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Important MCQ colloction for part-1 MRCOG(4)

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Important MCQ colloction for part-1 MRCOG(4)

Post by drsaima2000 on Sun Jul 17, 2011 12:07 am

118. The following micro-organisms are generally sensitive to Benzylpenicillin:


A- Streptococcus Pneumonaie ..........................................................T

B- Cryptococcus neoformans ...........................................................F

C- Bordetella pertussis ....................................................................F

D- Streptococcus viridans .................................................................T

E- Mycoplasma pneumoniae .............................................................F

Penicillin binds to specific penicillin-binding proteins (PBP's) in the cell wall, mainly of gram positive organisms. Penicillin resistance is usually due to production of altered PBPs or beta-lactamases which leave the penicillin molecule. Penicillin is mainly useful for Group A Strep., Group B Strep., meningococcal and pneumococcal infections, though and anthrax are also sensitive. Pneumococci with modified PBPs are an increasing problem.

119. Regarding the capsulated bacteria:

A- Meningococci are carried by farm animals .....................................F

B- Streptococcus pneumoniae produces a -haemolysis when cultured on blood agar ....................T

C- Neisseria species are Gram positive ..............................................F

D- Escherichia coli carries V antigens which allow serotyping .....................F

E- Neisseria lactamica and Neisseria meningitidiscan be differentiated on the basis of carbohydrate utilisation ................T


The meningococcus (Neisseria meningitidis) is carried by humans – up to 20% of the population. S. pneumoniae is a-haemolytic, giving green (partial) haemolysis on blood agar culture, and is differentiated from other a-haemolytic streptococci by sensitivity to optochin. Neisseria species are Gram negative cocci E.coli are subtyped on the basis of O antigens (cell envelope antigens), H (flagellar antigens) and in some K (cpasular) antigens

120. Physiological effects of metoclopramide include:

A- stimulates upper gastrointestinal motility ........................................T

B- increases gastric acid secretion .....................................................F

C- increases gastric fluid pH ..............................................................F

D- acts on central dopaminergic receptors ..........................................T

E- increases gastroesophageal sphincter tone .....................................T



Metoclopramide causes increased GI motility, increases sphincter tone and also has central antiemetic actions mediated through dopaminergic receptors.

121. The thyroid gland

A- lies posterior to the parathyroid glands ...........................................F

B- is closely related to the internal carotid artery .................................F

C- is histologically composed of papillae ............................................F

D- normally weighs 100 grams .........................................................F

E- internalises iodine through active transport ....................................T




The parathyroids lie posteriorly to the thyroid gland and the recurrent laryngeal nerves lie posteromedially. The gland is composed of follicles and iodine is internalised by an active transport system - the iodide symporter. The normal weight of the gland is approximately 30 grams.

122. The following are known complications of Phenytoin therapy:

A- Ataxia .........................................................................................T

B- Hirsutism ....................................................................................T

C- Alopecia .....................................................................................F

D- Dental caries ..............................................................................F

E- Megaloblastic anaemia .................................................................T

Gingival hypertrophy and tenderness as well as coarse facial features and hirsuitism may occur. Haematological side effects include megaloblastic anaemia, aplastic anaemia, thrombocytopaenia. Neurological side effects include peripheral neuropathy, ataxia, and rarely nystagmus and dyskinesias as well as granulocytosis. Eye involvement may occur in cases of overdosages including blurred vision and nystagmus. Cataracts are not associated with phenytoin use

.
123.The following are recognised carcinogens

A- nicotine .......................................................................................F

B- electromagnetic microwaves ........................................................F

C- Infra-red radiation .......................................................................F

D- beta-naphthylamine ....................................................................T

E- Arsenic ........................................................................................T




Nicotine is not a carcinogen, it is the hydrocarbons/tar in the smoke that predisposes to carcinoma. Naphthas are associated with bladder tumours. Arsenic may predispose to skin cancers as does UV radiation (not infra -red). There is no demonstrable association between infra-red waves and risk of malignancy .

124.
Antimicrobial agents effective against Pseudomonas aeruginosa infections include:

A- gentamicin ..................................................................................T

B- flucloxacillin .................................................................................F

C- cephalexin ...................................................................................F

D- carbenicillin .................................................................................T

E- metronidazole .............................................................................F



others ceftazidime + ciprofloxacin

125. Which of the following are classed as loop diuretics:

A- Metolazone .................................................................................F

B- Spironolactone ............................................................................F

C- Furosemide ................................................................................T

D- Bumetanide ................................................................................T

E- Triameterne .................................................................................F




Loop diuretics are so called as they inhibit reabsorption of sodium and hence water from the ascending limb of the loop of Henle. They are therefore potent diuretics and include Bumetanide, Furosemide (Furosemide) and Torasemide. Metolazone and Bendroflumethiazide are thiazide diuretics whilst Triameterene, Amiloride and Spironolactone are potassium sparing diuretics and act on the distal convoluted tubule.

126. Benzyl penicillin

A- can be administered orally ...........................................................F

B- undergoes first pass hepatic metabolism .....................................F

C- is an effective treatment for cellulitis .............................................T

D- is an effective treatment for spontaneous bacterial peritonitis .........F

E- is effective against Clostridium Tetani ............................................T



Benzyl Penicillin (Penicillin G) is inactivated by gastric acid and so must be given parenterally (unlike penicillin V). It is an effective treatment for strep infections eg cellulitis and is also effective for tetanus. It is not appropriate for SBP where thrid generation cephalosporins are advocated.

127. Aminoglycosides:

A- are active against streptococcus ....................................................T

B- acts on the bacterial cell wall ........................................................F

C- are useful against anaerobes ........................................................F

D- should not be used in patients with renal failure .............................F

E- damages the cochlear nerve ........................................................T




These antibiotics are derived from Streotomyces spp. and are active against streptococcal species. They interrupt bacterial protein synthesis by inhibiting ribosomal function. Anaerobes produce phosphorylating adenylating or acetylating enzymes that inactivate aminoglycoside antibiotics. Aminoglycosides are nephrotoxic but this is a dose-related effect. Blood levels must be checked and caution taken with other nephrotoxic agents

This is a group of antibacterial antibiotics that are derived from the various species of Streptomyces, in which case they have the spelling -mycin, and micromonospora in which case the spelling is -micin.
They act by binding to the 30S ribosome and preventing proper functioning by leading to misreading of tRNA.
Included in this group are gentamicin and streptomycin.
Side effects include:
• aminoglycosides may cause vertigo
• streptomycin may cause nerve deafness

128. The following drugs have anti-cholinergic effects:

A- Propantheline bromide ..................................................................T

B- Carbachol ....................................................................................F

C- Distigmine bromide ......................................................................F

D- Benzhexol ....................................................................................T

E- Atropine ........................................................................................T




Carbachol has cholinergic properties and Distigmine is an acetylcholine esterase. The others all have anticholinergic effects.

129. Warfarin metabolism may be inhibited by

A- Oral contraceptive .......................................................................F

B- Omeprazole .................................................................................T

C- Aspirin ........................................................................................F

D- Rifampicin ...................................................................................F

E- Metronidazole ..............................................................................T



The anti-coagulant effects of warfarin may be exacerbated through the inhibition of its metabolism by cytoP450. Omeprazole, Metronidazole, cimetidine and amiodarone may all do this and so INR should be carefully monitored. However, Rifampicin induces P450 and so would reduce the anticoagulant effects of Warfarin (as may other inducers of P450 such as some anticonvulsants). Oestrogen may reduce the anticoagulant effect independently of P450.

130. Vancomycin-resistant enterococci:

A- cause resistant infective diarrhoea ................................................F

B- produce an enzyme that inactivates vancomycin .............................F

C- may be found in healthy community volunteers not recently hospitalized ................T

D- high dose ampicillin is the treatment of choice ................................F

E- are commonly vancomycin-dependent ...........................................F




a-When they cause clinical problems they are usually UTI, bacteraemia, wound infections, neonatal infections, endocarditis etc. b-They alter peptidoglycan precursors used to build cell walls. Vancomycin binds to D-ala-D-ala but the resistant enterococci have D-ala-D-lac or D-ala terminating precursors. They aquire genes that produce enzymes to change the precursors. c-2% in UK general practice, 28% in Belgium. Community reservoir in meat, poultry and ?cheese. d-only if the MIC of ampicillin is not too high. Anecdotal evidence exists for its use in E. faecalis endocarditis. (20g / day) e-Some strains only. An explanation for this curious process is that there is an inability to produce cell walls because the vancomycin-sensitive precursor genes have been turned off and the resistant ones only appear in the presence of vancomycin.

131. Listeria monocytogenes:

A- Can grow at 6°C ..........................................................................T

B- Is a gut commensal ......................................................................T

C- Is a Gram negative bacillus ..........................................................F

D- Infections is best treated with benzyl penicillin ...............................F

E- Is a cause of septicaemia in neonates ...........................................T




Listeria can survive in temperatures of 4°C - 60°C. It is found in the intestinal tract of animals and humans, milk, leaf vegetables, processed foods and soil. It is a gram positive bacilli. It can be treated with ampicillin, trimethoprim or chloramphenicol. Listerosis in late pregnancy can give rise to septicaemia in neonates.

132. The following drugs can cause bronchoconstriction:

A- Propranolol ..................................................................................T

B- Atropine.......................................................................................F

C- Morphine ....................................................................................T

D- Ritodrine .....................................................................................F

E- Aspirin .......................................................................................T


These bronchoconstrictors act in the following manner - Propranolol by being a beta blocker and Morphine causes histamine release. Aspirin induced bronchoconstriction is thought to be due to shunting of arachidonic acid into the lipo-oxygenase pathway or removal of cyclo-oxygenase product which prevent bronchospasm. Ritodrine is a beta sympathomimetic and atropine is an anticholinergic agent that causes bronchodilation.

133. Which of the following is/are a selective oestrogen receptor modulator (SERM)?

A- Cyproterone acetate ....................................................................F

B- Tibolone ......................................................................................F

C- Tamoxifen .................................................................................T

D- Raloxifene ..................................................................................T

E- Metformin ...................................................................................F



Cyproterone acetate is a progestogen and a constituent of the OCP dianette. Both Tamoxifen and Raloxifene are SERMs with both agonist and anatagonist action on the varying oestrogen receptors. Metformin is a biguanide and insulin sensitiser used in diabetes, but more recently as an effective treatment in PCOs. Tibolone is an oestrogen agonist.

134. Opsonization:

A- Enhances phagocytosis..................................................................T

B- Is mediated by certain complement components............................T

C- Does not involve immunoglobulins.................................................F

D- May utilize fibronectin...................................................................T

E- Is MHC restricted..........................................................................F




a) Phagocytosis, though possible in a saline medium, is enhanced in the presence of fresh serum. This is due to substances called opsonins. b) Opsonins include C3b, for which phagocytic cells possess a receptor. c) Immunoglobulins, especially IgG1 and IgG3, for the Fc portion of which phagocytic cells possess receptors, are potent opsonizing agents. d) Fibronectin acts as a glue for neutrophil-target interaction. It is a glycoprotein. e) Opsonization is not MHC-restricted.

Mechanism

Both the membrane of a phagocytosing cell, as well as its target, have a negative charge (zeta-potential), making it difficult for the two cells to come close together. During the process of opsonization (alternatively opsonisation), antigens are bound by antibody and/or complement molecules. Phagocytic cells express receptors, CR1 and Fc receptors, that bind opsonin molecules, C3b and antibody, respectively. With the antigen coated in these molecules, binding of the antigen to the phagocyte is greatly enhanced. Most phagocytic binding cannot occur without opsonization of the antigen.

Furthermore, opsonization of the antigen and subsequent binding to an activated phagocyte will cause increased expression of complement receptors on neighboring phagocytes.



Examples
Examples of opsonin molecules include:

antibodies: IgG and IgA
components of the complement system: C3b, C4b, and iC3b
Mannose-binding lectin (initiates the formation of C3b)
The most important are IgG and C3b

135. Octreotide:

A- is a somatostatin analogue ............................................................T

B- is an effective treatment for Cushing's syndrome ............................F

C- is an effective treatment for carcinoid syndrome .............................T

D- is used in the treatment of polycystic ovarian syndrome ..................F

E- is associated with the development of biiary calculi ..........................T




Octreotide is a somatostatin analogue that is used in the treatment of acromegaly (not diagnosis which is the oral glucose tolerance test), carcinoid syndrome and also in the acute treatment of oesophageal varices. Side effects include biliary stasis and hence biliary calculi.

is an octapeptide that mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone.


Pharmaceutical Effects

Since octreotide resembles somatostatin in physiological activities, it can:

Inhibit secretion of many hormones, such as gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin, pancreatic polypeptide, TSH, and vasoactive intestinal peptide.
Reduce secretion of fluids by the intestine and pancreas.
Reduce gastrointestinal motility and inhibit contraction of the gallbladder.
Inhibit the action of certain hormones from the anterior pituitary.
Cause vasoconstriction in the blood vessels.
It has also been shown to produce analgesic effects, most probably acting as a partial agonist at the mu opioid receptor

136. Which of the following may produce severe hyperkalaemia in combination:

A- Lisinopril and spironolactone .........................................................T

B- Furosemide and Amiloride ............................................................F

C- Propranolol and verapamil ...........................................................F

D- Aspirin and allopurinol .................................................................F

E- Losartan and amiloride .................................................................T




The combination of ACE inhibitors/Angiotensin blockers with potassium sparing diuretics such as spironolactone and amiloride may produce dangerous hyperkalaemia. Amiloride is often given with Furosemide (co-amilofruse) to replete potassium stores. Propranolol is not given with verapamil due to the induction of severe bradycardia

137. Diazepam

A- has a hypnotic effect ....................................................................T

B- has an anticonvulsant effect ..........................................................T

C- has an antidepressant effect..........................................................F

D- is a respiratory depressant ...........................................................T

E- effects may be antagonised by naloxone ........................................F


Diazepam is a benzodiazepine and acts as a hypnotic, amnesic and anticonvulsnat through agonism at the cerebral GABA receptors. It may cause respiratory depression and these effects can be antagonised by Flumazenil

138. Labetalol:

A- Has alpha blocking action ..............................................................T

B- Causes bronchodilation ................................................................F

C- Decreases bile secretion ..............................................................T

D- Is 70% protein bound ..................................................................F

E- Has a half-life of 2 hours ...............................................................F





Labetalol is a combined beta and alpha adrenergic receptor antagonist with a ratio of activity between 2:1 and 5:1 respectively. It is selective for alpha-1 receptors but is non-selective for beta receptors. It is used to treat severe hypertension and pre-eclampsia and in hypotensive anaesthesia. Labetalol has a half-life of approximately four hours (not 2) and is approximately 50% protein bound. It has been shown to cross the placental barrier, but not the blood brain barrier. It is metabolised in the liver and excreted in the urine and faeces. Oral administration of the drug undergoes extensive first-pass metabolism. Severe hepatocellular damage has been reported after both short and long term use and the reduction of bile secretion may rarely lead to jaundice.

139. Typical adverse effects of combined oral contraceptive preparations include:

A- Migraine ......................................................................................T

B- Hyperprolactinaemia ....................................................................F

C- Depression .................................................................................T

D- Breast tenderness ........................................................................T

E- Loss of libido ................................................................................F


Headaches
Nausea
Breakthrough bleeding
Breast tenderness
Mood changes
Weight gain
Dizziness
Amenorrhea

140. Metformin:

A- stimulates the release of insulin from the beta cells of the pancrease ..........F

B- therapy is associated with lactic acidosis...............................................T

C- therapy reduces prolactin concentrations in polycystic ovarian syndrome .............F

D- therapy improves the rate of conception in polycystic ovarian syndrome ............T

E- therapy causes hypoglycaemic events ............................................F



Metformin is a bigunaide and acts to improve insulin sensitivity through improving hepatic and muscular glucose utilisation. PCOs is associated with increased insulin resistance and conception, oligomennorrhoea and hirsutism may be improved thorugh metformin. Side effects include lactic acidosis (rarely) and it should not be used in subjects whose creatinine clearance is above 130 micromol/l or heart failure. As it improves insulin sensitivity it is not per se associated with hypoglycaemia.

141. Co-trimoxazole:

A- Contains two different drugs ............................................................T

B- Inhibits folic acid synthesis ............................................................T

C- Potentiates the action of warfarin ..................................................T

D- Is bacteriostatic ................................................................................F

E- Displaces methotrexate from protein binding sites ...................................T



Combination of sulphonamide and trimethorpim, with synergistic bactericidal effect through inhibition of folic acid synthesis. It potentiates the effects of warfarin (like erythromycin, isoniazid) and the sulphonamide component can displace methotrexate from its plasma protein binding site.

142. Metronidazole

A- Is effective against Giardia lamblia .................................................T

B- Is effective when administered per rectum ......................................T

C- Should not be administered intravenously .......................................F

D- Is usually effective against Entamoeba histolytica ............................T

E- Interferes with ethanol metabolism .................................................T

Metronidazole is effective for treating against infections with protozoa such as Trichomonas vaginalis, ameba, and giardia. It also is effective against anaerobic bacterial infections. It can be administered rectally and can cause a ‘disulfiram-like’ reaction when taken with alcohol.


Indications

Systemic metronidazole is indicated for the treatment of:


Bacterial

Bacterial vaginosis, commonly associated with overgrowth of Gardnerella species and coinfective anerobes (Mobiluncus, Bacteroides), in symptomatic patients
Pelvic inflammatory disease in conjunction with other antibiotics such as ofloxacin, levofloxacin, or ceftriaxone
Anaerobic bacterial infections such as Bacteroides fragilis, spp, Fusobacterium spp, Clostridium spp, Peptostreptococcus spp, Prevotella spp, or any other anaerobes in intra-abdominal abscess, peritonitis, empyema, pneumonia, aspiration pneumonia, lung abscess, diabetic foot ulcer, meningitis and brain abscess, bone and joint infections, septicemia, endometritis, tubo-ovarian abscess, or endocarditis
Pseudomembranous colitis due to Clostridium difficile
Helicobacter pylori eradication therapy, as part of a multi-drug regimen in peptic ulcer disease


Protozoal

Vaginitis due to Trichomonas vaginalis infection in both symptomatic patients as well as their asymptomatic sexual contacts - always consult the GP and contact all previous partners
Protozoal infections due to Entamoeba histolytica (Amoebic dysentery or Hepatic abscesses), and Giardia lamblia (Giardiasis) should be treated alone or in conjunction with iodoquinol or diloxanide furoate
With amphotericin B and certain other drugs, it is used as an adjunct in the attempted treatment of primary amoebic meningoencephalitis caused by Naegleria fowleri infection of the bowels


Nonspecific



Prophylaxis for those undergoing potentially contaminated colorectal surgery or appendectomies and may be combined with neomycin
Acute gingivitis and other dental infections (TGA approved, non-Food and Drug Administration (FDA) approved)
Crohn's disease with colonic or perianal involvement (non-FDA approved)- believed to be more effective in combination with ciprofloxacin
Topical metronidazole is indicated for the treatment of rosacea, and in the treatment of malodorous fungating wounds

143. Which of the following antihypertensives are ACE inhibitors

A- Verapamil ....................................................................................F

B- Propranolol ..................................................................................F

C- Lisinopril .....................................................................................T

D- Ramipril ......................................................................................T

E- Losartan ......................................................................................F


Verapamil is a calcium antagonist and propanolol a beta blocker. Lisinopril, Trandolapril, Ramipril, Enalapril and Captopril are ACE inhibitors . Losartan like Irbesartan and Eprosartan are Angiotensin receptor blockers.

144. The following compounds are predominantly progestogens:

A- Buserelin .....................................................................................F

B- Dydrogesterone ...........................................................................T

C- Norethisterone .............................................................................T

D- 17 Alpha Hydroxyprogesterone .....................................................T

E- Androstenedione ..........................................................................F




Progestogens are a subclass of sex steroid with key effects on preparing the female genital tract for reception of fertilized ovum and maintenance of pregnancy. Progestogens include dydrogesterone, cyproterone acetate, norethisterone, medroxyprogesterone, norgestrel and of course 17OHP. Androstenedione is an androgen and Buserelin is a LHRH analogue.

145. The following substances are sympathomimetic amines:

A- Amphetamines .............................................................................T

B- Ephedrine ...................................................................................T

C- Histamine ...................................................................................F

D- Isoprenaline ...............................................................................T

E- Chlorpromazine ...........................................................................F



Sympathomimetic amines include Ephedrine, Amphetamine and isoprenaline. Histamine is a vasoactive amine. Chlorpromazine is an antipsychotic belonging to the phenothiazine class of drug

146. Lidocaine:

A- inhibits the uptake of sodium into nerve cell membranes ...................T

B- has a local vasodilatory effect ........................................................T

C- toxicity should be suspected if the patient develops slurred speech ............T

D- is an alkaline solution ...................................................................T

E- 1% solution contains 1 g of lidocaine in 100 ml fluid ................................T




Lidocaine blocks fast sodium channels.
Most local anaesthetics, with the exception of cocaine, cause dilation of blood vessels.
Toxic effects associated with local anaesthetics usually result from excessively high plasma concentrations. Other signs of toxicity include inebriation and lightheadedness followed by sedation, circumoral paraesthesia and twitching.
Lidocaine is an alkaline solution and the pH of the surrounding tissues influences both the pharmacokinetics and pharmacodynamics of lidocaine.
0.5% solution = 5mg/ml ( 1% solution = 10mg/ml ( 100ml of solution = 1000mg or 1g of lidocaine.



is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic, and in minor surgery

Anesthesia

Lidocaine alters depolarization in neurons, by blocking the fast voltage gated sodium (Na+) channels in the cell membrane With sufficient blockade, the membrane of the presynaptic neuron will not depolarize and so fail to transmit an action potential, leading to its anaesthetic effects. Careful titration allows for a high degree of selectivity in the blockage of sensory neurons, whereas higher concentrations will also affect other modalities of neuron signaling


Indications

Topical lidocaine has been shown to relieve postherpetic neuralgia in some patients, though there is not enough study evidence to recommend it as a first-line treatment. It also has uses as a temporary fix for tinnitus. Although not completely curing the illness, it has been shown to reduce the effects by around two thirds .

Contraindications for the use of lidocaine include:

Heart block, second or third degree (without pacemaker) .
Severe sinoatrial block (without pacemaker) .
Serious adverse drug reaction to lidocaine or amide local anaesthetics .
Concurrent treatment with quinidine, flecainide, disopyramide, procainamide (Class I antiarrhythmic agents) .
Prior use of Amiodarone hydrochloride .
Hypotension not due to Arrhythmia .
Bradycardia .
Accelerated idioventricular rhythm .
Pacemaker .
147. Which of the following is/are true regarding Tramadol:

A- is an opioid receptor agonist with a higher affinity for the delta receptor ....................F

B- acts on peripheral receptors .......................................................................F

C- is a neuronal noradrenaline reuptake inhibitor ...........................................T

D- decreases serotonin release ..........................................................F

E- is secreted in breast milk ...............................................................T



Tramadol is a commonly used, centrally-acting opioid analgesic. It is a non-selective pure agonist at mu, delta and kappa receptors with a higher affinity for the mu receptor. Other mechanisms which contribute to its analgesic effect are inhibition of neuronal reuptake of noradrenaline and enhancement of serotonin release. Small quantities of Tramadol and its metabolites are found in human breast milk.

Tramadol ......... is a centrally acting analgesic, used for treating moderate to severe pain. It is a synthetic opioid and it appears to have actions at the μ-opioid receptor as well as the noradrenergic and serotonergic systems .

148. Metronidazole:

A- Inhibits dihydrofolate reductase......................................................F

B- Has 80% bioavailability if given rectally...........................................T

C- Discolours the urine......................................................................T

D- Causes peripheral neuropathy.......................................................T

E- Has 80% bioavailability if given rectally .........................................T

149.
Which of the following are Tocolytic:

A- Salbutamol ..................................................................................T

B- Suxamethonium ...........................................................................F

C- Propofol ......................................................................................F

D- Progesterone ...............................................................................T

E- GTN .............................................................................................F


These are drugs that inhibit uterine contractions.

1- Beta-sympathomimetics ;
Action

Relaxation of the smooth muscle fibres by stimulating the beta receptors present on the cell membrane.
Examples:

**Ritodrine (Yutopar):
Side effects

Maternal:
Tachycardia,
hypotension (relaxation of the smooth muscle fibres in the blood vessels wall),
flushing,
sweating
nausea,
vomiting,
headache,
anxiety,
tremors,
hyperglycaemia,
hypokalaemia,
acidosis and
pulmonary oedema.
Foetal:
Tachycardia,
arrhythmia,
loss of beat-to-beat variation,
neonatal hypotension and hypoglycaemia.

Contraindications
Heart disease.
Hypertension or hypotension.
Hyperthyroidism.
Antepartum haemorrhage (dilatation of the uterine arteries may increase the bleeding).
Diabetes. [/b][/i]

2- β-sympathomimetic drugs

Example .......
**Terbutaline,
**Isoxuprine (Duvadilan - vasoxiprine) 20 mg 3-4 times daily.
**Salbutamol.


3- Calcium Antagonists ;
Action: Antagonise the action of calcium within the myometrial cells so reduce its contractility.

** Nifedipine 10 mg oral tablet.


4- Magnesium Sulphate

Action: The intracellular calcium is displaced by magnesium ion leading to inhibition of the uterine activity.


5- Prostaglandin Inhibiting Agents

Action: Inhibition of uterine contractions by inhibiting prostaglandin synthesis.

Dosage: e.g. indomethacin 100 mg suppository initially, followed by 25 mg orally every 6 hours for up to 24 hours after contractions ceased.



6- Ethyl Alcohol :

Action

Inhibits the release of oxytocin from the posterior pituitary gland.
Suppresses the myometrial activity directly.
Inhibits prostaglandin F2 a synthesis.
Dosage

It is given IV and the dose is adjusted to maintain blood alcohol level of 0.9-1.6 mg/litre.

Side effects
Nausea, vomiting and depression.
Drunken mother and foetus.
Maternal and foetal acidosis.

150.

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