standing orders for midwifes pgd-midwives2001

Core Section of Patient Group Directions

1. Introduction

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.

2. 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.

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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.

3. 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:

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.

3.2 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

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patient group directions for the administration of products in the midwifery formulary.

3.3 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. Treatment Available

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. Documentation

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.

6. Further Points

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.

7. Concurrent Medication

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See individual product monograph

8. Management and monitoring of Group Protocols

8.1 Consultative Group

Vince Summers: Chief Trust PharmacistBrian Magowan: Consultant ObstetricianHazel Gueldner: Obs & Gynae PharmacistMargaret Davison: Midwife

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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 Paracetamol 1gram as a single dose, once only

ANTACID Maalox suspension 10ml as a single dose, once only

orPeptac liquid 10-20ml as a single dose, once only

APERIENT Ispaghula Husk 3.5g one sachet in water, once only

PROPHYLAXIS FOR Ranitidine tablet 150mg at 22.00 on nightMENDELSON’S SYNDROMEbefore theatre, repeated two hours before IN ELECTIVE LSCS theatre. Sodium Citrate 0.3M 30ml

orally once only immediately prior to transfer to Theatre

I.V. THERAPY 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

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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.

DINOPROSTONE VAGINAL GELAs per induction of labour guidelines.

FOLIC ACID Folic acid 400microgram tablet once daily, until 12-14 weeks gestation.

DEMULCENT COUGH Simple linctus 5ml once onlyPREPARATION

ANTISPASMODIC 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. injectionThreatened miscarriage after 12 weeks gestationSpontaneous miscarriage after 12 weeks gestationEctopic pregnancyTherapeutic termination of pregnancy – medical and surgicalFollowing sensitising events such as amniocentesisIncomplete miscarriage requiring E.R.P.O.C.

After 20 weeks gestatation Anti- D 500i.u. by i.m. injectionAntepartum haemorrhageExternal cephalic versionIntrauterine deathInvasive prenatal diagnostic and intrauterine proceduresBlunt abdominal trauma

Routine Ante-natal Anti-D prophylaxisAnti-D 500i.u. by i.m. injection at 28 and 34 weeks gestation

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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

INTRAPARTUM

ANALGESIA Entonox inhalation as required

Diamorphine i.m. 5-10mg every 3-4 hours (women <50kg before pregnancy 5mg only) providing delivery is not imminent, up to a maximum of 2 doses without reference to a Registrar. Monitor respirations for 30 minutes after administration

ANTI - EMETICS Cyclizine 50mg i.m. every 8 hours as required to a maximum of 150mg/24 hours

Metoclopramide 10mg i.m. 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 Ranitidine tablet 150mg every 6 hoursMENDELSON’S SYNDROMESodium Citrate 0.3M 30ml prior to

Theatre as a single dose

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ACTIVE MANAGEMENT Oxytocin 10i.u.as per unit policyOF LABOUR

Syntometrine 1ml i.m. with anterior shoulder at delivery

I.V. THERAPY Compound Sodium Lactate 1 litre i.v. every 8-12 hours as required to a maximum of 2 litres

Heparin 10u/ml 5ml instilled into i.v. cannula every 4-8 hours when required

LOCAL ANAESTHETIC Lignocaine 1% 0.1ml intradermally prior to cannulation, once only


LAXATIVES Glycerine Suppository 1 or 2 per rectum

orDocusate sodium 90mg microenema as required

EPISIOTOMY Lignocaine 1% 10ml by perineal infiltration

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PAEDIATRICS

The following may be administered to babies after delivery without reference to Paediatric staff:

Oxygen by facemask

Phytomenadione 1mg by i.m. injection

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ANAESTHETICS RESTRICTIONS

New anaesthetic guidelines in relation to post-operative pain management have been recently issued (March 1999). Midwives should, therefore, be aware it is no longer appropriate to use obstetric patient group directions for post-operative analgesia during the first 24 hours. The anaesthetic department has assumed responsibility for post-operative pain management in this period. If the patent requires an adjustment to their prescription the on-call anaesthetist should be contacted.

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POSTPARTUM

EPISIOTOMY REPAIR Lignocaine 1% by perineal infiltration to a maximum of 20ml

ANALGESIANSAID ANALGESIC Only one NSAID should be prescribed

at any one time

Cesarean Section for first 24 hours : Anaesthetist will be responsible for analgesia. Unless contra-indicated diclofenac suppository 100mg will be given rectally in Theatre. One dose of an NSAID can be given 14-16 hours after the suppository. If Diclofenac is given, the total dose must not exceed 150mg by all routes in any 24 hours period.

Vaginal delivery or Cesarean Section after first 24 hours:

Ibuprofen tablet or syrup 400mg or 600mg three times a day.

Diclofenac tablet or suppository 50mg three times a day (to a maximum of 150mg in 24 hours by any route).

PARACETAMOL BASED Only one PARACETAMOL BASED ANALGESIC ANALGESIC should be prescribed at any one time.

Paracetamol 1gram every 4-6 hours to a maximum of 4grams in any 24 hours as plain or effervescent tablets or rectally as suppository.

Co-dydramol 2 tablets every 4-6 hours to a maximum of 8 tablets in any 24 hours.

ANTIEMETIC Cyclizine 50mg i.m. every 8 hours as required to a maximum of 150mg/24 hours.

Metoclopramide 10mg i.m. every 8 hours as required to a maximum of

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30mg in 24 hours or 500 micrograms per Kg in 24 hours for women<60kg

LAXATIVES Ispaghula Husk 3.5g, 1 sachet in water twice

daily

Lactulose 10ml orally twice daily

Glycerine suppository 1 or 2 per rectum as required

HAEMORRHOID Anusol cream apply twice daily and after eachPREPARATIONS bowel movement

Scheriproct ointment apply twice daily for 5-7 days then once daily until symptoms cleared

I.V. THERAPY Compound Sodium Lactate 1 litre i.v. every 8-12 hours as required to a maximum of 2 litres

Heparin 10u/ml 5ml instilled into i.v. cannula every 4-8 hours when required

LOCAL ANAESTHETIC Lignocaine 1% 0.1ml intradermally prior to cannulation, once only


ANTI –D Anti-D Immunoglobulin 500i.u or more. by i.m. injection to Rh D negative women with a Rh D positive baby within 72 hours of delivery as per obstetric unit guidelines.

VACCINES Rubella vaccine (live) 0.5ml by deep subcutaneous or intramuscular injection if mother not immune.

IRON SUPPLEMENT Ferrous sulphate tablet 200mg three times a day if haemoglobin below 10g/dl.If symptomatic refer to SHO.

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DEMULCENT COUGH Simple linctus 5ml 3-4 times a day.PREPARATION

ANTISPASMODIC Peppermint water 10ml in plenty of water, once only.

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EMERGENCY PRESCRIPTIONS

The following can be administered FOLLOWING AND ONLY WITH reference to medical staff, provided that all are entered correctly in the casenotes/drug or i.v. prescription sheet, signed by the initiating midwife and countersigned by the duty SHO as soon as practicable

OXYGEN Oxygen 6 litres/minute by face mask

TREATMENT OF Glucagon 1mg i.m. or i.v.SEVEREHYPOGLYCAEMIA Hypostop gel orally as required

ANTEPARTUM Compound Sodium Lactate 500-1000ml stat IVHAEMORRHAGE

Gelofusine 500ml stat IV

POSTPARTUM Syntometrine 1ml i.m.HAEMORRHAGE

Oxytocin 10i.u by i.m. or i.v. injection

Oxytocin 40i.u. 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. It must be checked by two midwives.

TO CONTINUE Ritodrine 150mg in Glucose 5% 500ml,TREATMENT OF rate as per guidelines.PREMATURE LABOUR

Atosiban concentrate for intravenous infusion 75mg (10ml) in 90ml Sodium Chloride 0.9% as per obstetric unit guidelines.

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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.

(i) Amethocaine Gel

(ii) Anti-D Immunoglobulin

(iii) Anusol Cream

(iv) Atosiban Injection

(v) Co-dydramol Tablets

(vi) Compound Sodium Lactate Infusion BP

(vii) Cyclizine Injection 50mg

(viii) Diamorphine Injection 5mg or 10mg

(ix) Diclofenac Tablets and Suppositories

(x) Dinoprostone Vaginal Gel 1mg or 2mg (Prostin)

(xi) Docusate Sodium Microenema 90mg

(xii) Entonox

(xiii) Ferrous Sulphate Tablet 200mg

(xiv) Folic Acid Tablets 400micrograms

(xv) Gelofusine (Gelatin) Intravenous Infusion

(xvi) Glucagon Injection 1mg (GlucaGen)

(xvii) Glycerin Suppository 4g

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(xviii)Heparin Injection 10iu/ml

(xix) Hypostop Gel(xx) Ibuprofen Tablet 400mg or 600mg or Suspension 100mg/5ml

(xxi) Ispaghula Husk Sachet 3.5g (orange)

(xxii) Lactulose Solution

(xxiii)Lignocaine (Lidocaine) 1% Injection

(xxiv) Maalox Suspension

(xxv) Metoclopramide Injection 10mg

(xxvi) Oxygen

(xxvii) Oxytocin Injection

(xxviii) Paracetamol Tablet 500mg or Suppositories 500mg

(xxix) Peppermint Water

(xxx) Peptac Liquid

(xxxi) Phytomenadione Injection 1mg

(xxxii) Ranitidine Tablets 150mg

(xxxiii) Ritodrine Injection

(xxxiv) Rubella Vaccine 0.5ml

(xxxv) Scheriproct Ointment

(xxxvi) Simple Linctus

(xxxvii) Sodium Citrate 0.3M Solution

(xxxviii) Syntometrine Injection

(xxxix) Temazepam Tablet 10mg

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(i) AMETHOCAINE GEL

Pharmaceutical PresentationWhite gel containing amethocaine 4% w/w. Each tube contains 1.5g of gel which disperses 1g equivalent to 40mg amethocaine.

IndicationLocal anaesthetic for application to a skin site prior to insertion of a needle or cannula.

Contra-indicationAllergy to any of the ingredients or other local anaesthetic.Premature infants or infants less than 1 month old.

Dose1g of gel to be applied to the affected area. (Do not rub the gel into the skin). Apply a plastic film dressing for 30-45 minutes, then remove the dressing and wipe off the gel. Maximum duration of gel application to the skin must not exceed 1 hour.

Side effectsRedness, itching and swelling of the site of application.12Rarely blistering of the skin may occur.

Patient InformationThe site will remain numb for about 4-6 hours. The gel should only be applied to the intended site and should not be placed on any wounds or broken skin, the eyes, ears, mouth, genitals or anus.

References: BNF No 41; Ametop Package Information leafletAugust 2001

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(ii) ANTI-D IMMUNOGLOBULIN 250IU or 500IU

Pharmaceutical PresentationClear liquid containing either 250IU or 500IU per vial.

IndicationProtection of non-immune Rh(D) negative individual exposed to Rh(D) positive cells.

Contra-indicationMust not be given to Rh(D) positive individuals, or those with known sensitivity to any of the ingredients or those who are known to have immune Anti-D antibodies. The product must not be given intravenously.

DoseAs per guidelines within 72 hours of a sensitising event, by deep intramuscular injection, preferably into the deltoid muscle.

NB: The product should be stored at between 2C and 8C in a fridge. However, it can be kept for 1 week at ambient temperature (25C) without detrimental effect on one occasion during the shelf life.

Side effectsThis product is generally well tolerated. 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. Large doses may cause fever and chills.

Patient InformationAdministration of live vaccines should not be carried out until 3 months after you have had this product. If you have had a live vaccine in the last 2-4 weeks, the efficacy of that vaccine may be impaired. There may also be interference with some laboratory tests so tell your GP if you have to attend for any blood tests.

References: Technical Information leafletAugust 2001

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(iii) ANUSOL CREAM

Pharmaceutical PresentationA buff coloured cream containing zinc oxide 10.75%, bismuth oxide 2.14% and balsam peru 1.8%.

IndicationRelief of pain, swelling, itch and irritation of external and internal haemorrhoids (piles).

Contra-indicationSensitivity to any of the ingredients.Care should be taken if there is any rectal bleeding.

DoseApply to the affected area after washing and drying, morning and night and after each bowel movement.For internal haemorrhoids the nozzle provided should be used.

Side effectsMild irritation or burning on application of cream.Sensitivity reactions including rash.

Patient InformationThe tube is for your own personal use. If the nozzle is used to apply the cream to internal haemorrhoids, it should be cleaned after each use.To aid recovery and help prevent recurrence of haemorrhoids, you should eat a diet with plenty of fibre, drink plenty of water and take regular exercise.

References: BNF No 41, Anusol Package Information leafletAugust 2001

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(iv) ATOSIBAN INJECTION

Pharmaceutical PresentationSolution for IV injection: Solution containing Atosiban 6.75 as Atosiban acetate in 0.9ml.

Solution for IV infusion: Solution containing Atosiban 37.5mg as Atosiban acetate in 5ml for intravenous infusion after dilution.

IndicationTo delay imminent pre-term birth in 24 to 33 weeks of pregnancy.

Contra-indicationKnown hypersensitivity to any of the ingredients. Gestational age below 24 or above 33 weeks, Premature membrane rupture after 30 weeks gestation, Intrauterine growth retardation, abnormal fetal heart rate, uterine haemorrhage, eclampsia or severe pre-eclampsia, intrauterine fetal death, placenta praevia, abruptio placenta, suspected intrauterine infection.Caution in hepatic or renal disease or diabetic patients.

DoseAs per unit policy. Bolus dose of 0.9ml should be the solution for IV injection and need to be given by a doctor; the infusion should be prepared using the solution for IV infusion.

Side effectsNausea, vomiting, headache, dizziness, flushing, tachycardia, hypotension, hyperglycaemia, fever, insomnia, pruritis, rash, rarely uterine haemorrhage or atony. Hypersensitivity reactions including injection site inflammation has been noted.

Patient InformationThis is to suppress the contractions of the uterus. This infusion may be continued for up to 45 hours to try and prevent progression of labour. If you feel unwell, tell your midwife.

Reference: BNF 41, Tractocile Data SheetAugust 2001

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(v) CO-DYDRAMOL TABLETS 10/500

Pharmaceutical PresentationRound white tablet containing Paracetamol 500mg and dihydrocodeine 10mg.

IndicationRelief of mild to moderate pain

Contra-IndicationCurrent prescription for any other paracetamol-containing analgesic.Known hypersensitivity to paracetamol or dihydrocodeine or medicines containing these drugs.Caution in patients with breathing difficulties, hypothyroidism, alcoholic liver disease, liver or kidney problems. May affect warfarin treatment.Metoclopramide may enhance absorption of paracetamol.

DoseTwo tablets every 4-6 hours, to a maximum of 8 tablets in any 24 hours.

Side EffectsConstipation, nausea, headache and dizziness.Hypersensitivity reactions or blood disorders may occur.

Patient InformationThis product contains paracetamol. Maximum of 2 tablets at any one time and maximum of 8 tablets in any 24 hour period. Also contains dihydrocodeine. May cause drowsiness. If you feel drowsy you should not drive or operate machinery. If you take an overdose, seek medical advice immediately.

References: BNF No 41 Package Information leafletAugust 2001

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(vi) COMPOUND SODIUM LACTATE INFUSION BP

Pharmaceutical PresentationSolution for infusion containing sodium chloride, sodium lactate, potassium chloride, calcium chloride, sodium hydroxide and lactic acid in water for injection.

IndicationIntravenous fluid.

Contra-indicationCaution in heart failure, oedema, hypertension, eclampsia, aldosteranism or renal failure.

Dose1000ml to be given over 8-12 hours as required in the management of the patient.

Side effectsExcess administration may lead to hypokalaemia and metabolic alkatosis, especially with impaired renal function. Symptoms include tiredness, shortness of breath, muscle weakness, mood changes and irregular heart beat.

Patient Information

References: Martindale 32nd editionAugust 2001

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(vii) CYCLIZINE INJECTION 50mg

Pharmaceutical PresentationAmpoule containing cyclizine lactate 50mg in 1ml solution.

IndicationAntihistamine type antiemetic.

Contra-indicationKnow sensitivity to cyclizine.Caution in glaucoma, severe heart failure, obstructive bowel disease, and patients taking other sedating drugs or alcohol.

Dose50mg by intramuscular injection three times daily as required to maximum 150mg/day.

Side effectsUrticaria, rash, drowsiness, blurred vision, dry mouth, tachycardia, urine retention, constipation, nervousness, insomnia, restlessness, hallucinations (auditory and visual), cholestatic jaundice, chorea, hypersensitivity hepatitis, agranulocytosis and fixed drug eruptions have been reported.

Patient InformationThere may be side effects such as drowsiness, dry mouth, palpitations, difficulty in passing urine, constipation and vision problems. Tell your midwife if you experience any of these problems.

References: BNF No 41, Valoid data sheetAugust 2001

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(viii) DIAMORPHINE INJECTION 5mg or 10mg

Pharmaceutical PresentationEach vial contains a white sterile freeze-dried powder of diamorphine hydrochloride BP 5 or 10mg for reconstitution for injection.

IndicationTreatment of severe pain during labour.

Contra-indicationKnown hypersensitivity to diamorphine. Respiratory depression, obstructive airways disease, raised intracranial pressure (head injury requires caution), phaeochromaocytoma or within 2 weeks of taking a monoamine oxidase inhibitor.Great caution should be used if known or suspected history of drug abuse.Caution in toxic psychosis, acute alcoholism, adrenal insufficiency, CNS depression, myoedema, severe inflammatory obstructive bowel disorders, hepatic or renal impairment.

DoseReconstitute the powder with water for injection prior to use.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. This must not be given if delivery is imminent.Monitor respiration for 30 minutes after administration.

Side effectsRespiratory depression, possible circulatory depression, sedation, nausea, vomiting, constipation, sweating, dizziness, confusion, urinary retention, biliary spasm, miosis, vertigo, palpitations, orthostatic hypotension, dry mouth, mood changes, urticarial, pruritis, facial flushing and raised intracranial pressure.

Patient InformationThe analgesic will usually be given with something to make you feel less sick. The effect should last for 3 or 4 hours. If you feel unwell tell your midwife.

References: BNF No 41, Data SheetAugust 2001

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(ix) DICLOFENAC TABLETS 50mg or SUPPOSITORY 50-100mg

Pharmaceutical PresentationTablets: Round brown tablets each containing diclofenac sodium 50mgSuppositories: Suppository containing diclofenac 50mg or 100mg in a wax base.

IndicationNon-steroidal anti-inflammatory drug for the relief of pain.

Contra-indicationKnown hypersensitivity to diclofenace, aspirin, any other NSAID, or any of the ingredients. Any other NSAID prescription, Asthma unless previous NSAID or aspirin administration was tolerated. Active gastro-intestinal disease. Contra-indicated within 8-12 days of mifepristone administration. Caution in patients on lithium diuretics, cyclosporin, warfarin and other drugs (see BNF), or those with renal, hepatic or cardiac impairment.

DoseCaesarean section: 100mg by suppository in theatre, followed by either 50mg diclofenac or another NSAID by mouth 14-16 hours later.Vaginal delivery: 50mg every 8 hours by mouth or rectum.

Side effectsGastro-intestinal upset, nausea, vomiting, diarrhoea, occasional bleeding or ulceration, bronchospasm, dizziness, headache, blurred vision, haematuria, fluid retention.

Patient InformationThese tablets should be taken regularly, with or just after food or a drink of milk to minimise the effects on the stomach (NB: suppositories can also cause stomach irritation.) If you have indigestion or stomach pain, tell your midwife. Also if you experience being short of breath (especially if you have asthma or other chest problems) tell your midwife. You can safely take paracetamol-based painkillers with this medication.

Suppositories should be removed from their packaging and inserted into the rectum as directed.

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References: BNF No 41, Voltarol data sheetAugust 2001

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(x) DINOPROSTONE VAGINAL GEL 1mg or 2mg (Prostin)

Pharmaceutical PresentationTranslucent gel containing either 1mg or 2mg dinoprostone per 3gram.

IndicationInduction of labour as per guidelines when there are no maternal or fetal contra-indications.

Contra-indicationKnown sensitivity to prostaglandins. Active cardiac, renal, hepatic or pulmonary disease. Suspected or confirmed placenta praevia or unexplained vaginal bleeding during the pregnancy, fetal distress or malpresentation.In patients where prolonged contractions are inappropriate, eg previous surgery, difficult labour or grand multipare, ruptured membranes or active pelvic inflammatory disease. Caution in asthma, epilepsy, glaucoma, hypertension or compromised hepatic renal or cardiovascular function.

DoseAs per guidelines for induction of labour.

Side effectsNausea, vomiting, diarrhoea, most common.Rarely, hypersensitivity to dinoprostone, uterine rupture, cardiac arrest, abruptio placenta, uterine hypercontractility or hypertonus, fetal distress, maternal hypertension, stillbirth, neonatal death, rapid cervical dilation, fever, bronchospasm or asthma, pulmonary or amniotic fluid embolism, backache, rash, pain, irritation and warmth of vagina, uterine hypercontractility with or without fetal bradycardia and low Apgar scores in the newborn.

Patient InformationYou will be examined by the midwife prior to administration of the gel into the vagina. You will be asked to lie down for 30 minutes after this. After 6 hours you may need a second dose. Tell you midwife if anything occurs after the gel is inserted, for example contractions.

References: BNF No 41 Prostin data sheetAugust 2001

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(xi) DOCUSATE SODIUM ENEMA 90mg Microenema(Fletchers enemette)

Pharmaceutical PresentationEnema containing Docusate sodium 90mg and glycerol 3.78g.Also contains polyethylene glycol and sorbic acid.

IndicationEvacuation of bowel before medical procedures.Relief of constipation

Contra-indicationIntestinal obstruction.

DoseThe enema should be inserted into the rectum and the contents squeezed out before the tube is withdrawn.

Side effectsMay cause transient discomfort. Prolonged use may lead to rectal irritation, atonic non-functioning colon and hypokalaemia.

Patient InformationThis preparation is for rectal use.The enema will produce a response within one hour.If you experience any discomfort or there is no response within 1 hour let a member of staff know.

References: BNF No 41, Package Information leafletAugust 2001

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(xii) ENTONOX

Pharmaceutical PresentationGas which is odourless, tasteless and colourless containing oxygen 50% and nitrous oxide 50%.

IndicationInhalational analgesia during labour.

Contra-indicationSpontaneous or traumatic pneumothorax.Severe bullous emphysema.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. Above 10C, the cylinders can be kept upright and gases will remain mixed.

DoseTo be inhaled on demand.

Side effectsBone marrow depression or megaloblastic anaemia may occur with prolonged use of 24 hours or greater.

If the mask or cylinder head becomes frosted, the cylinder should be replaced with a new one (to prevent gas separation).

Patient InformationIf this is not suiting you, please discuss other analgesia options with your midwife.

References: Martindale 32nd edition, Grampian PGDAugust 2001

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(xiii) FERROUS SULPHATE TABLET 200mg

Pharmaceutical PresentationRound, white sugar coated tablet containing ferrous sulphate 200mg

IndicationTreatment of iron deficiency anaemia.

Contra-indicationHypersensitivity to any iron preparationsPatients who cannot tolerate iron preparations or have disorders of iron metabolism.Haemoglobin levels above 11.5g/dl.Caution with other medications (See BNF).

DoseOne tablet three times a day. The tablet should be swallowed whole.

Side effectsNausea, epigastric pain, gastrointestinal irritation, altered bowel habit (diarrhoea or constipation).

Patient InformationTablets should preferably be taken on an empty stomach. However if this causes gastro-intestinal irritation they may be taken with or after food to minimise this effect. The stools may be discoloured (black). The tablet may cause either diarrhoea or constipation. If this becomes a problem, please let a member of staff know.May interfere with other medication – ask if you are taking other medication especially antibiotics, methyldopa, penicillamine or cholestyramine.

References: Martindale 32nd editionAugust 2001

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(xiv) FOLIC ACID TABLET 400micrograms

Pharmaceutical PresentationWhite tablets containing folic acid 400micrograms.

IndicationPrevention of neural tube defects in early pregnancy.

Contra-indicationKnow sensitivity to folic acid.

DoseOne tablet daily with food until the 12th-14th week of pregnancy.Ideally this should be started before conception but can be started at any time if pregnancy is suspected.

Side effectsNil known.

Patient InformationThis 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.

References: Preconcieve package information leafletAugust 2001

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(xv) GELOFUSINE (Gelatin) INTRAVENOUS INFUSION

Pharmaceutical PresentationIntravenous infusion solution containing succinylated gelatin 4%.

IndicationCorrection of low blood volume during haemorrhage as a short term measure.

Contra-indicationKnown hypersensitivity to any of the ingredients.Use with caution in cardiac disease or renal impairment.

Dose500ml to be infused as required.

Side effectsHypersensitivity reactions, but rarely severe anaphylactoid reactions.A transient increase in bleeding time may occur.

Patient InformationThis is used to keep the volume of blood in the body at a similar level as you are losing blood.

References: Gelofusine package information leafletAugust 2001

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(xvi) GLUCAGON INJECTION 1mg (GlucaGen)

Pharmaceutical PresentationKit containing one vial containing 1mg glucagon (rys) as a white powder along with one syringe containing 1ml water for injection.

IndicationTreatment of severe hypoglycaemia when patient cannot take anything by mouth.

Contra-indicationSensitivity to any of the ingredients, phaeochromocytoma.Caution in patients on indomethacin or warfarin.

Dose1mg by subcutaneous, intramuscular or intravenous injection immediately after reconstitution, followed by carbohydrate by mouth when recovery is sufficient to allow this.

NB: If the solution is not clear, do not inject.

If this does not have an effect within 10 minutes, a doctor must be called.

Side effectsNausea and vomiting common if dose given too rapidly or more than 1mg given. Diarrhoea, hypokalaemia and rapid heart beat may occur. Hypersensitivity reactions rare.

Patient InformationThe pack should be stored in the fridge and used by the expiry date. If this is not possible, it may be stored at room temperature up to 25oC for a maximum of 18 months or until the expiry date, whichever is shorter.

References: BNF No 41, GlucaGen package information leafletAugust 2001

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(xvii)GLYCERIN SUPPOSITORY 4g

Pharmaceutical PresentationPale amber suppository containing glycerin BP 70% w/w gelatin and water.

IndicationTreatment of constipation by the rectal route.

Contra-indicationSensitivity to any of the ingredients.First 3 months of pregnancy.Intestinal blockage.

DoseOne or two suppositories to be inserted rectally after being moistened with water.

Side effectsStomach cramps may be experienced. May irritate the rectum.

Patient InformationThis preparation will produce a response within 15 to 30 minutes.The suppositories are for rectal use, it should not be swallowed.If any discomfort occurs, let a member of staff know.This product should only be used for a short time. If you need to use it for more than a few days, consult your doctor.

References: Package Information leafletAugust 2001

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(xviii) HEPARIN INJECTION 10iu/ml

Pharmaceutical PresentationSolution containing Heparin Sodium 10 international units per ml.

IndicationAnticoagulant to flush in-dwelling cannulae to maintain patency.

Contra-indicationKnown hypersensitivity to heparin or any of the ingredients.Haemorrhagic disorders or haemophilia or bleeding including thrombocytopenia.

Dose5ml to be instilled into cannula as required every 4-8 hours as required.NB: ensure compatibility with drugs injected before and after the heparin to avoid precipitation.

Side effectsAs this is a low dose preparation, it is unlikely that any side effects will be experienced. Higher doses of heparin may cause haemorrhage, skin necrosis, thrombocytopenia, hyperkalaemia.

Patient InformationThis 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.

References: BNF No 41, Hepsal information leafletAugust 2001

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(xix) HYPOSTOP GEL

Pharmaceutical PresentationClear lemon flavoured gel for oral use containing dextrose 40%.

IndicationTreatment of hypoglycaemia by the oral route.

Contra-indicationSensitivity to any of the ingredients.

Dose23g by the oral route as required. May be repeated if necessary after 10-15 minutes.

Side effectsNausea.

Patient InformationThe 23gram dose contains 9.2grams glucose.

References: Package Information leafletAugust 2001

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(xx) IBUPROFEN TABLET 400mg or 600mg or SUSPENSION 100mg/5ml

Pharmaceutical Presentation400mg: Round pink sugar coated tablet containing ibuprofen 400mg600mg: Lozenge shaped pink tablet containing ibuprofen 600mgSuspension: Orange flavoured liquid containing ibuprofen 100mg per 5ml

IndicationNon-steroidal anti-inflammatory drug for treatment of mild to moderate pain.

Contra-indicationHypersensitivity to aspirin or any other NSAID or any ingredient of the tablet.Asthma unless NSAID tolerated with previous use.Active gastro-intestinal disease.Current prescription for another NSAID.Warfarin therapy.Contra-indicated within 8-12 days after use of mifepristone.Caution in patients on diuretics, cyclosporin, lithium and other drugs (see BNF).Caution in renal, hepatic or cardiac impairment.

DoseOne tablet or 20-30ml suspension, can be given up to three times a day with food. Maximum 1.8grams per day. Doses above 1.8g per day need to be prescribed by a doctor – may prescribe up to 2.4g per day individual doses.

Side effectsGastro-intestinal upset, nausea, diarrhoea, occasional bleeding or ulceration, bronchospasm headache, dizziness, blurred vision, haematuria, fluid retention. Rarely renal or hepatic problems.

Patient InformationThese tablets or suspension should be taken regularly with or just after food or a drink of milk to minimise effects on the stomach. If any indigestion or stomach problems occur, tell your midwife. Also if shortness of breath occurs (especially if you have asthma or other chest problems), contact your midwife. Also let someone know if you have a skin rash or any unexplained bruising or swelling.You can safely take paracetamol-based painkillers with this medicine.

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References: BNF No 41, Brufen data sheetAugust 2001

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(xxi) ISPAGHULA HUSK SACHET 3.5g (Orange)

Pharmaceutical PresentationSachet containing ispaghula husk 3.5g. Also contains orange flavour and beta-carotene (colour), aspartame (sweetener), citric acid, potassium bicarbonate, sodium bicarbonate and povidone.

IndicationTreatment of constipation (bulk-forming type).

Contra-indicationIntestinal obstruction, faecal impaction, colonic atony.Phenylketonuria.Hypersensitivity to any of the ingredients.

DoseOne sachet in a glass of cold water (approx 150ml or ¼ pint) twice daily after meals.

Side effectsFlatulence, bloating may be experienced.

Patient InformationThe sachets should be taken regularly and should work within 3 days.Fluid intake must be adequate to help the preparation work effectively.If flatulence and/or bloating occur, this should diminish after a few days.

References: BNF No 41, Fybogel information leafletAugust 2001

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(xxii) LACTULOSE SOLUTION

Pharmaceutical PresentationClear or pale yellow coloured solution containing Lactulose 3.35g per 5ml.

IndicationTreatment of constipation by osmotic action.

Contra-indicationGalactosemia, intestinal obstruction, allergy to any of the ingredients.Caution in lactose intolerance.

Dose10mls of solution orally twice daily.This may be taken with water or fruit juice.

Side effectsAbdominal discomfort, flatulence and cramps.

Patient InformationNeeds to be taken regularly to be effective. May take up to 2-3 days to have an effect.Any bloating should disappear within a few days.If diarrhoea starts, stop taking this preparation.


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(xxiii)LIGNOCAINE (LIDOCAINE) 1% INJECTION

Pharmaceutical PresentationAmpoules containing clear solution of lignocaine 1% w/v.

IndicationLocal anaesthesia for use prior to cannulation or episiotomy or during repair of the perineum.

Contra-indicationKnown hypersensitivity to lignocaine.Complete heart block, hypovolaemia or supraventricular tachycardia. Avoid in porphyria.Caution in epilepsy, bradycardia, impaired respiratory or hepatic function.

DoseNB: Care must be taken to ensure solution is not

injected into a vein or artery.Local anaesthesia prior to cannulation:0.1ml by local infiltration.Local anaesthesia prior to episiotomy: 10ml by local infiltration.Repair of perineum: up to 20ml by local infiltration (only if at least 1 hour has passed after episiotomy. If not, total volume administered should not exceed 20ml for episiotomy and repair).

Side effectsTransient drowsiness and amnesia may occur, followed by confusion, convulsions, bradycardia, hypotension and respiratory depression which may lead to cardiac arrest.

Patient InformationThere will be a loss of sensation at the site of injection which will slowly be reversed.


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(xxiv) MAALOX SUSPENSION

Pharmaceutical PresentationWhite suspension, flavoured with peppermint, containing magnesium hydroxide 195mg and dried aluminium hydroxide 220mg per 5ml.

IndicationAntacid suspension.

Contra-indicationKidney failure, bowel obstruction or severe abdominal pain of unknown cause.

Dose10ml may be given 20-60 minutes after meals and at bedtime as required.

Side effectsMagnesium hydroxide has laxative effects and aluminium hydroxide may cause constipation. Alteration of bowel habit may occur with prolonged excessive use.

Patient InformationThe antacid may interfere with the absorption of other medicines such as antibiotics or epilepsy medicines. 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: BNF No 41, Maalox Data SheetAugust 2001

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(xxv) METOCLOPRAMIDE INJECTION 10mg

Pharmaceutical PresentationAmpoule containing solution of metoclopramide hydrochloride BP 10mg in 2ml.

IndicationPrevention and treatment of nausea and vomiting.

Contra-indicationKnown hypersensitivity to any of the ingredients. Phaeochromocytoma, gastro-intestinal obstruction, performation or haemorrhage.Caution in patients with epilepsy or drugs that have extrapyramidal side effects, hepatic or renal impairment.

DoseWomen over 60kg at start of pregnancy : 10mg every 8 hours as required to a maximum of 30mg/day.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.

Side effectsExtrapyramidal effects, especially dystonia, hyperprolactinaemia, drowsiness, restlessness, rash, pruritis, depression, diarrhoea, neuroleptic malignant syndrome, oedema.

Patient InformationThis will help prevent or treat nausea and vomiting.

References: BNF No 41, Maxolon Data SheetAugust 2001

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(xxvi) OXYGEN

Pharmaceutical PresentationColourless, tasteless, odourless gas.

IndicationTo correct hypoxia. To correct hypoxia in neonates after delivery.

Contra-indicationAreas where there is fire or danger of spark.No oil or grease must be put onto the valves or an explosion may result.

DoseAs required. Administration can be by face mask, nasal cannula, endotracheal tube, head box or oxygen tent.

Side effectsPulmonary toxicity (as cough, substernal distress and decrease in vital capacity) and CNS toxicity (nausea, vertigo, twitching, convulsions, mood changes and loss of consciousness).

Patient Information

References: Grampian PGD, BNF No 41August 2001

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(xxvii) OXYTOCIN INJECTION 10iu/ml

Pharmaceutical PresentationEach ampoule contains oxytocin Ph Eur 10units in 1ml solution.

IndicationOxytocic to aid induction of labour or prevent uterine bleeding after delivery by intravenous infusion or injection.

Contra-indicationSensitivity to any of the ingredients.Hypertonic uterine contractions, obstructed delivery or where vaginal delivery is inadvisable, fetal distress.Use with care in patients who have had a previous caesarean section, over 35 years of age, mild or moderate cardiac disease or hypertension or have a small pelvis. Do not use for prolonged periods in severe pre-eclamptic toxaemia, severe cardiovascular disease or in oxytocin-resistant uterine inertia.

DoseAugmentation of labour: see unit policy.

Management of 3rd stage of labour in patients with cardiac disease or moderate to severe hypertension: 10 units IM instead of syntometrine - as per unit policy.

Management of major obstetric haemorrhage: see unit policy.

Side effectsNausea, vomiting, uterine spasm at low dose, uterine hyperstimulation at high doses with fetal distress, soft-tissue damage.High doses in large volume of fluid may cause water intoxication (headache, anorexia, nausea, vomiting, drowsiness, abdominal pain, unconsciousness and convulsions).

Patient InformationThis is to help the labour or to control bleeding after the baby is born. If you feel unwell or uncomfortable, tell your midwife.

References: BNF No 41, Syntocinon Data SheetAugust 2001

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(xxviii) PARACETAMOL TABLET 500mg or SUPPOSITORY 500mg

Pharmaceutical PresentationRound white tablet containing paracetamol 500mg.White suppository containing paracetamol 500mg

IndicationRelief of mild to moderate pain or pyrexia.

Contra-indicationHypersensitivity to paracetamol or paracetamol-containing preparations. Prescription for another paracetamol-containing preparation.Caution in patients taking metoclopramide, domperidone, cholestyramine or warfarin.

DoseTwo tablets every 4-6 hours, to a maximum of 8 tablets in any 24 hours.Two suppositories every 4-6 hours by rectum to a maximum of 8 in 24 hours.

Side effectsRare, but may cause skin rashes or blood disorders.

Patient InformationDo not take any other medicines containing paracetamol whilst taking these tablets. Maximum 2 tablets or suppositories at any one time and no more than 8 tablets or suppositories in any 24 hour period.If you take an overdose, see medical advice immediately.

References: BNF No 41August 2001

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(xxix) PEPPERMINT WATER

Pharmaceutical PresentationClear liquid containing peppermint oil 0.05% v/v with a distinctive aroma of peppermint.

IndicationRelief of flatulence.

Contra-indicationAllergy to any of the constituents.

Dose10ml to be taken in plenty of water up to four times a day when required.

Side effectsRare, but do include hypersensitivity, skin rash, headache, muscle tremor, ataxia and bradycardia.

Patient InformationSolution should be taken with plenty of water.Once opened, the bottle should be discarded after 1 month.

References: Package Information SheetAugust 2001

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(xxx) PEPTAC LIQUID

Pharmaceutical PresentationAniseed-flavoured suspension containing sodium bicarbonate 133.5g, sodium alginate 250g and calcium 80mg in 5ml.The preparation is sugar and gluten free.

IndicationDyspepsia.

Contra-indicationSensitivity to any of the ingredients.Caution if on a low sodium diet – contains 3.1mmol per 5ml.Caution with other medication including phenytoin, gabapentin, azithromycin, sodium valproate and others – see BNF for details.

Dose10mls after meals and at bedtime when required.

Side effectsConstipation, flatulence, stomach cramps or belching.

Patient InformationShake the bottle well before use.Do not take this within one to two hours of taking any other medicines by mouth.This medicine is safe to take during pregnancy and while breastfeeding.

References: BNF No 41, Peptac Information leaflet, Pepatc data sheetAugust 2001

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(xxxi) PHYTOMENADIONE INJECTION 1mg (Konakion Neonatal)

Pharmaceutical PresentationAmpoule containing a green/yellow solution of phytomenadione 1mg in 0.5ml for intramuscular injection.

IndicationPrevention of haemorrhagic disease of the new-born.

Contra-indicationKnow hypersensitivity to any of the constituents.Caution if mother/baby has been given anticoagulant medication or has liver disease or has artificial heart valves.

Dose0.5ml by intramuscular injection.

Side effectsFlushing of face, bluish stain colour, sweating, feeling of chest tightness or cold extremeties (hands, feet, nose and ears).

Patient InformationThis is the injection form of phytomenadione (vitamin K). If you wish the baby to be given the oral preparation, please discuss it with the midwife who will contact a paediatrician.

References: BNF No 41, Konakion data sheetAugust 2001

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(xxxii) RANITIDINE TABLETS 150mg

Pharmaceutical PresentationRound white tablet containing ranitidine 150mg.

IndicationTo reduce the amount of acid in the stomach prior to theatre to prevent Mendelson’s syndrome.

Contra-indicationKnown sensitivity to ranitidine. Porphyria.Caution in renal or hepatic disease (reduce dose).The tablets are unsuitable for people with lactose intolerance or galactosaemia.

DoseAntepartum:One tablet at 22.00 the night before and 2 hours prior to theatre along with sodium citrate 0.3M.Intrapartum: One tablet every 6 hours during labour, with sodium citrate 0.3M immediately prior to theatre.

Side effectsHeadache, dizziness, rash, confusion, unexplained fever, gastro-intestinal upset, diarrhoea, jaundice, wheeze, feeling faint. Rarely tachycardia, agitation, visual disturbances, erythema multiforme, alopecia, depression, muscle or joint pain, gynaecomastia in men.

Patient InformationThese tablets affect the acid in the stomach. If you feel

unwell whilst taking these tablets, tell your midwife.

References: BNF No 41, Ranitic information leafletAugust 2001

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(xxxiii) RITODRINE INJECTION

Pharmaceutical PresentationEach 5ml ampoule contains ritodrine hydrochlorde 10mg per ml in an aqueous buffered vehicle.

IndicationManagement of uncomplicated pre-term labour between 24 and 33 weeks gestation.

Contra-indicationKnown hypersensitivity to any of the ingredients. Antepartum haemorrhage, intra-uterine fetal death, intra-uterine infection, eclampsia and severe pre-eclampsia, cord compression, placenta praevia. Caution in cardiac disease, hypertension, diabetes mellitus, hypothyroidism, mild to moderate pre-eclampsia, beta-blocker therapy and other drug therapy (see BNF).

DoseAs per unit policy, the solution should be added to dextrose 5% infusion.Monitor heart rate during administration.

Side effectsNausea, vomiting, tachycardia, palpitations, hypotension, sweating, tremor, hypokalaemia, uterine bleeding, pulmonary oedema. chest pain, arrhythmias, liver function abnormalities. Rarely enlargement of salivary gland. Leucopenia and agranulocytosis reported on prolonged administration.

Patient InformationThis infusion will relax the uterus and will slow down or stop the labour. Tell your midwife if you feel unwell during the infusion.

References: Yutopar data sheet, BNF No 41August 2001

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(xxxiv) RUBELLA VACCINE 0.5ml

Pharmaceutical PresentationSolution containing live rubella vaccine in 0.5ml solution.

IndicationActive immunisation against rubella in women of child-bearing age.

Contra-indicationSensitivity to any of the ingredients. Pregnancy (early pregnancy – consult product literature/BNF).

Dose0.5ml by deep subcutaneous or intramuscular injection.

Side effectsMild dose of rubella may occur.

Patient InformationThis will protect you against the risks of German measles.You are advised not to become pregnant within one month of having this injection. If you do, consult your doctor at the earliest opportunity.

References: BNF No 41, Ervevax information leafletAugust 2001

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(xxxv) SHERIPROCT OINTMENT

Pharmaceutical PresentationOintment containing cinchocaine hydrochloride 5mg and prednisolone 1.5mg per gram.

IndicationShort term use (up to 7 days) for the relief of haemorrhoids (piles) and anal itching.

Contra-indicationSensitivity to any of the ingredients or local anaesthetics.Viral infection (eg chicken pox, herpes etc).Bacterial or fungal skin infection which is not being treated.Caution in first 3 months of pregnancy.

DoseApply to the affected area twice daily after washing and drying. If severe symptoms, it can be applied up to four times on the first day of treatment only. Once the condition is controlled, application may be done once daily, up to a maximum treatment course of 7 days.

Side effectsAllergic skin reactions may occur.Thinning of skin may occur on prolonged use.

Patient InformationThe tube is for your own personal use. If the nozzle is used to apply the ointment to internal haemorrhoids it should be cleaned after each use.To aid recovery and help prevent recurrence of haemorrhoids you should eat a diet with plenty of fibre, drink plenty of water and take regular exercise.

References: BNF No 41, Scheriproct information leafletAugust 2001

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(xxxvi) SIMPLE LINCTUS

Pharmaceutical PresentationSugar free solution containing Citric Acid BP 114.29mg in 5ml.Also contains glycerol, sodium carboxymethylcellulose, sodium benzoate, saccharin sodium, lycasin, ethanol, anise oil, chloroform, natural red colour.

IndicationSymptomatic relief of dry irritating cough.

Contra-indicationKnown allergy to citric acid or any of the ingredients.May affect the absorption of oral steroids including the contraceptive pill.

Dose5ml up to 3-4 times a day.

Side effectsRare, allergic reactions have been recorded for saccharin and sodium benzoate. Excessive quantities may cause irritation or a deterioration of tooth enamel.

Patient InformationThis should soothe your cough. If symptoms persist or do not resolve, let your midwife know.

References: Simple Linctus information sheetAugust 2001

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(xxxvii) SODIUM CITRATE 0.3M SOLUTION

Pharmaceutical PresentationSolution for oral use containing sodium citrate 441.15mg per 5ml.Bottle should be used within 14 days of first opening.

IndicationProphylaxis of Mendelson’s Syndrome during cesarean section in conjunction with ranitidine tablets.

Contra-indicationKnown hypersensitivity to sodium citrate.Caution in cardiac disease, hypertension, renal impairment, people on a sodium-restricted diet, oedema, eclampsia and aldosteronism.

Dose30ml orally prior to transfer to theatre.

Side effectsMay have a laxative effect.

Patient InformationThis along with ranitidine tablets, alters the acidity of the stomach contents to reduce problems associated with anaesthesia.

References: Martindale 32nd edition, Sodium Citrate 0.3M information sheetAugust 2001

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(xxxviii)SYNTOMETRINE INJECTION

Pharmaceutical PresentationSolution containing ergometrine 500micrograms and oxytocin 5units in 1ml solution.

IndicationManagement of third stage of labour or to control bleeding after delivery.

Contra-indicationSensitivity to any of the contents, pregnancy and early labour, severe cardiovascular, pulmonary, hepatic or renal disease, eclampsia and pre-eclampsia, sepsis.Caution in mild/moderate hypertension, hepatic, cardiovascular or renal problems.

DoseManagement of third stage of labour – 1ml intramuscularly after shoulder delivered.Control of bleeding – 1ml intramuscularly.

Side effectsNausea, vomiting, abdominal pain, headache, dizziness or skin rashes may occur.

Patient InformationThis will help reduce the blood loss after the delivery of the baby.

References: BNF No 41, Syntrometrine data sheetAugust 2001

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(xxxix) TEMAZEPAM TABLET 10mg

Pharmaceutical PresentationRound white tablet containing temazepam 10mg.

IndicationShort term use in insomnia.

Contra-indicationKnown hypersensitivity to temazepam or any other ingredients, respiratory depression, severe hepatic impairment, myasthenia gravis, pulmonary insufficiency.

DoseOne 10mg tablet may be given each night, up until 02.00 in the morning.

Side effectsDrowsiness which may continue the next day, light headedness, confusion, ataxia, amnesia.

Patient InformationThis should help you sleep better, although the effects may persist during the next day. You should not drive whilst taking these tablets if you feel sleepy. They are for short term use only so will only be prescribed in hospital for you.


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standing orders for midwifes pgd-midwives2001

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