Pharmacology and Safe Medication Practice in Midwifery
What this domain tests
This domain tests safe use of oxytocin, misoprostol, magnesium sulfate, antibiotics, anti-D immunoglobulin, tocolytics, and analgesics. Questions focus on indications, routes, monitoring, and high-alert checks.
Core rules
- Follow the five rights: right person, medicine, dose, route, and time. For high-alert medicines such as oxytocin and magnesium sulfate, use an independent double-check and a controlled infusion device.
- Oxytocin is given by controlled infusion for induction or augmentation. Never give an undiluted intravenous bolus. Monitor contraction frequency, fetal heart rate, and fluid balance.
- Magnesium sulfate is given for seizure prophylaxis or treatment. Monitor deep tendon reflexes, respiratory rate, urine output, and level of consciousness. Calcium gluconate is the antidote.
- Give anti-D immunoglobulin to Rh-negative unsensitised women after potentially sensitising events and postpartum according to local protocol, usually within 72 hours.
- Use antibiotics promptly in suspected maternal sepsis, chorioamnionitis, and preterm prelabour rupture of membranes.
- Document the medicine, dose, route, time, batch, and response.
Worked example
An oxytocin infusion contains 10 international units in 500 mL, which is 20 milli-international units per mL. At 60 mL per hour, the dose is 20 milli-international units per minute. Check the prescription, pump settings, contraction pattern, and fetal heart rate before increasing the rate. If contractions occur more than four in ten minutes, reduce or stop the infusion and reassess.
Traps that cost marks
Do not give oxytocin as a bolus. Do not use misoprostol with oxytocin without a clear protocol because of hyperstimulation risk. Do not give ergometrine to hypertensive women. Do not rely on maternal report alone for magnesium toxicity; check reflexes and respiration.
Key points
- Oxytocin must be given by controlled infusion, never as an undiluted bolus.
- High-alert medicines require an independent double-check.
- Monitor reflexes, respiration, and urine output during magnesium sulfate therapy.
- Calcium gluconate is the antidote for magnesium toxicity.
- Anti-D is usually given within 72 hours of a sensitising event.
- Document medicine, dose, route, time, and response.