Streptococcus, PPhaemorrhage.pdf for pharmacy students

Note; Gastroesophageal reflux disease (GERD)
It is a very common problem presenting as ‘heartburn’, acid eructation, sensation of stomach contents coming back in foodpipe, especially after a large meal, aggravated by stooping or lying flat. Some cases have an anatomical defect (hiatus hernia) but majority are only functional (LES relaxation in the absence of swallowing). Repeated reflux of acid gastric contents into lower 1/3rd of esophagus causes esophagitis, erosions, ulcers, pain on swallowing, dysphagia strictures, and increases the risk of esophageal carcinoma.
The primary barrier to reflux is the tone of LES which can be altered by several influences: Inherent tone: of sphincteric smooth muscle.
Hormonal: gastrin increases, progesterone decreases (reflux is common in pregnancy).
Neurogenic: vagus is motor to the sphincter, promotes esophageal peristalsis.
Dietary: fats, alcohol, coffee, chocolates decrease, while protein rich foods increase LES tone.
Drugs: anticholinergics, tricyclic antidepressants, Ca2+ channel blockers, nitrates reduce LES tone.
Smoking: relaxes LES.
Delayed gastric emptying and increased intragastric pressure may overcome the LES barrier to reflux. GERD is a wide spectrum of conditions from occasional heartburn to persistent incapacitating reflux which interferes with sleep and results in esophageal, laryngotracheal and pulmonary complications. Severity of GERD may be graded as:
Stage 1: occasional heartburn ( 3 episodes/week of moderately severe symptoms, nocturnal awakening due to regurgitation, esophagitis present or absent.
Stage 3: Daily/chronic symptoms, disturbed sleep, esophagitis/erosions/stricture, symptoms recur soon after treatment stopped.Note; Gastroesophageal reflux disease (GERD)
It is a very common problem presenting as ‘heartburn’, acid eructation, sensation of stomach contents coming back in foodpipe, especially after a large meal, aggravated by stooping or lying flat. Some cases have an anatomical defect (hiatus hernia) but majority are only functional (LES relaxation in the absence of swallowing). Repeated reflux of acid gastric contents into lower 1/3rd of esophagus causes esophagitis, erosions, ulcers, pain on swallowing, dysphagia strictures, and increases the risk of esophageal carcinoma.
The primary barrier to reflux is the tone of LES which can be altered by several influences: Inherent tone: of sphincteric smooth muscle.
Hormonal: gastrin increases, progesterone decreases (reflux is common in pregnancy).
Neurogenic: vagus is motor to the sphincter, promotes esophageal peristalsis.
Dietary: fats, alcohol, coffee, chocolates decrease, while protein rich foods increase LES tone.
Drugs: anticholinergics, tricyclic antidepressants, Ca2+ channel blockers, nitrates reduce LES tone.
Smoking: relaxes LES.
Delayed gastric emptying and increased intragastric pressure may overcome the LE

1. Pharmacology Medication Dosing Recommendations During Pregnancy and Lactation Prepared by Dr / Mohammad Dmmaj

Drug Dosage Comments
Group B Streptococcus
1) Penicillin G 5 million units IV initially, then 2.5–3 million units IV
every 4 hours until delivery
First choice
2) Ampicillin 2 g IV initially, then 1 g IV every 4 hours until delivery
3) Cefazolin 2 g IV initially, then 1 g IV every 8 hours until delivery
4) Clindamycin 900 mg IV every 8 hours until delivery Only if isolate proven sensitive to clindamycin and
Erythromycin(500 mg I.V every 6 hours until delivery)
5) Vancomycin 1 g IV every 12 hours until delivery If other options are inappropriate
Postpartum hemorrhage
1) Oxytocin 10 units IM or 5 units push or 20–40 units in 1 L if IV Use normal saline or lactated Ringer
2) Carbetocin 100 mcg IM or IV over 1 minute
3) Methylergonovine 0.2 mg IM or IV every 2–4 hours up to five doses Do not use in hypertensive women
4) Carboprost 5–10 mg orally three to four times daily Use with caution in asthmatic women
5) Dinoprostone 20 mg vaginal suppository every 2 hours
6) Misoprostol 400–800 mcg po or 800–1000 mcg rectally once
7) Tranexamic acid 10–15 mg/kg IV over 20 minutes
8) Ethamsylate (Dicynone) 250–500 mg TDS oral or IV