MRS. EDNA'S COMMUNITY MIDWIFERY ASSIGNMENT-1.docx

**INTRODUCTION** A drug is any chemical substance that affects the functioning of living things and the organisms such as bacteria, fungi, virus that infects them. It is any chemical substance that when consumed causes a change in an organism\'s physiology, including its psychology, if applicable....

**INTRODUCTION** A drug is any chemical substance that affects the functioning of living things and the organisms such as bacteria, fungi, virus that infects them. It is any chemical substance that when consumed causes a change in an organism\'s physiology, including its psychology, if applicable. Drugs are typically distinguished from food and other substances that provide nutritional support. They can be via inhalation, injection, ingestion, absorption via a patch on the skin, suppository, or dissolution under the tongue. Pharmacology, the science of drugs, deals with all aspects of drugs in medicine, including their mechanism of action, physical and chemical properties, metabolism, therapeutics, and toxicity. Traditionally drugs were obtained through extraction from medicinal plants, but more recently also by organic synthesis. Pharmaceutical drugs may be used for a limited duration, or on a regular basis for chronic disorders. **DEFINITION** A drug is a chemical substance, typically of known structure, which, when administered to a living organism, produces a biological effect. A pharmaceutical drug, also called a medication or medicine, is a chemical substance used to treat, cure, prevent, or diagnose a disease or to promote well-being. Some drugs can be administered with prescription while some others can be administered without prescription. Some of these nonprescription drugs may include; analgesics such as acetaminophen(paracetamol), antacids, anti- histamines, laxatives. e.t.c **IMPORTANCE OF MEDICINES** 1\) Medicines are given to cure, halt, or prevent diseases, illness or ailments. 2\) They are given/ taken to ease symptoms or help in the diagnosis of illnesses. 3\) They can also take to feel good. 4\) Some drugs have calming effects and can therefore be taken to relieve anxiety, cope with stress and feelings of depression. 5\) Some drugs are given to aid the patient fall asleep and stay awake. 6\) Drugs can be taken to boost/ increase the confidence of a person. **DRUGS THAT CAN ADMINISTERED BY THE MIDWIFE WITHOUT PRESCRIPTION** According to the Nursing and Midwifery Council(NMC), registered midwives can prescribe and administer any of the drugs that are specified under midwives' exemptions; some of these drugs include lidocaine, oxytocin and pethidine. e.t.c. As of 2011, midwifery students could also administer drugs on the midwives' exemption list (apart from controlled drugs) but under the direct supervision of a midwife. Exemptions are different from prescribing, which requires the involvement of a pharmacist and the completion of an accredited prescribing course. The NMC attributes professional accountability for any prescribing decisions to the prescribing midwife. **SOME DRUGS THAT CAN ADMINISTERED BY THE MIDWIFE WITHOUT MEDICAL PRESCRIPTION** Below are sample standing orders for drugs that may be prescribed and administered by midwives without medical prescription: 1)Analgesics such as Opioids (usually pethidine), Paracetamol, Diclofenac. e.t.c. 2)Local anaesthetics such as lidocaine. 3)Gastrointestinal drugs such as laxatives, antacids. e.t.c 4)Oxytocics e.g.oxytocin, ergometrine, carboprost.e.t.c 5)Haematological medications such as iron/folate oral preparations, anti-D immunoglobulin, hepatitis B vaccine/immunoglobulin, vitamin K neonatal. 6\) Adrenaline 1:1000 intramuscular (for anaphylaxis) 7\) Infusions such as Hartmann's solution, 0.9% saline. 8\) Naloxone (adult and neonatal). 9\) Topical clotrimazole/nystatin, hydrocortisone Transcutaneous electrical nerve stimulation (TENS). e.t.c. 1\. **ANALGESICS:** are commonly used to relieve pain, ranging from mild to severe. They work by altering the perception of pain in the brain. There are different types of analgesics including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen (paracetamol). It\'s important to use them as directed and avoid excessive consumption to prevent potential side effects. Always consult a healthcare professional for proper guidance, especially if you have any underlying health conditions or are taking other medications. **Note:** Paracetamol 500mg Tables can be used during pregnancy. 2\. **OXYTOCIC AGENTS:** are medications that stimulate uterine activity and are used to induce labor, increase contractions, reduce the risk of postpartum hemorrhage immediately after birth, and expel fetal contents in incomplete abortion. Endogenous oxytocic drugs are also given routinely following C-section to prevent the development of uterine atony. it is indicated during: Preeclampsia Maternal diabetes Premature rupture of membranes Stimulation of contractions in inactive uteri Incomplete or inevitable abortion Postpartum period Delivery of placenta in the third stage of labor Control postpartum hemorrhage Oxytocin is a nonapeptide hormone synthesized by the hypothalamus but stored and released by the posterior pituitary gland. Oxytocin is a uterine stimulant and causes uterine contractions by activating G protein-coupled receptors that increase intracellular calcium levels in the uterine myofibrils, resulting in uterine contractions. Uterine contractions increase the production of local prostaglandin, which further stimulates uterine contraction. Oxytocin helps in the ejection of breast milk which helps to feed the baby. Oxytocin has both antidiuretic and vasodilatory effects, increasing cerebral, coronary, and even renal blood flow. **WHAT ARE SIDE EFFECTS OF OXYTOCIC AGENTS?** Side effects of oxytocic agents on mother include: Nausea and vomiting Arrhythmias (irregular heartbeats) Severe maternal hypotension Seizure Anaphylaxis **Side of oxytocic agents on fetus include:** Hypoxia Decreased fetal heart rate Uteroplacental hypoperfusion Hypercapnia Perinatal hepatic necrosis Jaundice Low Apgar score **3. HAEMATOLOGICAL MEDICATIONS** such as iron/folate oral preparations, anti-D immunoglobulin, hepatitis B vaccine/immunoglobulin, vitamin K neonatal are being prescribed and used by the midwife. **Folic Acid** Folate and folic acid are forms of vitamin B9 used for deficiency and to prevent pregnancy complications. **Uses** - Folate deficiency. Taking folic acid improves folate deficiency. - High levels of homocysteine in the blood (hyperhomocysteinemia). This condition has been linked to heart disease and stroke. Taking folic acid by mouth lowers homocysteine levels in people with normal or high homocysteine levels and in people with kidney failure. - Toxicity caused by the drug methotrexate. Taking folic acid by mouth seems to reduce nausea and vomiting from methotrexate treatment. - Birth defects of the brain and spine (neural tube birth defects). Consuming folic acid 600-800 mcg by mouth daily during pregnancy reduces the risk of these birth defects. Folic acid can come from the diet or supplements. Some people who are at high risk should get 4000-5000 mcg daily. - Decline in memory and thinking skills in older people. Taking folic acid by mouth, with or without other supplements, may improve memory and thinking skills in older people who have a larger decline in thinking skills than expected at that age. But it doesn\'t seem to work in older people who are experiencing the usual decline in thinking skills for their age. - Depression. Taking folic acid by mouth along with antidepressants seems to improve symptoms in some people with depression. - High blood pressure. Taking folic acid by mouth daily for at least 6 weeks reduces blood pressure in some people with high blood pressure who are not taking other blood pressure medications. - Gum enlargement caused by the drug phenytoin. Applying folic acid to the gums seems to prevent this issue. But taking folic acid by mouth doesn\'t seem to help. - Stroke. In areas of the world that don\'t add folic acid to grain products, taking folic acid supplements can reduce the risk of stroke. But supplements don\'t seem to be helpful for people who live in countries that do add folic acid to grain products. - A skin disorder that causes white patches to develop on the skin (vitiligo). Taking folic acid by mouth seems to improve symptoms of this condition. **Side Effects** When taken by mouth: It is likely safe for most people to take folic acid in doses of no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior changes, skin reactions, seizures, and other side effects. There is some concern that taking too much folic acid for a long time might cause serious side effects. Some research suggests that taking folic acid in doses of 0.8-1.2 mg daily might increase the risk for cancer or increase the risk of heart attack in people who have heart problems. **Precautions and Warnings** - When taken by mouth: It is likely safe for most people to take folic acid in doses of no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior changes, skin reactions, seizures, and other side effects. - Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe for most people in doses up to about 400 mcg daily. - The maximum recommended amount of folic acid during pregnancy or breastfeeding is 800 mcg daily for those under 18 years of age and 1000 mcg daily for those over 18 years of age. Do not use more unless directed by a healthcare professional. - Children: It is likely safe for children to take folic acid by mouth in the recommended amounts for their age. But children should avoid taking folic acid in doses that are higher than the daily upper limits. These limits are 300 mcg for 1-3 years of age, 400 mcg for 4-8 years of age, 600 mcg for 9-13 years of age, and 800 mcg for 14-18 years of age. - Procedures to widen narrowed arteries (angioplasty): Using folic acid, vitamin B6, and vitamin B12 might worsen narrowed arteries. Folic acid should not be used by people recovering from this procedure. - Cancer: Early research suggests that taking 0.8-1 mg of folic acid daily might increase the risk of cancer. Until more is known, people with a history of cancer should avoid high doses of folic acid. - Seizure disorder: Taking folic acid supplements, especially in high doses, might make seizures worse in people with seizure disorders. - Vitamin B12 deficiency: Taking folic acid supplements might improve certain lab tests in people with low vitamin B12 levels. This may make it seem like vitamin B12 deficiency is improved when it isn\'t. If left untreated, this could cause permanent nerve damage. **Dosing** Folic acid is an important nutrient. The amount that should be consumed on a daily basis is called the recommended dietary allowance (RDA). The RDA for folic acid is provided as Dietary Folate Equivalents, or DFE. 1 mcg DFE is the same as 1 mcg of folate found in food. But 1 mcg DFE is the same as 0.6 mcg of folic acid supplements. The RDA in adults is 400 mcg DFE daily. In pregnancy, the RDA is 600 mcg DFE daily. When breastfeeding, the RDA is 500 mcg DFE daily. In children, the RDA depends on age. **Hepatitis B Vaccine** The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease. The hepatitis B vaccine is also known as the first "anti-cancer" vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide. **Three-Dose Hepatitis B Vaccine Schedule** ​All doses of the vaccine are required in order to be fully protected against hepatitis B. It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life. **1st Shot** - At any given time, but newborns should receive this dose in the delivery room **2nd Shot** - At least one month (or 28 days) after the 1st shot **3rd Shot** - At least 4 months (16 weeks) after the 1st shot and 2 months after the 2nd shot. Infants should be a minimum of 24 weeks old at the time of the 3rd shot. You do not need to restart the hepatitis B vaccine series if you miss any of the shots. For example, if you start the vaccine series and stop, then get the 2nd shot when you can and make sure to get the 3rd shot at least two months later. Or, if you get the first two doses of vaccine and miss the third dose, then just schedule the last shot when you can. **Hepatitis B Side Effects** Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site. The vaccine may not be recommended for those with documented yeast allergies or a history of an adverse reaction to the vaccine. **Vitamin k** Vitamin k is given to prevent Vitamin K Deficiency Bleeding (aka "Hemorrhagic Disease of the Newborn") can result. Incidence of VKDB reported varies from 1.5% to 0.001% , depending on population studied and feeding patterns (formula is protective since it's supplemented with vit K) Vitamin K is undetectable in cord blood.Lactobacillus (primary gut flora in breastfed babies) does not synthesize vitamin K. Breastmilk contains only small amounts of vitamin K (1 -- 9 mcg/L); formula (53-66 mcg/L) **Uses** Vitamin K is needed for blood clotting. Newborn babies are given vitamin K injections to prevent a serious disease called haemorrhagic disease of the newborn (HDN). Vitamin K can be given by mouth if preferred, but oral doses aren't as effective. Vitamin K is necessary for synthesis of factors II (prothrombin), VII, IX, and X **Dosage** vitamin K by drops, Two doses of drops were needed for all babies (one at birth and one 3 to 5 days later), and another in the fourth week, if the baby was breastfed. It is clear that getting vitamin K by one injection is safer and more effective than by three sets of drops. 1 mg vitamin K SQ (preferred) or IV (risk of anaphylaxis) biochemical response (normalized PT) is rapid, 4 -- 6 hours 0.5mg -- 1mg vitamin K IM at birth In some parts of Europe: 2 -- 4mg PO vitamin K after first feeding then 2mg at 2 -- 4 weeks and again at 6 -- 8 weeks OR 2 -- 4mg PO vitamin K after first feeding then 2mg within first week and weekly while breastfeeding 2mg PO vitamin K after first feeding then 2mg within first week followed by 25mcg daily for 13 weeks **Side effects** Anaphylaxis, though most common after IV infusion, has rarely been reported with IM injection. Scleroderma-like patch at the site of injection has been reported primarily in adults after repeated injections, though there are reports of 7 infants with similar dermatologic reactions (again, millions of doses are given without problems). **Rho(D) immune globulin (RhIG)** This is a medication used to prevent RhD isoimmunization in mothers who are RhD negative and to treat idiopathic thrombocytopenic purpura (ITP) in people who are Rh positive. It is often given both during and following pregnancy. It may also be used when RhD-negative people are given RhD-positive blood. It is given by injection into muscle or a vein. A single dose lasts 12 weeks. It is made from human blood plasma. **Side effect** Common side effects include fever, headache, pain at the site of injection, and red blood cell breakdown. Other side effects include allergic reactions, kidney problems, and a very small risk of viral infections. In those with ITP, the amount of red blood cell breakdown may be significant. Use is safe with breastfeeding. **Contraindications** The following females are not candidates for RhIG: - D-negative females whose fetus is known to be D-negative - D-negative females who have been previously all immunized to D (they have already formed an anti-D alloantibody) - Any D-positive females - Women who test positive for one of the weak D mutations by molecular testing should be considered RhD positive and not receive RhIG - Women who test positive for one of the partial D mutations (by molecular testing) should be treated as RhD negative and receive RhIG as clinically indicate **Dosage Forms & Strengths** 50 mcg 300 mcg 1,500 Units/2 mL 1,500 Units/1.3 mL 2,500 Units/2.2 mL 5,000 Units/4.4 mL 15,000 Units/13 mL **Administer to Mother to Prevent Hemolytic Disease in Newborn** Antepartum: 1500 IU\~300 mcg IV/IM at 28-30 weeks of gestation Postpartum: 1500 IU IV/IM within 72 hr If both given risk reduced to 0.1% If unable to give within 72 hr, give within 28 days; do not withhold If \>15 mL of Rho+ fetal RBC present in mother\'s circulation, multiple 1500 IU doses are required **References** American Academy of Pediatrics, Committee on Fetus and Newborn. Controversies Concerning Vitamin K and the Newborn. Pediatrics 2003 July; 112(1):191-2. Ross, JA, Davies SM. Vitamin K prophylaxis and childhood cancer. Med Pediatr Oncol. 2000 Jun;34(6):434-7.