METHERGIN

Uterine stimulant:

Methylergonovine directly stimulates the uterine muscle to increase force and frequency of contractions. When usual doses of
methylergonovine are used, these contractions precede periods of relaxation; when larger doses are used, basal uterine tone is
elevated and these relaxation periods will be decreased. Contraction of the uterine wall around bleeding vessels at the placental site
produces hemostasis . The sensitivity of the uterus to the oxytocic effect is much greater toward the end of pregnancy.The oxytocic
actions of methylergonovine are greater than its vascular effects.
Other actions/effects:
Methylergonovine has minor actions on the central nervous system (CNS). {12} In the CNS, methylergonovine is a partial agonist
and partial antagonist at some serotonin and dopamine receptors. {12} Methylergonovine also possesses weak dopaminergic
antagonist actions in certain blood vessels {12} and partial agonist actions at serotonin receptors in umbilical and placental blood
vessels {12}. It does not possess significant alpha-adrenergic blocking activity.
Absorption: Absorption is rapid after oral (60%) and intramuscular (78%) administration

Onset of action:

Contraction of uterus, postpartum:

Oral: 5 to 10 minutes.
Intramuscular: 2 to 5 minute
Intravenous: Immediate.

Pregnancy/Reproduction
Pregnancy—
Methylergonovine is contraindicated during pregnancy. Tetanic contractions may result in decreased uterine blood flow and fetal
distress.
Labor and delivery—
High doses of methylergonovine administered prior to delivery may cause uterine tetany and fetal distress {11} {35}. Methylergonovine
should not be administered prior to delivery of the placenta {25}. Administration prior to delivery of the placenta may cause captivation
of the placenta or missed diagnosis of twin gestation, due to excessive uterine contraction
Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance
(reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).
Patient monitoring
Blood pressure determinations andPulse rate determinations andUterine response   (recommended at frequent intervals after
parenteral therapy to monitor for adverse reactions; especially important with intravenous administration or before repeating doses.

MEFENAMIC ACID

Pharmacology Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin
synthesis.
Indications and UsagE
Relief of moderate pain lasting less than 1 wk; treatment of primary dysmenorrhea.
Unlabeled Uses
Treatment of sunburn, migraine (acute attack), PMS.
Contraindications
Patients in whom aspirin, iodides, or any NSAID has caused allergic-type reactions; preexisting renal disease; active ulceration or
chronic inflammation of GI tract.
Dosage and Administration
Acute Pain
Adults and Children (14 yr or age and older)
PO 500 mg, followed by 250 mg every 6 h as needed. Usually not used more than 1 wk.
Primary Dysmenorrhea
Adults and Children (14 yr of age and older)
PO 500 mg, followed by 250 mg every 6 h starting with onset of bleeding and associated symptoms.
Storage/Stability
Store at room temperature (59° to 86°F) in tightly closed, light-resistant container.

CEFRADINE
Drug class Description :
Cephalosporins.
Drug description :
Capsules 250mg: Opaque, orange body with opaque blue cap printed Squibb and 113 in white on each half. Each capsule contains 250mg
cefradine. Capsules 500mg: Opaque blue printed in white with Squibb and 114 on each half. Each capsule contains 500mg cefradine. Syrup
250mg/5ml: When reconstituted contains 250mg cefradine per 5 ml.
Presentation :
Oral Capsules. Oral powder for reconstitution.
Indications :
In the treatment of infections of the urinary and respiratory tracts and of the skin and soft tissues. These include: Upper respiratory infections
- pharyngitis, sinusitis, otitis media, tonsillitis, laryngo-tracheo bronchitis. Lower respiratory infections
- acute and chronic bronchitis, lobar and bronchopneumonia. Urinary tract infections
- cystitis, urethritis, pyelonephritis. Skin and soft tissue infections
- abscess, cellulitis, furunculosis, impetigo.
Cefradine has been shown to be effective in reducing the incidence of postoperative infections in patients undergoing surgical procedures
associated with a high risk of infection. It is also of value where postoperative infections would be disastrous and where patients have a reduced
host resistance to bacterial infection. Protection is best ensured by achieving adequate local tissue concentrations at the time contamination is
likely to occur. Thus, cefradine should be administered immediately prior to surgery and continued during the postoperative period.
Bacteriology studies to determine the causative organisms and their sensitivity to cefradine should be performed. Therapy may be instituted prior
to receiving the results of the sensitivity test.
Adult Dosage :
Cefradine may be given without regard to meals.
Adults:
For urinary tract infections the usual dose is 500mg four times daily or 1g twice daily; severe or chronic infections may require larger doses.
Prolonged intensive therapy is needed for complications such as prostatitis and epididymitis. For respiratory tract infections and skin and soft
tissue infections the usual dose is 250mg or 500mg four times daily or 500mg or 1g twice daily depending on the severity and site of infections.
All patients, irrespective of age and weight
Larger doses (up to 1g four times daily) may be given for severe or chronic infections. Therapy should be continued for a minimum of 48-72
hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by haemolytic strains
of streptococci, a minimum of 10 days' treatment is recommended to guard against the risk of rheumatic fever or glomerulonephritis. In the
treatment of chronic urinary tract infections, frequent bacteriological and clinical appraisal is necessary during therapy and may be necessary for
several months afterwards. Persistent infections may require treatment for several weeks. Smaller doses than those indicated above should not be
used. Doses for children should not exceed doses recommended for adults. As cefradine is available in both injectable and oral form, patients may
be changed from the cefradine injectable to cefradine oral at the same dosage level.
Renal Impairment Dosage:
Patients not on dialysis:
The following dosage schedule is suggested as a guideline based on a dosage of 500mg Q6H and on creatinine clearance. Further modification in
the dosage schedule may be required because of the dosage selected and individual variation.
Special Precautions : There is evidence of partial cross-allergenicity between the penicillins and the cephalosporins. Therefore
cefradine should be used with caution in those patients with known hypersensitivity to penicillins. There have been instances of
patients who have had reactions to both drug classes (including anaphylaxis).
Dosage should be reduced in renal failure.
After treatment with cefradine, a false positive reaction for glucose in the urine may occur with Benedict's or Fehling's solution or
with reagent tablets such as Clinitest*, but not with enzyme-based tests such as Clinistix* or Diastix*.
As with all antibiotics, prolonged use may result in overgrowth of non-susceptible organisms.
Interactions :
Loop diuretics may increase nephrotoxicity of cephalosporins.
Probenecid has been seen to raise serum concentrations of cefradine, by reducing renal clearance of the cephalosporins..
Adverse Reactions :
Limited essentially to gastro-intestinal disturbances and on occasion to hypersensitivity phenomena. The latter are more likely to
occur in individuals who have previously demonstrated hypersensitivity and those with a history of allergy, asthma, hay fever or
urticaria. The majority of reported side-effects have been mild and are rare, and include glossitis, heartburn, dizziness, tightness in
the chest, headache, nausea, vomiting, diarrhoea, abdominal pain, vaginitis, candidal overgrowth. Skin and hypersensitivity
reactions include urticaria, pruritus, skin rashes, fever, athralgia and oedema.
As with other cephalosporins, there have been rare reports of erythema multiforme, Stevens Johnson Syndrome, anaphylaxis and
toxic epidermal necrolysis. Also, mild transient eosinophilia, leucopenia and neutropenia, rarely positive direct Coombs tests and
pseudomembraneous colitis have been reported.
Elevations of BUN and serum creatinine and reversible interstitial nephritis have been reported. Transient hepatitis and cholestatic
jaundice have been reported very rarely. Elevations of ALT, AST, total bilirubin and alkaline phosphatase have been observed.