental barrier. [

Metabolism
Amoxicillin bio transformation occurs in the liver. The half-life of amoxicillin is approximately 1
hour in adults. The half-life in children can be shorter. In neonates, the half-life ranges from 3-4
hours to neonatal months. In infants and children, ranging from 1-2 hours. The half-life will
extend in patients with kidney failure.

Elimination
Amoxicillin is excreted in the urine. About 50-80% of the dose of amoxicillin is secreted into the
urine without changing shape. Excretion of the drug to the kidneys will last longer in neonates
and infants because kidney function is not yet fully developed.

3. Macrolides do not show side effects that are harmful to the fetus such as erythromycin,
claritomycin and azithromycin.

4. Resistance
Some bacteria have been reported resistance to amoxicillin, namely Methicillin-resistant
Staphylococcus aureus (MRSA) and the gram-positive cocci group. Amoxiciliin resistance occurs
due to several factors, including:
- Excessive use in society obtained without a doctor's prescription
- Giving unnecessary, or irrational prescriptions.
- Extensive use in agriculture
5. Uterus Tonika
Drugs that work to affect uterine contractions. Uterine tonic medications.
Oxitocin
Drugs that stimulate uterine contractions.

Prostaglandins
Hormones secreted by various body tissues, such as uterine muscles

Hemostatid Drugs (Anti-Bleeding)

-Vit K
-Tranexamic Acid
Tranexamic acid is amstate an analogue of aminoka proic acid and a phlebenolytic inhibitor

Imunologi
- Vaksin
- Serum

The use of drugs - inhalation drugs

Opioid

- Meperidine, buprenorphine (temgesic), pentazosin (fortral) and morphine antagonists such

as criminalokson (narca)

Iron supplement

Ferrous sulfate
TASK 2

1. POGI :
Calcium channel blockers work on arteriolar smooth muscle and cause vasodilation with inhibits
the entry of calcium into cells. Decreased peripheral resistance due to administration calcium
channel blockers can reduce afterload, whereas their effect on venous circulation is only minimal.
Provision of calcium channel blockers can provide maternal side effects, including tachycardia,
palpitations, headaches, flushing and limb edema due to local microvascular effects and fluid
retention. Nifedipine is a calcium channel blocker that has been used for decades lastly to prevent
preterm labor (tocolysis) and as an antihypertensive. Based on RCT, the use of oral nifedipine
lowers blood pressure faster than labetalol intravenously, approximately 1 hour after the start of
administration. Nifedipine in addition acts as a vasodilator selective and natriuretic renal
arteriolar, and increase urine production. Compared with labetalol which has no effect on the
cardiac index, nifedipine increase the cardiac index which is useful in severe preeclampsia. The
regimen recommended is 10 mg oral capsules, repeated every 15-30 minutes, with a maximum
dose of 30 mg. Excessive use of calcium channel blockers has been reported to cause fetal hypoxia
and acidosis. This is due to the relative hypotension after administration of calcium channels
blocker.
2. POGI :
Magnesium sulfate
How it works magnesium sulfate can not be fully understood. One mechanism works is causing
vasodilation through relaxation of smooth muscles, including blood vessels peripheral and
uterine, so besides being an anticonvulsant, magnesium sulfate is also useful as antihypertensive
and tocolytic. Magnesium sulfate also plays a role in inhibiting receptors N-methyl-D-aspartate
(NMDA) in the brain, which if activated as a result of asphyxia, can cause entry of calcium into
neurons, which results in cell damage and seizures can occur.

The pharmacokinetics of oxytocin depend on the route of administration. In intramuscular

administration, the onset of action of uterine contractions occurs within 3-5 minutes. In
intravenous administration, the onset of action occurs within 1 minute.

Oxitocyn
Absorption
Continuous intravenous oxytocin is given to induce or speed up the parturition process. The
response of uterine motility emerges gradually and reaches a stable state within 20-40 minutes.
When administration is stopped, the concentration of oxytocin decreases rapidly within 1 hour,
but still maintains adequate concentrations at lower amounts.
Intravenous and intramuscular injection of oxytocin is usually given for the prevention or
management of postpartum hemorrhage. In giving oxytocin IV, oxytocin works very fast in 1
minute, and in giving oxytocin IM, oxytocin works within 3-5 minutes and can last up to 2-3 hours.
Intranasal oxytocin 10-20 units cause myoepithelial alveoli mammary gland contractions within
minutes and last for up to 20 minutes.
 Distribution
The distribution volume of oxytocin is around 12.2 L or 0.17 L / kg. Oxytocin is distributed through
extracellular fluid and across the placenta so that low levels of oxytocin are present in the fetal
circulation. Oxytocin can be found in low levels in breast milk.

Metabolism
Oxytocin is degraded by oxytocinase, an enzyme that is produced only during pregnancy and is
present in plasma, placenta, and uterine tissue. Enzymes are produced gradually during
pregnancy and increase rapidly at term, the enzymes then decrease after delivery. Oxytocin is also
rapidly metabolized in the liver, and in small amounts it is metabolized in the mammary gland.

Excretion
Oxytocin is excreted through the liver and kidneys within 3-20 minutes. If the oxytocin cleansing
rate of pregnant women is compared with non-pregnant women and men, the metabolic
cleansing rate of oxytocin is faster in pregnant women. Significantly 85% oxytocin concentration
decreased within 1 hour in pregnant women, whereas there was no significant degradation in
non-pregnant women and men. The level of metabolic cleansing in the three groups was no
significant difference, which is around 20 ml / kg per minute. Only 1% oxytocin in the unaltered
form is excreted in the urine.

3. POGI :
Methylergometrine
Pharmacokinetics of methylergometrine in the form of rapid absorption orally with an onset of
5-15 minutes, metabolism in the liver, and elimination mainly through urine.

Absorption
After oral administration, methylergometrine is rapidly absorbed with bioavailability that
reaches 60%. Bioavailability is higher around 78% if the drug is given via intramuscularly.
Methylergometrine will reach peak plasma concentrations in 60-90 minutes, with half-life in
plasma ranging from 0.5 to 2 hours. The onset and duration of action varies depending on the
route of administration of the drug. The effect of the drug after oral administration will appear
within 5-15 minutes, via intramuscular the drug will have an effect within 2-5 minutes whereas if
injected intravenously the effect will immediately occur <1 minute. The duration of action of the
drug in oral and intramuscular administration are both in the range of 45 minutes, but the effect
lasts longer up to 3 hours if the drug is injected intravenously. [1,3-6,14-16]

Distribution
Methylergometrine distribution is most abundant in plasma and extracellular tissue, but is
rapidly distributed into other tissues.

Metabolism
Methylergometrine is metabolized in the liver through first-pass metabolism.
 Elimination
Methylergometrine elimination mainly occurs in the kidneys through urine, but a small portion
will be eliminated through feces

4. Medscape, POGI :
Folic acid
Folic acid derived from food must undergo hydrolysis, reduction, and methylation in the
digestive tract before it is absorbed. The conversion of folic acid to its active form,
tetrahydrofoat, requires vitamin B12. Folic acid is present in plasma about 15-30 minutes after
oral administration, peak levels are usually achieved within 1 hour. After i.v administration, folic
acid is quickly cleared from plasma. Most of the metabolite products appear in the urine after 6
hours, complete excretion is achieved in 24 hours.