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Patient group direction supersedes Midwives Standing Orders. This patient group direction states which medicines may be supplied and administered by midwives within the Borders General Hospital NHS Trust. Midwives may, under the Medicines Act 1968, supply all medical products on the General Sale List and Pharmacy List and administer a small range of Prescription Only Medicines. The formulary contains monographs for all products within the patient group directions and should be used in conjunction with the information in the core section of the patient group direction.
Clinical Decision Making
Patients who may receive midwives formulary medicines This patient group direction should be used for the supply and/or administration of the agreed medicines to ante-partum, intra-partum or post partum mothers within the Borders General Hospital NHS Trust. The medicines may only be used within individual product monograph recommendations and contra-indications. 2.1 Consent If the patient does not wish to receive treatment with a formulary item, and no alternative is listed, medical help should be sought to find a suitable therapy. Patient Information Leaflets may be supplied if available. 2.2 Contra-indications No product in this formulary should be used without consideration of the possible consequences to the patient. Formulary products should not be used if the patient has previously had or suspected an adverse reaction to the product, or if a contra-indication for that patient occurs in the monograph. In these cases the patient should be referred to a doctor. 2.3 Precautions The products listed in this formulary should be used only for the specific condition specified in the monograph. Formulary items should not be used for the treatment of patients who have known, or suspected hypersensitivity to any product or any of its ingredients. In the event that an adverse reaction occurs, use of the product should be stopped and medical help sought immediately. Facilities for treating anaphylaxis should always be available.
Designated staff authorised to administer midwives formulary products
Authorised Staff The following staff who are employed by the Borders General Hospital NHS Trust are authorised to administer Midwives Formulary products without individual medical prescription for conditions specified in the product monograph. 3.1 Registered Midwife In addition the following requirements are necessary: 3.2 To be professionally accountable To have received adequate training and be competent To be familiar with contra-indications to the product To have access to the current group protocols for the administration of Medicines in the Midwives Formulary To be trained to identify anaphylaxis To have immediate access to appropriate equipment and drugs to treat anaphylaxis and have access to the current protocol and guidelines for its management To maintain their own professional level of competence and knowledge.
Head of Midwifery/Midwife Managers will be responsible for: Ensuring that there are patient group directions for the administration of medicines in the midwifery formulary Ensuring that midwives administering products have received adequate training and follow the patient group directions for the administration of products in the midwifery formulary.
The midwife will be given a copy of the patient group directions which she/he will sign along with the line manager and Pharmacist.
4.1 Product, Dose, Route and Frequency See individual product monograph and summary table 4.2 Adverse Reactions See individual product monographs 4.3 Follow-up Treatment Patients should be observed for any sign of adverse drug reaction
5.1 Out-patient settings The supply of medicines must be documented in the woman’s case notes, eg an immediate discharge letter should be completed and filed (B77). 5.2 In-patients All medicines must be prescribed on the Obstetric Medicine Chart for Self Medication/Borders General Hospital NHS Medicine Chart and documented in the case notes, according to policies and procedures relating to the department. The name of the prescribing midwife must be printed legibly and signed.
Manufacturer and patient information leaflets for any product in the formulary should be read and advice taken from them. The recommendations for storage and handling of any product in the formulary must be followed.
See individual product monograph
Management and monitoring of Group Protocols
8.1 Consultative Group Vince Summers: Brian Magowan: Hazel Gueldner: Margaret Davison: Chief Trust Pharmacist Consultant Obstetrician Obs & Gynae Pharmacist Midwife
The following can be administered without reference to medical staff, provided that all are entered correctly in the drug prescription sheet as per BGH prescribing guidelines and signed by the initiating midwife. All intravenous and Controlled Drugs must be checked by two midwives. NB: Any prescriptions for diamorphine and temazepam must be countersigned by the duty SHO within 24 hours. Please refer to the appended monograph for the individual drug before administering. ANTEPARTUM ANALGESIA ANTACID Paracetamol 1gram as a single dose, once only Maalox suspension 10ml as a single dose, once only or Peptac liquid 10-20ml as a single dose, once only Ispaghula Husk 3.5g one sachet in water, once only Ranitidine tablet 150mg at 22.00 on night before theatre, repeated two hours before theatre. Sodium Citrate 0.3M 30ml orally once only immediately prior to transfer to Theatre Compound Sodium Lactate 1 litre i.v. over 8-12 hours, to a maximum of two litres Heparin 10iu/ml 5ml instilled into i.v. cannula when required every 4-8 hours LOCAL ANAESTHETIC Lignocaine 1% 0.1ml intradermally prior to cannulation once only Amethocaine gel 4% 1g under occlusive dressing 45 minutes prior to venous cannulation once only NIGHT SEDATION Temazepam 10mg as a single dose up to 2.00am in the morning.
APERIENT PROPHYLAXIS FOR MENDELSON’S SYNDROME IN ELECTIVE LSCS I.V. THERAPY
DINOPROSTONE VAGINAL GEL As per induction of labour guidelines. FOLIC ACID DEMULCENT COUGH PREPARATION ANTISPASMODIC Folic acid 400microgram tablet once daily, until 12-14 weeks gestation. Simple linctus 5ml once only Peppermint water 10ml in plenty of water, once only.
ANTI –D IMMUNOGLOBULIN Anti-D immunoglobulin may be given to all non-sensitised Rh D negative women within 72 hours of a sensitising event in the following circumstances Prior to 20 weeks gestation Anti-D 250iu by i.m. injection Threatened miscarriage after 12 weeks gestation Spontaneous miscarriage after 12 weeks gestation Ectopic pregnancy Therapeutic termination of pregnancy – medical and surgical Following sensitising events such as amniocentesis Incomplete miscarriage requiring E.R.P.O.C. After 20 weeks gestatation Anti- D 500i.u. by i.m. injection Antepartum haemorrhage External cephalic version Intrauterine death Invasive prenatal diagnostic and intrauterine procedures Blunt abdominal trauma Routine Ante-natal Anti-D prophylaxis Anti-D 500i.u. by i.m. injection at 28 and 34 weeks gestation
The above should be used in conjunction with the guidelines Obstetric/Antenatal screening/Rhesus Programme from the Borders General Hospital Laboratory Handbook 3rd Edition 1999
up to a maximum of 2 doses without reference to a Registrar.m.1ml intradermally prior to cannulation. every 8 hours as required to a maximum of 30mg in 24 hours or 500 micrograms per Kg in 24 hours for women<60kg PROPHYLAXSIS FOR MENDELSON’S SYNDROME ACTIVE MANAGEMENT OF LABOUR Ranitidine tablet 150mg every 6 hours Sodium Citrate 0.as per unit policy Syntometrine 1ml i.v.V. with anterior shoulder at delivery Compound Sodium Lactate 1 litre i.m.3M 30ml prior to Theatre as a single dose Oxytocin 10i.u. every 812 hours as required to a maximum of 2 litres Heparin 10u/ml 5ml instilled into i. every 8 hours as required to a maximum of 150mg/24 hours Metoclopramide 10mg i. once only Amethocaine gel 4% 1g under occlusive dressing 45 minutes prior to venous cannulation once only LAXATIVES Glycerine Suppository 1 or 2 per rectum or Docusate sodium 90mg microenema as required Lignocaine 1% 10ml by perineal infiltration I. Monitor respirations for 30 minutes after administration ANTI-EMETICS Cyclizine 50mg i.m. cannula every 4-8 hours when required LOCAL ANAESTHETIC Lignocaine 1% 0.v.INTRAPARTUM ANALGESIA Entonox inhalation as required Diamorphine i. 5-10mg every 3-4 hours (women <50kg before pregnancy 5mg only) providing delivery is not imminent.m. THERAPY EPISIOTOMY 6 .
m. injection 7 .PAEDIATRICS The following may be administered to babies after delivery without reference to Paediatric staff: Oxygen by facemask Phytomenadione 1mg by i.
If the patent requires an adjustment to their prescription the on-call anaesthetist should be contacted. 8 . The anaesthetic department has assumed responsibility for post-operative pain management in this period.ANAESTHETICS RESTRICTIONS New anaesthetic guidelines in relation to post-operative pain management have been recently issued (March 1999). therefore. Midwives should. be aware it is no longer appropriate to use obstetric patient group directions for post-operative analgesia during the first 24 hours.
Diclofenac tablet or suppository 50mg three times a day (to a maximum of 150mg in 24 hours by any route). One dose of an NSAID can be given 14-16 hours after the suppository.POSTPARTUM EPISIOTOMY REPAIR ANALGESIA NSAID ANALGESIC Lignocaine 1% by perineal infiltration to a maximum of 20ml Only one NSAID should be prescribed at any one time Cesarean Section for first 24 hours: Anaesthetist will be responsible for analgesia. every 8 hours as required to a maximum of 150mg/24 hours. every 8 hours as required to a maximum of 30mg in 24 hours or 500 micrograms per Kg in 24 hours for women<60kg LAXATIVES Ispaghula Husk 3. Unless contra-indicated diclofenac suppository 100mg will be given rectally in Theatre. If Diclofenac is given.m. ANTIEMETIC Cyclizine 50mg i. Paracetamol 1gram every 4-6 hours to a maximum of 4grams in any 24 hours as plain or effervescent tablets or rectally as suppository.m. Vaginal delivery or Cesarean Section after first 24 hours: Ibuprofen tablet or syrup 400mg or 600mg three times a day. the total dose must not exceed 150mg by all routes in any 24 hours period. PARACETAMOL BASED ANALGESIC Only one PARACETAMOL BASED ANALGESIC should be prescribed at any one time.5g. 1 sachet in water twice daily Lactulose 10ml orally twice daily Glycerine suppository 1 or 2 per rectum as required 9 . Metoclopramide 10mg i. Co-dydramol 2 tablets every 4-6 hours to a maximum of 8 tablets in any 24 hours.
m.v. once only Amethocaine gel 4% 1g under occlusive dressing 45 minutes prior to venous cannulation once only ANTI –D Anti-D Immunoglobulin 500i.u or more.V. by i. every 812 hours as required to a maximum of 2 litres Heparin 10u/ml 5ml instilled into i. Ferrous sulphate tablet 200mg three times a day if haemoglobin below 10g/dl. once only.1ml intradermally prior to cannulation. Peppermint water 10ml in plenty of water.HAEMORRHOID PREPARATIONS Anusol cream apply twice daily and after each bowel movement Scheriproct ointment apply twice daily for 5-7 days then once daily until symptoms cleared I.v. VACCINES IRON SUPPLEMENT DEMULCENT COUGH PREPARATION ANTISPASMODIC 10 . Rubella vaccine (live) 0.5ml by deep subcutaneous or intramuscular injection if mother not immune. injection to Rh D negative women with a Rh D positive baby within 72 hours of delivery as per obstetric unit guidelines. Simple linctus 5ml 3-4 times a day. If symptomatic refer to SHO. THERAPY Compound Sodium Lactate 1 litre i. cannula every 4-8 hours when required LOCAL ANAESTHETIC Lignocaine 1% 0.
v.v. signed by the initiating midwife and countersigned by the duty SHO as soon as practicable OXYGEN TREATMENT OF SEVERE HYPOGLYCAEMIA ANTEPARTUM HAEMORRHAGE POSTPARTUM HAEMORRHAGE Oxygen 6 litres/minute by face mask Glucagon 1mg i.v. TO CONTINUE TREATMENT OF PREMATURE LABOUR Ritodrine 150mg in Glucose 5% 500ml.9% as per obstetric unit guidelines. It must be checked by two midwives. provided that all are entered correctly in the casenotes/drug or i.EMERGENCY PRESCRIPTIONS The following can be administered FOLLOWING AND ONLY WITH reference to medical staff. Hypostop gel orally as required Compound Sodium Lactate 500-1000ml stat IV Gelofusine 500ml stat IV Syntometrine 1ml i.u by i.m.m. Oxytocin 10i. injection Oxytocin 40i. or i.m. in 1 litre Compound Sodium Lactate at a rate of up to 250ml/hour Gelofusine 500ml stat IV The following can be prepared and administered if there is an existing prescription written by Medical staff. Atosiban concentrate for intravenous infusion 75mg (10ml) in 90ml Sodium Chloride 0. prescription sheet.u. or i. 11 . rate as per guidelines.
(i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) (xiii) (xiv) (xv) (xvi) (xvii) (xviii) (xix) Amethocaine Gel Anti-D Immunoglobulin Anusol Cream Atosiban Injection Co-dydramol Tablets Compound Sodium Lactate Infusion BP Cyclizine Injection 50mg Diamorphine Injection 5mg or 10mg Diclofenac Tablets and Suppositories Dinoprostone Vaginal Gel 1mg or 2mg (Prostin) Docusate Sodium Microenema 90mg Entonox Ferrous Sulphate Tablet 200mg Folic Acid Tablets 400micrograms Gelofusine (Gelatin) Intravenous Infusion Glucagon Injection 1mg (GlucaGen) Glycerin Suppository 4g Heparin Injection 10iu/ml Hypostop Gel 12 .FORMULARY A Monograph for the following drugs allowed to be administered under the patient group directions are appended. If you are at all unsure about the suitability of a particular drug for a particular patient please refer to the duty SHO or a pharmacist before prescribing or administering.
5g (orange) Lactulose Solution Lignocaine (Lidocaine) 1% Injection Maalox Suspension Metoclopramide Injection 10mg Oxygen Oxytocin Injection Paracetamol Tablet 500mg or Suppositories 500mg Peppermint Water Peptac Liquid Phytomenadione Injection 1mg Ranitidine Tablets 150mg Ritodrine Injection Rubella Vaccine 0.5ml Scheriproct Ointment Simple Linctus Sodium Citrate 0.3M Solution Syntometrine Injection Temazepam Tablet 10mg 13 .(xx) (xxi) (xxii) (xxiii) (xxiv) (xxv) (xxvi) (xxvii) (xxviii) (xxix) (xxx) (xxxi) (xxxii) (xxxiii) (xxxiv) (xxxv) (xxxvi) (xxxvii) (xxxviii) (xxxix) Ibuprofen Tablet 400mg or 600mg or Suspension 100mg/5ml Ispaghula Husk Sachet 3.
Ametop Package Information leaflet 14 . the eyes. Premature infants or infants less than 1 month old. itching and swelling of the site of application. Apply a plastic film dressing for 30-45 minutes. Dose 1g of gel to be applied to the affected area. then remove the dressing and wipe off the gel.5g of gel which disperses 1g equivalent to 40mg amethocaine. Contra-indication Allergy to any of the ingredients or other local anaesthetic. mouth. Each tube contains 1. References: August 2001 BNF No 41.12 Rarely blistering of the skin may occur. The gel should only be applied to the intended site and should not be placed on any wounds or broken skin. Maximum duration of gel application to the skin must not exceed 1 hour. Indication Local anaesthetic for application to a skin site prior to insertion of a needle or cannula. (Do not rub the gel into the skin). genitals or anus. Patient Information The site will remain numb for about 4-6 hours. Side effects Redness.(i) AMETHOCAINE GEL Pharmaceutical Presentation White gel containing amethocaine 4% w/w. ears.
Side effects This product is generally well tolerated. by deep intramuscular injection. Dose As per guidelines within 72 hours of a sensitising event. References: August 2001 Technical Information leaflet 15 . it can be kept for 1 week at ambient temperature (25C) without detrimental effect on one occasion during the shelf life. the efficacy of that vaccine may be impaired. preferably into the deltoid muscle. The product must not be given intravenously. or those with known sensitivity to any of the ingredients or those who are known to have immune Anti-D antibodies. Large doses may cause fever and chills. Contra-indication Must not be given to Rh(D) positive individuals. Patient Information Administration of live vaccines should not be carried out until 3 months after you have had this product. Indication Protection of non-immune Rh(D) negative individual exposed to Rh(D) positive cells.(ii) ANTI-D IMMUNOGLOBULIN 250IU or 500IU Pharmaceutical Presentation Clear liquid containing either 250IU or 500IU per vial. However. If you have had a live vaccine in the last 2-4 weeks. There may also be interference with some laboratory tests so tell your GP if you have to attend for any blood tests. Rare anaphylactoid reactions may occur if individual has antibodies against immunoglobulin A (IgA) or has atypical reactions after blood transfusion or administration of blood derivatives. NB: The product should be stored at between 2C and 8C in a fridge.
Care should be taken if there is any rectal bleeding.(iii) ANUSOL CREAM Pharmaceutical Presentation A buff coloured cream containing zinc oxide 10. bismuth oxide 2. If the nozzle is used to apply the cream to internal haemorrhoids. Anusol Package Information leaflet 16 . To aid recovery and help prevent recurrence of haemorrhoids. Indication Relief of pain. For internal haemorrhoids the nozzle provided should be used. Side effects Mild irritation or burning on application of cream. it should be cleaned after each use. Contra-indication Sensitivity to any of the ingredients.14% and balsam peru 1. swelling. itch and irritation of external and internal haemorrhoids (piles). References: August 2001 BNF No 41. you should eat a diet with plenty of fibre. Dose Apply to the affected area after washing and drying. morning and night and after each bowel movement. Patient Information The tube is for your own personal use. drink plenty of water and take regular exercise. Sensitivity reactions including rash.8%.75%.
the infusion should be prepared using the solution for IV infusion. Indication To delay imminent pre-term birth in 24 to 33 weeks of pregnancy.9ml. hyperglycaemia. fever. Solution for IV infusion: Solution containing Atosiban 37. Contra-indication Known hypersensitivity to any of the ingredients. uterine haemorrhage. Premature membrane rupture after 30 weeks gestation. vomiting. insomnia. This infusion may be continued for up to 45 hours to try and prevent progression of labour. hypotension. abnormal fetal heart rate.9ml should be the solution for IV injection and need to be given by a doctor. If you feel unwell.(iv) ATOSIBAN INJECTION Pharmaceutical Presentation Solution for IV injection: Solution containing Atosiban 6. Dose As per unit policy. rarely uterine haemorrhage or atony. eclampsia or severe pre-eclampsia. tachycardia. dizziness. flushing. abruptio placenta. Caution in hepatic or renal disease or diabetic patients. placenta praevia. Patient Information This is to suppress the contractions of the uterus.5mg as Atosiban acetate in 5ml for intravenous infusion after dilution. pruritis. Gestational age below 24 or above 33 weeks. Bolus dose of 0. headache. Side effects Nausea.75 as Atosiban acetate in 0. Intrauterine growth retardation. Tractocile Data Sheet 17 . tell your midwife. intrauterine fetal death. rash. suspected intrauterine infection. Hypersensitivity reactions including injection site inflammation has been noted. Reference: August 2001 BNF 41.
seek medical advice immediately. Known hypersensitivity to paracetamol or dihydrocodeine or medicines containing these drugs. alcoholic liver disease. Maximum of 2 tablets at any one time and maximum of 8 tablets in any 24 hour period. to a maximum of 8 tablets in any 24 hours. If you feel drowsy you should not drive or operate machinery. Caution in patients with breathing difficulties. headache and dizziness. References: August 2001 BNF No 41 Package Information leaflet 18 . Also contains dihydrocodeine. May affect warfarin treatment. liver or kidney problems. nausea. Dose Two tablets every 4-6 hours. hypothyroidism. Side Effects Constipation. Patient Information This product contains paracetamol. Indication Relief of mild to moderate pain Contra-Indication Current prescription for any other paracetamol-containing analgesic. Metoclopramide may enhance absorption of paracetamol. If you take an overdose. Hypersensitivity reactions or blood disorders may occur.(v) CO-DYDRAMOL TABLETS 10/500 Pharmaceutical Presentation Round white tablet containing Paracetamol 500mg and dihydrocodeine 10mg. May cause drowsiness.
muscle weakness.(vi) COMPOUND SODIUM LACTATE INFUSION BP Pharmaceutical Presentation Solution for infusion containing sodium chloride. shortness of breath. oedema. sodium hydroxide and lactic acid in water for injection. hypertension. Patient Information References: August 2001 Martindale 32nd edition 19 . Indication Intravenous fluid. Dose 1000ml to be given over 8-12 hours as required in the management of the patient. aldosteranism or renal failure. especially with impaired renal function. Side effects Excess administration may lead to hypokalaemia and metabolic alkatosis. eclampsia. potassium chloride. sodium lactate. calcium chloride. Contra-indication Caution in heart failure. Symptoms include tiredness. mood changes and irregular heart beat.
palpitations. hypersensitivity hepatitis. Caution in glaucoma. Dose 50mg by intramuscular injection three times daily as required to maximum 150mg/day. Tell your midwife if you experience any of these problems. Indication Antihistamine type antiemetic. insomnia. obstructive bowel disease.(vii) CYCLIZINE INJECTION 50mg Pharmaceutical Presentation Ampoule containing cyclizine lactate 50mg in 1ml solution. constipation and vision problems. Patient Information There may be side effects such as drowsiness. drowsiness. References: August 2001 BNF No 41. Valoid data sheet 20 . restlessness. dry mouth. cholestatic jaundice. nervousness. dry mouth. tachycardia. rash. agranulocytosis and fixed drug eruptions have been reported. severe heart failure. Side effects Urticaria. blurred vision. difficulty in passing urine. and patients taking other sedating drugs or alcohol. Contra-indication Know sensitivity to cyclizine. urine retention. hallucinations (auditory and visual). chorea. constipation.
(viii) DIAMORPHINE INJECTION 5mg or 10mg Pharmaceutical Presentation Each vial contains a white sterile freeze-dried powder of diamorphine hydrochloride BP 5 or 10mg for reconstitution for injection. Dose Reconstitute the powder with water for injection prior to use. raised intracranial pressure (head injury requires caution). Great caution should be used if known or suspected history of drug abuse. pruritis. Caution in toxic psychosis. sedation. 5-10mg (pre-pregnancy weight <50kg 5mg only) by intramuscular injection every 3-4 hours to a maximum of two injections before reference to a registrar. possible circulatory depression. dry mouth. severe inflammatory obstructive bowel disorders. adrenal insufficiency. If you feel unwell tell your midwife. confusion. biliary spasm. vertigo. urinary retention. facial flushing and raised intracranial pressure. constipation. orthostatic hypotension. CNS depression. obstructive airways disease. phaeochromaocytoma or within 2 weeks of taking a monoamine oxidase inhibitor. Indication Treatment of severe pain during labour. Side effects Respiratory depression. Patient Information The analgesic will usually be given with something to make you feel less sick. vomiting. Data Sheet 21 . This must not be given if delivery is imminent. miosis. acute alcoholism. The effect should last for 3 or 4 hours. myoedema. Respiratory depression. nausea. hepatic or renal impairment. dizziness. Contra-indication Known hypersensitivity to diamorphine. References: August 2001 BNF No 41. palpitations. urticarial. mood changes. Monitor respiration for 30 minutes after administration. sweating.
occasional bleeding or ulceration. Caution in patients on lithium diuretics. References: August 2001 BNF No 41. blurred vision. Asthma unless previous NSAID or aspirin administration was tolerated. Any other NSAID prescription. aspirin. followed by either 50mg diclofenac or another NSAID by mouth 14-16 hours later. bronchospasm. Indication Non-steroidal anti-inflammatory drug for the relief of pain. warfarin and other drugs (see BNF). diarrhoea. haematuria. fluid retention. dizziness. headache. Vaginal delivery: 50mg every 8 hours by mouth or rectum. Side effects Gastro-intestinal upset. Patient Information These tablets should be taken regularly. Voltarol data sheet 22 . or any of the ingredients. Dose Caesarean section: 100mg by suppository in theatre. or those with renal. Contra-indication Known hypersensitivity to diclofenace. any other NSAID. with or just after food or a drink of milk to minimise the effects on the stomach (NB: suppositories can also cause stomach irritation. nausea.(ix) DICLOFENAC TABLETS 50mg or SUPPOSITORY 50-100mg Pharmaceutical Presentation Tablets: Round brown tablets each containing diclofenac sodium 50mg Suppositories: Suppository containing diclofenac 50mg or 100mg in a wax base. cyclosporin. Active gastro-intestinal disease. vomiting. tell your midwife.) If you have indigestion or stomach pain. You can safely take paracetamol-based painkillers with this medication. hepatic or cardiac impairment. Also if you experience being short of breath (especially if you have asthma or other chest problems) tell your midwife. Contraindicated within 8-12 days of mifepristone administration. Suppositories should be removed from their packaging and inserted into the rectum as directed.
rapid cervical dilation. bronchospasm or asthma. Caution in asthma. Rarely. difficult labour or grand multipare. In patients where prolonged contractions are inappropriate. diarrhoea. abruptio placenta. maternal hypertension. After 6 hours you may need a second dose. Side effects Nausea. Patient Information You will be examined by the midwife prior to administration of the gel into the vagina. pain. uterine hypercontractility or hypertonus. uterine hypercontractility with or without fetal bradycardia and low Apgar scores in the newborn. hypertension or compromised hepatic renal or cardiovascular function. References: August 2001 BNF No 41 Prostin data sheet 23 . renal. rash. fever. epilepsy. hepatic or pulmonary disease. You will be asked to lie down for 30 minutes after this. vomiting. fetal distress or malpresentation.(x) DINOPROSTONE VAGINAL GEL 1mg or 2mg (Prostin) Pharmaceutical Presentation Translucent gel containing either 1mg or 2mg dinoprostone per 3gram. Tell you midwife if anything occurs after the gel is inserted. pulmonary or amniotic fluid embolism. glaucoma. Active cardiac. for example contractions. stillbirth. cardiac arrest. most common. Dose As per guidelines for induction of labour. backache. Suspected or confirmed placenta praevia or unexplained vaginal bleeding during the pregnancy. eg previous surgery. uterine rupture. Contra-indication Known sensitivity to prostaglandins. irritation and warmth of vagina. ruptured membranes or active pelvic inflammatory disease. Indication Induction of labour as per guidelines when there are no maternal or fetal contraindications. hypersensitivity to dinoprostone. neonatal death. fetal distress.
Side effects May cause transient discomfort. References: August 2001 BNF No 41. The enema will produce a response within one hour.(xi) DOCUSATE SODIUM ENEMA 90mg Microenema (Fletchers enemette) Pharmaceutical Presentation Enema containing Docusate sodium 90mg and glycerol 3. Also contains polyethylene glycol and sorbic acid.78g. Relief of constipation Contra-indication Intestinal obstruction. Patient Information This preparation is for rectal use. Indication Evacuation of bowel before medical procedures. If you experience any discomfort or there is no response within 1 hour let a member of staff know. Dose The enema should be inserted into the rectum and the contents squeezed out before the tube is withdrawn. Prolonged use may lead to rectal irritation. atonic non-functioning colon and hypokalaemia. Package Information leaflet 24 .
Dose To be inhaled on demand. Patient Information If this is not suiting you. the cylinders can be kept upright and gases will remain mixed. Above 10C. References: August 2001 Martindale 32nd edition. the cylinder should be replaced with a new one (to prevent gas separation).(xii) ENTONOX Pharmaceutical Presentation Gas which is odourless. Caution: Cylinder should be stored horizontally for at least 24 hours at room temperature to ensure gases are mixed if the temperature is below 10C in the storage area. please discuss other analgesia options with your midwife. Severe bullous emphysema. Contra-indication Spontaneous or traumatic pneumothorax. Side effects Bone marrow depression or megaloblastic anaemia may occur with prolonged use of 24 hours or greater. tasteless and colourless containing oxygen 50% and nitrous oxide 50%. If the mask or cylinder head becomes frosted. Indication Inhalational analgesia during labour. Grampian PGD 25 .
The tablet should be swallowed whole. altered bowel habit (diarrhoea or constipation). please let a member of staff know. The tablet may cause either diarrhoea or constipation. Haemoglobin levels above 11. penicillamine or cholestyramine. epigastric pain. Dose One tablet three times a day. Side effects Nausea.(xiii) FERROUS SULPHATE TABLET 200mg Pharmaceutical Presentation Round. gastrointestinal irritation. Patient Information Tablets should preferably be taken on an empty stomach. methyldopa. The stools may be discoloured (black). white sugar coated tablet containing ferrous sulphate 200mg Indication Treatment of iron deficiency anaemia. If this becomes a problem. However if this causes gastro-intestinal irritation they may be taken with or after food to minimise this effect. Contra-indication Hypersensitivity to any iron preparations Patients who cannot tolerate iron preparations or have disorders of iron metabolism. References: August 2001 Martindale 32nd edition 26 . May interfere with other medication – ask if you are taking other medication especially antibiotics.5g/dl. Caution with other medications (See BNF).
Dose One tablet daily with food until the 12th-14th week of pregnancy. Patient Information This preparation will help to prevent any problems with the developing baby such as spina bifida. If you have epilepsy you should discuss taking this preparation with your doctor before you start taking it.(xiv) FOLIC ACID TABLET 400micrograms Pharmaceutical Presentation White tablets containing folic acid 400micrograms. Contra-indication Know sensitivity to folic acid. Indication Prevention of neural tube defects in early pregnancy. Side effects Nil known. Ideally this should be started before conception but can be started at any time if pregnancy is suspected. References: August 2001 Preconcieve package information leaflet 27 .
Side effects Hypersensitivity reactions. References: August 2001 Gelofusine package information leaflet 28 . Indication Correction of low blood volume during haemorrhage as a short term measure. A transient increase in bleeding time may occur. Use with caution in cardiac disease or renal impairment. but rarely severe anaphylactoid reactions. Dose 500ml to be infused as required. Contra-indication Known hypersensitivity to any of the ingredients. Patient Information This is used to keep the volume of blood in the body at a similar level as you are losing blood.(xv) GELOFUSINE (Gelatin) INTRAVENOUS INFUSION Pharmaceutical Presentation Intravenous infusion solution containing succinylated gelatin 4%.
Caution in patients on indomethacin or warfarin. Patient Information The pack should be stored in the fridge and used by the expiry date. Contra-indication Sensitivity to any of the ingredients. Side effects Nausea and vomiting common if dose given too rapidly or more than 1mg given. If this is not possible. NB: If the solution is not clear. it may be stored at room temperature up to 25oC for a maximum of 18 months or until the expiry date. hypokalaemia and rapid heart beat may occur. Indication Treatment of severe hypoglycaemia when patient cannot take anything by mouth.(xvi) GLUCAGON INJECTION 1mg (GlucaGen) Pharmaceutical Presentation Kit containing one vial containing 1mg glucagon (rys) as a white powder along with one syringe containing 1ml water for injection. phaeochromocytoma. followed by carbohydrate by mouth when recovery is sufficient to allow this. Diarrhoea. whichever is shorter. GlucaGen package information leaflet 29 . a doctor must be called. intramuscular or intravenous injection immediately after reconstitution. References: August 2001 BNF No 41. Dose 1mg by subcutaneous. do not inject. If this does not have an effect within 10 minutes. Hypersensitivity reactions rare.
it should not be swallowed. let a member of staff know. References: August 2001 Package Information leaflet 30 . consult your doctor. First 3 months of pregnancy. Side effects Stomach cramps may be experienced. If you need to use it for more than a few days. Indication Treatment of constipation by the rectal route. If any discomfort occurs. This product should only be used for a short time. May irritate the rectum.(xvii) GLYCERIN SUPPOSITORY 4g Pharmaceutical Presentation Pale amber suppository containing glycerin BP 70% w/w gelatin and water. Intestinal blockage. The suppositories are for rectal use. Dose One or two suppositories to be inserted rectally after being moistened with water. Contra-indication Sensitivity to any of the ingredients. Patient Information This preparation will produce a response within 15 to 30 minutes.
Side effects As this is a low dose preparation. Indication Anticoagulant to flush in-dwelling cannulae to maintain patency. NB: ensure compatibility with drugs injected before and after the heparin to avoid precipitation. References: August 2001 BNF No 41. Contra-indication Known hypersensitivity to heparin or any of the ingredients. hyperkalaemia.(xviii) HEPARIN INJECTION 10iu/ml Pharmaceutical Presentation Solution containing Heparin Sodium 10 international units per ml. Hepsal information leaflet 31 . Dose 5ml to be instilled into cannula as required every 4-8 hours as required. it is unlikely that any side effects will be experienced. skin necrosis. thrombocytopenia. Patient Information This is a substance produced naturally in the body so you should have no problems after it is injected to help keep the cannula working while it is in your vein. Higher doses of heparin may cause haemorrhage. Haemorrhagic disorders or haemophilia or bleeding including thrombocytopenia.
(xix) HYPOSTOP GEL Pharmaceutical Presentation Clear lemon flavoured gel for oral use containing dextrose 40%. Contra-indication Sensitivity to any of the ingredients.2grams glucose. Indication Treatment of hypoglycaemia by the oral route. May be repeated if necessary after 10-15 minutes. References: August 2001 Package Information leaflet 32 . Patient Information The 23gram dose contains 9. Side effects Nausea. Dose 23g by the oral route as required.
Current prescription for another NSAID. contact your midwife. Warfarin therapy. Brufen data sheet 33 . tell your midwife.4g per day individual doses. References: August 2001 BNF No 41.8g per day need to be prescribed by a doctor – may prescribe up to 2. If any indigestion or stomach problems occur. Caution in patients on diuretics. Contra-indication Hypersensitivity to aspirin or any other NSAID or any ingredient of the tablet. Rarely renal or hepatic problems. occasional bleeding or ulceration. cyclosporin. Doses above 1. Also let someone know if you have a skin rash or any unexplained bruising or swelling. Side effects Gastro-intestinal upset. lithium and other drugs (see BNF). fluid retention. Also if shortness of breath occurs (especially if you have asthma or other chest problems). Patient Information These tablets or suspension should be taken regularly with or just after food or a drink of milk to minimise effects on the stomach. blurred vision. can be given up to three times a day with food. nausea. dizziness. Maximum 1. Asthma unless NSAID tolerated with previous use. Active gastro-intestinal disease.8grams per day. hepatic or cardiac impairment. Caution in renal.(xx) IBUPROFEN TABLET 400mg or 600mg or SUSPENSION 100mg/5ml Pharmaceutical Presentation 400mg: Round pink sugar coated tablet containing ibuprofen 400mg 600mg: Lozenge shaped pink tablet containing ibuprofen 600mg Suspension: Orange flavoured liquid containing ibuprofen 100mg per 5ml Indication Non-steroidal anti-inflammatory drug for treatment of mild to moderate pain. Dose One tablet or 20-30ml suspension. You can safely take paracetamol-based painkillers with this medicine. Contra-indicated within 8-12 days after use of mifepristone. bronchospasm headache. diarrhoea. haematuria.
Dose One sachet in a glass of cold water (approx 150ml or ¼ pint) twice daily after meals. aspartame (sweetener). Patient Information The sachets should be taken regularly and should work within 3 days. Contra-indication Intestinal obstruction. Fluid intake must be adequate to help the preparation work effectively. this should diminish after a few days. References: August 2001 BNF No 41. If flatulence and/or bloating occur. Phenylketonuria. potassium bicarbonate.5g. faecal impaction. Indication Treatment of constipation (bulk-forming type). Side effects Flatulence. citric acid. colonic atony. Fybogel information leaflet 34 .5g (Orange) Pharmaceutical Presentation Sachet containing ispaghula husk 3. sodium bicarbonate and povidone.(xxi) ISPAGHULA HUSK SACHET 3. Hypersensitivity to any of the ingredients. Also contains orange flavour and betacarotene (colour). bloating may be experienced.
If diarrhoea starts. Package Information leaflet 35 . Dose 10mls of solution orally twice daily. References: August 2001 BNF No 41. Side effects Abdominal discomfort. Patient Information Needs to be taken regularly to be effective. intestinal obstruction. This may be taken with water or fruit juice. allergy to any of the ingredients. Caution in lactose intolerance. flatulence and cramps. Contra-indication Galactosemia. May take up to 2-3 days to have an effect.35g per 5ml. Indication Treatment of constipation by osmotic action. stop taking this preparation.(xxii) LACTULOSE SOLUTION Pharmaceutical Presentation Clear or pale yellow coloured solution containing Lactulose 3. Any bloating should disappear within a few days.
Avoid in porphyria. impaired respiratory or hepatic function. Complete heart block. hypovolaemia or supraventricular tachycardia. Package Information leaflet 36 . Side effects Transient drowsiness and amnesia may occur. If not. Indication Local anaesthesia for use prior to cannulation or episiotomy or during repair of the perineum. bradycardia.1ml by local infiltration.(xxiii) LIGNOCAINE (LIDOCAINE) 1% INJECTION Pharmaceutical Presentation Ampoules containing clear solution of lignocaine 1% w/v. Dose NB: Care must be taken to ensure solution is not injected into a vein or artery. total volume administered should not exceed 20ml for episiotomy and repair). Local anaesthesia prior to cannulation: 0. Repair of perineum: up to 20ml by local infiltration (only if at least 1 hour has passed after episiotomy. convulsions. followed by confusion. Contra-indication Known hypersensitivity to lignocaine. Patient Information There will be a loss of sensation at the site of injection which will slowly be reversed. Caution in epilepsy. bradycardia. hypotension and respiratory depression which may lead to cardiac arrest. Local anaesthesia prior to episiotomy: 10ml by local infiltration. References: August 2001 BNF No 41.
bowel obstruction or severe abdominal pain of unknown cause. flavoured with peppermint.(xxiv) MAALOX SUSPENSION Pharmaceutical Presentation White suspension. containing magnesium hydroxide 195mg and dried aluminium hydroxide 220mg per 5ml. Indication Antacid suspension. Maalox Data Sheet 37 . If possible do not take this at the same time as other medication (if possible leave at least 2 hours after taking this medicine). References: August 2001 BNF No 41. Contra-indication Kidney failure. Side effects Magnesium hydroxide has laxative effects and aluminium hydroxide may cause constipation. Dose 10ml may be given 20-60 minutes after meals and at bedtime as required. Alteration of bowel habit may occur with prolonged excessive use. Patient Information The antacid may interfere with the absorption of other medicines such as antibiotics or epilepsy medicines.
pruritis. Patient Information This will help prevent or treat nausea and vomiting. depression. gastrointestinal obstruction. especially dystonia. neuroleptic malignant syndrome. Maxolon Data Sheet 38 . oedema. drowsiness. Contra-indication Known hypersensitivity to any of the ingredients.(xxv) METOCLOPRAMIDE INJECTION 10mg Pharmaceutical Presentation Ampoule containing solution of metoclopramide hydrochloride BP 10mg in 2ml. hepatic or renal impairment. rash. diarrhoea. Phaeochromocytoma. Dose Women over 60kg at start of pregnancy : 10mg every 8 hours as required to a maximum of 30mg/day. References: August 2001 BNF No 41. performation or haemorrhage. Women under 20 years old or under 60kg: 5-10mg every 8 hours as required by intramuscular injection to a maximum of 500mcg/kg in 24 hours. hyperprolactinaemia. Side effects Extrapyramidal effects. Caution in patients with epilepsy or drugs that have extrapyramidal side effects. Indication Prevention and treatment of nausea and vomiting. restlessness.
To correct hypoxia in neonates after delivery. Side effects Pulmonary toxicity (as cough. Indication To correct hypoxia. odourless gas. mood changes and loss of consciousness). convulsions. twitching. substernal distress and decrease in vital capacity) and CNS toxicity (nausea. Patient Information References: August 2001 Grampian PGD. nasal cannula. Contra-indication Areas where there is fire or danger of spark. BNF No 41 39 . head box or oxygen tent.(xxvi) OXYGEN Pharmaceutical Presentation Colourless. Administration can be by face mask. No oil or grease must be put onto the valves or an explosion may result. endotracheal tube. vertigo. tasteless. Dose As required.
Dose Augmentation of labour: see unit policy. uterine hyperstimulation at high doses with fetal distress. Syntocinon Data Sheet 40 . obstructed delivery or where vaginal delivery is inadvisable. Management of 3rd stage of labour in patients with cardiac disease or moderate to severe hypertension: 10 units IM instead of syntometrine . Patient Information This is to help the labour or to control bleeding after the baby is born. If you feel unwell or uncomfortable.(xxvii) OXYTOCIN INJECTION 10iu/ml Pharmaceutical Presentation Each ampoule contains oxytocin Ph Eur 10units in 1ml solution. Contra-indication Sensitivity to any of the ingredients. Management of major obstetric haemorrhage: see unit policy. High doses in large volume of fluid may cause water intoxication (headache.as per unit policy. mild or moderate cardiac disease or hypertension or have a small pelvis. vomiting. fetal distress. over 35 years of age. Do not use for prolonged periods in severe pre-eclamptic toxaemia. References: August 2001 BNF No 41. soft-tissue damage. vomiting. drowsiness. Side effects Nausea. abdominal pain. Use with care in patients who have had a previous caesarean section. tell your midwife. uterine spasm at low dose. anorexia. unconsciousness and convulsions). nausea. Hypertonic uterine contractions. Indication Oxytocic to aid induction of labour or prevent uterine bleeding after delivery by intravenous infusion or injection. severe cardiovascular disease or in oxytocin-resistant uterine inertia.
(xxviii) PARACETAMOL TABLET 500mg or SUPPOSITORY 500mg Pharmaceutical Presentation Round white tablet containing paracetamol 500mg. but may cause skin rashes or blood disorders. Maximum 2 tablets or suppositories at any one time and no more than 8 tablets or suppositories in any 24 hour period. Two suppositories every 4-6 hours by rectum to a maximum of 8 in 24 hours. Caution in patients taking metoclopramide. Patient Information Do not take any other medicines containing paracetamol whilst taking these tablets. see medical advice immediately. Prescription for another paracetamol-containing preparation. References: August 2001 BNF No 41 41 . If you take an overdose. to a maximum of 8 tablets in any 24 hours. cholestyramine or warfarin. Dose Two tablets every 4-6 hours. Contra-indication Hypersensitivity to paracetamol or paracetamol-containing preparations. Side effects Rare. domperidone. White suppository containing paracetamol 500mg Indication Relief of mild to moderate pain or pyrexia.
Patient Information Solution should be taken with plenty of water. Indication Relief of flatulence. but do include hypersensitivity.(xxix) PEPPERMINT WATER Pharmaceutical Presentation Clear liquid containing peppermint oil 0. headache. Contra-indication Allergy to any of the constituents. the bottle should be discarded after 1 month. Once opened. References: August 2001 Package Information Sheet 42 .05% v/v with a distinctive aroma of peppermint. skin rash. Dose 10ml to be taken in plenty of water up to four times a day when required. ataxia and bradycardia. Side effects Rare. muscle tremor.
flatulence. Contra-indication Sensitivity to any of the ingredients. Patient Information Shake the bottle well before use. Dose 10mls after meals and at bedtime when required. gabapentin. References: August 2001 BNF No 41. The preparation is sugar and gluten free.1mmol per 5ml.5g. Side effects Constipation. Pepatc data sheet 43 .(xxx) PEPTAC LIQUID Pharmaceutical Presentation Aniseed-flavoured suspension containing sodium bicarbonate 133. Indication Dyspepsia. Do not take this within one to two hours of taking any other medicines by mouth. azithromycin. Peptac Information leaflet. Caution if on a low sodium diet – contains 3. sodium alginate 250g and calcium 80mg in 5ml. sodium valproate and others – see BNF for details. stomach cramps or belching. This medicine is safe to take during pregnancy and while breastfeeding. Caution with other medication including phenytoin.
feet.5ml by intramuscular injection. Indication Prevention of haemorrhagic disease of the new-born. nose and ears). bluish stain colour.5ml for intramuscular injection.(xxxi) PHYTOMENADIONE INJECTION 1mg (Konakion Neonatal) Pharmaceutical Presentation Ampoule containing a green/yellow solution of phytomenadione 1mg in 0. Contra-indication Know hypersensitivity to any of the constituents. References: August 2001 BNF No 41. Dose 0. Caution if mother/baby has been given anticoagulant medication or has liver disease or has artificial heart valves. Side effects Flushing of face. Patient Information This is the injection form of phytomenadione (vitamin K). sweating. Konakion data sheet 44 . If you wish the baby to be given the oral preparation. feeling of chest tightness or cold extremeties (hands. please discuss it with the midwife who will contact a paediatrician.
diarrhoea. Rarely tachycardia.3M immediately prior to theatre. One tablet every 6 hours during labour.3M. dizziness. Dose Antepartum: Intrapartum: One tablet at 22. gastro-intestinal upset. Caution in renal or hepatic disease (reduce dose). erythema multiforme. If you feel unwell whilst taking these tablets.(xxxii) RANITIDINE TABLETS 150mg Pharmaceutical Presentation Round white tablet containing ranitidine 150mg. References: August 2001 BNF No 41. agitation.00 the night before and 2 hours prior to theatre along with sodium citrate 0. gynaecomastia in men. depression. rash. muscle or joint pain. Patient Information These tablets affect the acid in the stomach. wheeze. feeling faint. Indication To reduce the amount of acid in the stomach prior to theatre to prevent Mendelson’s syndrome. jaundice. visual disturbances. unexplained fever. Ranitic information leaflet 45 . Side effects Headache. tell your midwife. confusion. with sodium citrate 0. Contra-indication Known sensitivity to ranitidine. alopecia. Porphyria. The tablets are unsuitable for people with lactose intolerance or galactosaemia.
Contra-indication Known hypersensitivity to any of the ingredients. eclampsia and severe preeclampsia. Antepartum haemorrhage. Rarely enlargement of salivary gland. BNF No 41 46 . cord compression. Tell your midwife if you feel unwell during the infusion. vomiting. hypothyroidism. pulmonary oedema. arrhythmias. Patient Information This infusion will relax the uterus and will slow down or stop the labour. tremor. palpitations. chest pain. mild to moderate preeclampsia. intra-uterine infection. Monitor heart rate during administration. uterine bleeding. intra-uterine fetal death. Dose As per unit policy. tachycardia. Caution in cardiac disease. hypokalaemia. References: August 2001 Yutopar data sheet. the solution should be added to dextrose 5% infusion. hypotension. Leucopenia and agranulocytosis reported on prolonged administration. Side effects Nausea. placenta praevia. diabetes mellitus. liver function abnormalities. sweating.(xxxiii) RITODRINE INJECTION Pharmaceutical Presentation Each 5ml ampoule contains ritodrine hydrochlorde 10mg per ml in an aqueous buffered vehicle. beta-blocker therapy and other drug therapy (see BNF). Indication Management of uncomplicated pre-term labour between 24 and 33 weeks gestation. hypertension.
References: August 2001 BNF No 41. Contra-indication Sensitivity to any of the ingredients.5ml solution.5ml Pharmaceutical Presentation Solution containing live rubella vaccine in 0. Ervevax information leaflet 47 . You are advised not to become pregnant within one month of having this injection. Indication Active immunisation against rubella in women of child-bearing age. Patient Information This will protect you against the risks of German measles. If you do. Pregnancy (early pregnancy – consult product literature/BNF).(xxxiv) RUBELLA VACCINE 0.5ml by deep subcutaneous or intramuscular injection. Dose 0. Side effects Mild dose of rubella may occur. consult your doctor at the earliest opportunity.
If the nozzle is used to apply the ointment to internal haemorrhoids it should be cleaned after each use. Indication Short term use (up to 7 days) for the relief of haemorrhoids (piles) and anal itching. drink plenty of water and take regular exercise. To aid recovery and help prevent recurrence of haemorrhoids you should eat a diet with plenty of fibre. Side effects Allergic skin reactions may occur. Patient Information The tube is for your own personal use.(xxxv) SHERIPROCT OINTMENT Pharmaceutical Presentation Ointment containing cinchocaine hydrochloride 5mg and prednisolone 1. it can be applied up to four times on the first day of treatment only. herpes etc). Once the condition is controlled.5mg per gram. If severe symptoms. up to a maximum treatment course of 7 days. Thinning of skin may occur on prolonged use. Viral infection (eg chicken pox. Contra-indication Sensitivity to any of the ingredients or local anaesthetics. Bacterial or fungal skin infection which is not being treated. application may be done once daily. Dose Apply to the affected area twice daily after washing and drying. References: August 2001 BNF No 41. Scheriproct information leaflet 48 . Caution in first 3 months of pregnancy.
natural red colour. ethanol. Dose 5ml up to 3-4 times a day.29mg in 5ml. Excessive quantities may cause irritation or a deterioration of tooth enamel. let your midwife know. Patient Information This should soothe your cough. allergic reactions have been recorded for saccharin and sodium benzoate. anise oil. Indication Symptomatic relief of dry irritating cough. chloroform. Contra-indication Known allergy to citric acid or any of the ingredients.(xxxvi) SIMPLE LINCTUS Pharmaceutical Presentation Sugar free solution containing Citric Acid BP 114. lycasin. sodium benzoate. If symptoms persist or do not resolve. Also contains glycerol. sodium carboxymethylcellulose. Side effects Rare. saccharin sodium. References: August 2001 Simple Linctus information sheet 49 . May affect the absorption of oral steroids including the contraceptive pill.
Sodium Citrate 0. alters the acidity of the stomach contents to reduce problems associated with anaesthesia.3M information sheet 50 . Side effects May have a laxative effect. References: August 2001 Martindale 32nd edition. eclampsia and aldosteronism. Dose 30ml orally prior to transfer to theatre. Indication Prophylaxis of Mendelson’s Syndrome during cesarean section in conjunction with ranitidine tablets. Bottle should be used within 14 days of first opening. Patient Information This along with ranitidine tablets.3M SOLUTION Pharmaceutical Presentation Solution for oral use containing sodium citrate 441. Contra-indication Known hypersensitivity to sodium citrate.(xxxvii) SODIUM CITRATE 0.15mg per 5ml. Caution in cardiac disease. oedema. renal impairment. people on a sodiumrestricted diet. hypertension.
eclampsia and pre-eclampsia.(xxxviii) SYNTOMETRINE INJECTION Pharmaceutical Presentation Solution containing ergometrine 500micrograms and oxytocin 5units in 1ml solution. References: August 2001 BNF No 41. Patient Information This will help reduce the blood loss after the delivery of the baby. abdominal pain. severe cardiovascular. cardiovascular or renal problems. Indication Management of third stage of labour or to control bleeding after delivery. pregnancy and early labour. Side effects Nausea. Syntrometrine data sheet 51 . headache. hepatic or renal disease. Dose Management of third stage of labour – 1ml intramuscularly after shoulder delivered. sepsis. pulmonary. Contra-indication Sensitivity to any of the contents. Caution in mild/moderate hypertension. Control of bleeding – 1ml intramuscularly. hepatic. vomiting. dizziness or skin rashes may occur.
Patient Information This should help you sleep better. amnesia. confusion. Indication Short term use in insomnia. Side effects Drowsiness which may continue the next day. although the effects may persist during the next day. light headedness. myasthenia gravis. Dose One 10mg tablet may be given each night. up until 02. They are for short term use only so will only be prescribed in hospital for you. Contra-indication Known hypersensitivity to temazepam or any other ingredients.(xxxix) TEMAZEPAM TABLET 10mg Pharmaceutical Presentation Round white tablet containing temazepam 10mg. ataxia. Package Information leaflet 52 . References: August 2001 BNF No 41. pulmonary insufficiency. respiratory depression. severe hepatic impairment. You should not drive whilst taking these tablets if you feel sleepy.00 in the morning.
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