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Rx age: 30 years Gender: female Diagnosis: HTN in pregnancy methyldopa T 500 mg bid lasix...

Rx

age: 30 years

Gender: female

Diagnosis: HTN in pregnancy

methyldopa T 500 mg bid

lasix T 40 mg, 1/2 tab od

valsartan 80 mg, 160 mg od

ferrous sulphate 200 mg , tid

Note: patient cannot tolerate ferrous sulphate.

according to this prescription find the mistakes, the interaction, dose of each medication , the toxicity level , antidotes and the counselling  for all medication

Solutions

Expert Solution

Hypertension is a common disorders during pregnancy. These are a major cause of maternal and perinatal morbidity and mortality.

Treatment includes prescribing drugs such as Methyldopa, labetalol, beta blockers, slow release nifedipine and a diuretic mainly thiazide group.

The dose of Methyldopa is 500mg to 3gm per day in 2 divided doses depending upon the blood pressure.

Diuretics such as Hydrochlorothiazide is prescribed in a dose of 12.5mg to 25mg per day.

Mistakes/Errors:

  1. Lasix 40mg containing Furosemide has be shown to cause unexplained maternal death. It should not be prescribed during pregnancy. It can be used in pregnancy only if the potential benefits justify the potential risk to the fetus.Thiazide diuretic like Hydrochlorothiazide is prescribed in HTN during pregnancy due to its low teratogenicity.   

  2. Valsartan 80mg, 160mg belongs to a class of medications called the angiotensin II receptor antagonists used to treat hypertension. Valsartan should never be taken while being pregnant as it leads to serious injury or death of the fetus.

  3. Ferrous sulfate is an iron supplement used to treat anemia. Maternal anemia increases the risk of premature delivery, low birth weight and impaired behavioral development. The recommended dose 300mg of ferrous sulfate per day.

Interactions:

Methyldopa and ferrous sulfate – Taking these two medications together will decrease the body’s ability to absorb methyldopa.

Dose:

  • The dose of Methyldopa is 500mg to 3gm per day in 2 divided doses depending upon the blood pressure.
  • Diuretics such as Hydrochlorothiazide is prescribed in a dose of 12.5mg to 25mg per day.
  • Ferrous sulfate is prescribed at dose of 300mg per day.

Antidotes:

Methyldopa – There is no antidote for methyldopa

Lasix- There is no antidote.

Valsartan- There is no antidote.

Ferrous sulfate - IV Deferoxamine in severe cases.

Counselling:

1. Methyldopa

  • Used to treat hypertension.
  • Side effects include fatigue, headache, and mild edema.
  • Get immediate medical help if you experience the following – bleeding, shortness of breath, swelling of arms and legs, and severe dizziness.
  • Avoid getting up quickly from a sitting or lying position.
  • Do not stop taking the medication until and unless stopped by the doctor.

2. Lasix

  • Take the medication as prescribed by the doctor.
  • If you miss a dose, take it as soon as possible. Do not double the missed dose with the next dose.
  • Follow the instructions on daily fluid requirement while taking Lasix.
  • Do not stop taking the medication until and unless stopped by the doctor.

3. Valsartan

  • Take the medication as prescribed by the doctor.
  • If you miss a dose, take it as soon as possible. Do not double the missed dose with the next dose.
  • Do not consume alcohol while on Valsartan.
  • Do not use potassium supplements.
  • Do not move rapidly as it may cause dizziness.

4. Ferrous sulfate

  • Take the medication on empty stomach preferably 1 to 2 hours before food.
  • Do not take antacids or antibiotics within 2 hours of taking ferrous sulfate.
  • Do not crush, break or chew the extended release tablet or capsule.

Nightingale answered 2 years ago
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