Pharmacology and Safe Medication Practice in Midwifery
What this domain tests
Pharmacology and Safe Medication Practice in Midwifery tests the drugs a midwife actually handles - uterotonics, magnesium sulfate, antihypertensives, antenatal corticosteroids, anti-D and iron - including dose, route, contraindications, and the checking systems that prevent harm.
Core rules
- Five rights plus. Right patient (two identifiers), drug, dose, route and time, plus documentation and reason. High-alert medicines - oxytocin, magnesium sulfate, concentrated potassium, insulin, heparin - need an independent double-check and countersignature.
- Oxytocin. Induction or augmentation starting at 1–2 mU/min, titrated no faster than every 30 minutes; never given as an undiluted IV push. Stop for tachysystole (over 5 contractions in 10 minutes averaged over 30 minutes) with fetal heart change.
- Magnesium sulfate. Loading 4 g IV, maintained at 1 g/hour; antidote is calcium gluconate 1 g IV (10 mL of 10%) for respiratory depression.
- Antihypertensives. Labetalol 200 mg oral or 20 mg IV (avoid in asthma); hydralazine 5 mg IV over 5 minutes; nifedipine 10 mg oral. Target below 150/100.
- Corticosteroids. Betamethasone 12 mg IM twice, 24 hours apart, for 24–34 weeks; dexamethasone 6 mg IM every 12 hours for four doses.
- Anti-D. 300 µg IM at 28 weeks and within 72 hours of an Rh-positive birth, and after miscarriage, ectopic pregnancy, amniocentesis or abdominal trauma.
- Reporting. Document allergies and batch numbers for blood products and vaccines, and report adverse drug reactions through national pharmacovigilance.
Worked example
On oxytocin at 12 mU/min a woman has six contractions in 10 minutes with late decelerations. Stop the infusion, reposition left lateral, give an IV crystalloid bolus, check maternal pulse and BP, and consider terbutaline 250 µg subcutaneously if tachysystole persists. Inform the obstetrician and document the event and fetal recovery.
Traps that cost marks
Confusing milligrams with units of oxytocin; omitting the second betamethasone dose; giving carboprost to an asthmatic; charting a medicine before it is given.