Fundamentals of Pharmacology for Midwives

Ian Peate, OBE, FRCN, Senior Lecturer Roehampton University; Visiting Professor of Nursing, St George’s University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor-in-Chief of the British Journal of Nursing. Cathy Hamilton, RGN, RM, PgDip, PGCert, MSc, is a Principal Lecturer and Lead Midwife for Education, University of Hertfordshire.

Contributors xix

Preface xxi

Acknowledgements xxiii

How to Use Your Textbook and the Companion Website xiii

Part I Essentials of pharmacology 1

Chapter 1 Introduction to pharmacology 3
Jenny Brewster

Aim 3

Introduction 3

Pharmacology 4

Nursing and Midwifery Council (NMC) 4

Medicines optimisation 6

Embryology 6

The use of medicines in pregnancy 7

Pre- existing conditions 9

Occupational exposure 10

Drugs used in labour 10

Breast feeding 11

Conclusion 12

Glossary 12

Test yourself 12

References 12

Further reading 14

Chapter 2 How to use pharmaceutical and prescribing reference guides 15
Kirsty Fishburn and Andrea Hilton

Aim 15

Introduction 16

British National Formulary and British National Formulary for Children 16

Drug tariff 20

Electronic medicines compendium (eMC) 20

Medicines and Healthcare products Regulatory Agency 21

National Institute for Health and Care Excellence 22

UK teratology information service 23

Conclusion 24

Glossary 24

Test yourself 25

References 25

Chapter 3 Legal and ethical issues 27
Hema Turner

Aim 27

Introduction 27

The law 28

Ethical principles 32

Consent for treatment: adults 34

Research 37

Conclusion 38

Test yourself 39

References 39

Chapter 4 Medicines management 42
Rebecca Murray

Aim 42

Introduction 42

Medicines management and optimisation 43

Medicines regulations 44

The ‘rights’ of medicines administration 45

Medication errors 48

Self- administration of medicines 48

Storage and disposal of medicines 48

Student midwives 49

Conclusion 49

Glossary 50

Test yourself 50

References 50

Further reading 51

Part 2 Introduction to pharmacology 53

Chapter 5 Pharmacodynamics and pharmacokinetics 55
Barry Hill and Claire Leader

Aim 55

Introduction 55

Regulatory bodies 56

Teratogenesis and Fetotoxicity 56

Pharmacokinetics 57

Pharmacodynamics 67

Conclusion 75

Test yourself 75

References 75

Chapter 6 Formulations 77
Sinéad McKee and Cathy Hamilton

Aim 77

Introduction 77

Oral route of administration 78

Topical route of administration 81

Transdermal route of administration 83

Inhalation route of administration 85

Injection route of administration 86

Conclusion 88

Glossary 89

Test yourself 89

References 89

Further reading 91

Chapter 7 Adverse drug reaction 92
Cathy Hamilton

Aim 92

Introduction 92

Classification of ADR 93

Recognising an ADR 94

Predisposing factors for ADRs 94

Physical signs and symptoms of ADR 96

Management of a suspected ADR 96

Reporting ADRs 98

Conclusion 100

Glossary 101

Test yourself 101

References 101

Chapter 8 Analgesics 103
Iñaki Mansilla

Aim 103

Introduction 103

Physiological changes in pregnancy and the puerperium that may require pain management 104

Pain transmission during pregnancy, labour and puerperium 105

Pain management 106

Non- pharmacological approach to analgesia 113

Pharmacological approach to analgesia 113

Pharmacological analgesia provided by an anaesthetist and monitored by midwives 115

Postnatal analgesia 116

Conclusion 117

Glossary 117

Test yourself 117

References 117

Chapter 9 Antibiotics and antibacterials 121
Amanda Waterman

Aim 121

Introduction 121

Terminology and differences between micro- organisms 122

Antibiotic resistance and the global impact 123

Antibacterial stewardship programme 123

Bacteria 124

Prescribing 133

Conclusion 138

Glossary 139

Test yourself 139

References 140

Further reading 143

Part 3 Medications used during pregnancy and childbirth 145

Chapter 10 Medications used in labour 147
Chin Swain

Aim 147

Introduction 147

Uterotonic drugs 148

Epidural 156

Spinal anaesthesia 158

Documentation 159

Conclusion 159

Find out more 159

Glossary 160

Test yourself 161

References 161

Chapter 11 Medications and the cardiovascular system 163
Carl Clare

Aim 163

Introduction 163

Cardiac disease and pregnancy 164

Antiarrhythmic drugs 165

Antihypertensive drugs 172

Fibrinolytics 173

Cardiomyopathy 175

Hyperlipidaemia 178

Breast feeding 178

Conclusion 178

Find out more 178

Glossary 179

Test yourself 179

References 180

Further reading 180

Chapter 12 Medications and the renal system 181
Sam Bassett

Aim 181

Introduction 182

Anatomy and physiology of the renal tract 182

Physiological changes to the renal system during pregnancy 183

Common renal conditions in pregnancy 184

Specific conditions and their management 191

Conclusion 199

Find out more 199

Glossary 199

Test yourself 200

References 200

Chapter 13 Medications and diabetes 202
Carl Clare and Celia Wildeman

Aim 202

Introduction 202

Physiology 203

Pathophysiology 205

Signs and symptoms 205

Diagnosis and investigations 206

Treatment of diabetes 208

Care of the woman during pregnancy in the presence of pre- existing diabetes 212

Blood glucose monitoring in diabetes 214

Diabetic emergencies 217

Diabetes and birth 218

Conclusion 219

Find out more 219

Glossary 219

Test yourself 220

References 220

Further reading 221

Chapter 14 Medications and respiration 222
Helen McIntyre

Aim 222

Introduction 222

Asthma 223

Chronic obstructive pulmonary disease 225

Tuberculosis 229

Influenza 232

Pneumonia and COVID- 19 232

Pulmonary embolism 234

Cystic fibrosis 235

Human immunodeficiency virus 236

Find out more 236

Glossary 236

Test yourself 237

References 237

Chapter 15 Medications and the gastrointestinal system 239
Debbie Gurney

Aim 239

Introduction 239

Nausea and vomiting in pregnancy 240

Heartburn 243

Constipation 247

Irritable bowel syndrome 249

Diarrhoea 250

Anorectal conditions 250

Conclusion 252

Find out more 253

Glossary 253

Test yourself 254

References 254

Further reading 255

Chapter 16 Medications and nutritional supplementation 256
Cathy Ashwin

Aim 256

Introduction 257

Assessing the needs of the woman 257

Folic acid 257

Iron 259

Vitamin D and calcium 262

Vitamin B12 262

Vitamin A 263

Vitamin B6 264

Vitamin E 264

Vitamin K 265

Zinc 266

Magnesium 266

Herbal and integrative supplementation and therapies 266

Factors affecting adequate vitamin and mineral intake during pregnancy 268

Conclusion 268

Find out more 268

Glossary 269

Test yourself 269

References 270

Further reading 271

Chapter 17 Medications and the nervous system 272
Cathy Hamilton

Aim 272

Introduction 273

Headache and migraine 273

Epilepsy 275

Conclusion 284

Find out more 285

Glossary 285

Test yourself 285

References 285

Chapter 18 Medications and mental health 288
Emmanuel Ndisang

Aim 288

Introduction 288

Medications and mental health presentations 289

Psychotropic medication in the perinatal period 292

Psychotropic medications and lactation 297

Conclusion 298

Glossary 299

Test yourself 299

References 299

Further reading 301

Chapter 19 Medications and the immune system 302
Janet G. Migliozzi and Cathy Hamilton

Aim 302

Introduction 302

Immunity 303

Vaccines 304

Conclusion 314

Find out more 314

Glossary 315

Test yourself 315

References 316

Chapter 20 Medications and breast feeding 318
Deborah Sharp and Zoi Vardavaki

Aim 318

Introduction 319

Transfer of medication in breast milk 319

Maternal diseases and medication in the breast- feeding mother 323

Over- the- counter medicines 326

Midwife’s role 326

Breast feeding and medications information 327

Conclusion 327

Find out more 327

Glossary 328

Test yourself 328

References 328

Further reading 329

Chapter 21 Medications and sexually transmitted infections 330
Celia Wildeman

Aim 330

Introduction 331

Bacteria 331

Viruses 332

Parasites 332

Chlamydia trachomatis (chlamydia) 334

Gonorrhoea 338

Syphilis 341

Hepatitis B virus 342

Human papillomavirus 343

Human immunodeficiency virus (HIV) 344

Trichomonas vaginalis (TV) 345

Conclusion 346

Glossary 346

Test yourself 347

References 347

Further reading 348

Chapter 22 Medications and recreational drug use 349
Laura Abbott and Karen Mills

Aim 349

Introduction 349

Role of midwives working with women who use drugs 350

Drugs of misuse 350

Absorption, distribution, metabolism and excretion (ADME) of drugs 355

Understanding the role drugs play in the lives of women 355

Drug use, pregnancy and risks 357

Breast feeding and drug use 358

Conclusion 359

Find out more 360

Glossary 360

Test yourself 360

References 361

Further reading 363

Chapter 23 Medications used in emergency midwifery situations 364
Jayne E. Marshall

Aim 364

Principles of managing maternity emergencies 365

Communication 365

Professional responsibility in emergency situations 367

Maternal collapse 368

Thrombosis and thromboembolism 371

Drug toxicity/overdose 373

Major haemorrhage/hypovolaemia 374

Pre- eclampsia and eclampsia 379

Sepsis 383

Cardiac arrest 383

Perimortem caesarean section (resuscitative hysterotomy) 384

Conclusion 387

Find out more 387

Glossary 387

Test yourself 387

References 388

Further reading 389

Chapter 24 Medications used in contraception 390
Emma Dawson- Goodey

Aim 390

Introduction 390

Pharmacokinetic and pharmacodynamic interactions 392

Combined hormonal contraception 393

Progesterone- oral pill 396

Progesterone injection 397

Progesterone implant 398

Intrauterine contraceptive (IUC) 399

Emergency contraception 400

Conclusion 401

Find out more 402

Glossary 402

Test yourself 403

References 403

Further reading 403

Index 405