Answer: (Researched)

Essential drugs (or essential medicines), as defined by the World Health Organization (WHO), are those medicines that satisfy the priority health care needs of a population. They are selected with due regard to public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford.

The selection of essential medicines is a national responsibility, often guided by a national medicines policy and a committee of experts, based on WHO recommendations.

• 1. Public Health Relevance / Disease Burden:The medicine should address prevalent diseases and health conditions that are significant public health problems in the country or region.
• 2. Efficacy (Effectiveness):There must be strong scientific evidence from clinical trials demonstrating that the medicine is effective in treating or preventing the specific condition for which it is intended.
• 3. Safety:The medicine must have an acceptable safety profile, meaning its benefits outweigh its risks under normal conditions of use. Side effects should be manageable.
• 4. Quality Assurance:The medicine must be of assured quality, manufactured according to Good Manufacturing Practices (GMP), and meet established standards for identity, purity, strength, and stability.
• 5. Cost-Effectiveness:When several medicines are available for the same condition and are similar in efficacy and safety, the one that is most cost-effective (provides the best value for money) should be chosen. This includes the cost of the drug itself and any associated costs (e.g., administration, monitoring).
• 6. Availability and Accessibility:The medicine should be consistently available in adequate amounts within the health system and accessible to the population who needs it. This includes reliable supply chains.
• 7. Appropriate Dosage Forms and Strengths:The medicine should be available in dosage forms (e.g., tablets, syrups, injections) and strengths that are appropriate for different age groups and patient needs, and that allow for accurate dosing.
• 8. Patient Acceptability and Ease of Use:Consider factors like taste (for pediatric formulations), ease of administration, and frequency of dosing, which can affect patient compliance.
• 9. Local Healthcare Capacity and Resources:The choice of medicines should be compatible with the skills of healthcare personnel, available diagnostic facilities, and storage conditions at different levels of the health system.
• 10. Evidence-Based Selection:Selection should be based on a thorough review of scientific evidence and clinical guidelines, rather than anecdotal evidence or promotional pressures. Consistency with national or international treatment guidelines is important.
• 11. Preference for Single-Compound Drugs:Single-ingredient medicines are generally preferred over fixed-dose combinations (FDCs), unless the combination has a proven advantage in terms of efficacy, safety, or compliance for a specific condition (e.g., some anti-TB or anti-HIV drugs).

A well-designed prescription paper helps ensure clarity, legality, patient safety, and efficient dispensing.

• 1. Clarity and Legibility:The paper should allow for information to be written clearly and be easily readable by the pharmacist and patient. This means adequate space for writing and good quality paper that doesn't smudge easily. Pre-printed sections should be clear.
• 2. Essential Patient and Prescriber Information Fields: Must have clearly designated spaces for: Patient Details: Full name, age (or date of birth), address, and sometimes weight (especially for children). Prescriber Details: Full name, professional title, registration number, clinic/hospital address, contact number, and signature. Date of Prescription.
• 3. Designated Space for Drug Details: Adequate and structured space for writing the drug information clearly: Name of the drug (preferably generic name). Strength of the drug (e.g., 500mg). Dosage form (e.g., tablet, syrup, injection). Dose, frequency, and route of administration (e.g., "500mg orally three times a day"). Duration of treatment or quantity to be dispensed. Clear instructions for the patient.
• 4. Security Features (to prevent misuse or forgery - more important in some contexts):While not always present on all prescription papers, features like watermarks, serial numbers, or special paper can help prevent unauthorized duplication or alteration, especially for controlled drugs. In some systems, duplicate or triplicate forms are used.
• 5. Professional Appearance and Compliance with Legal/Regulatory Requirements:The prescription paper should look professional and include any information legally required by the local pharmacy or medical council (e.g., specific disclaimers, logos, institutional details). It should be of a standard size for easy handling and filing.
• 6. Space for Refill Information (if applicable):Clear indication of whether refills are allowed and how many.
• 7. Absence of Pre-printed Advertisements for Specific Drugs:To maintain objectivity and avoid influencing prescribing choices inappropriately.

Answer: (Researched)

Pharmacokinetics is the branch of pharmacology that studies the time course of drug absorption, distribution, metabolism, and excretion (ADME) in the body. Essentially, it describes "what the body does to the drug." Understanding pharmacokinetics helps in determining appropriate drug dosages, routes of administration, and dosing intervals to achieve optimal therapeutic effects while minimizing toxicity.

• 1. Absorption: The process by which a drug moves from its site of administration (e.g., mouth, skin, muscle) into the bloodstream (systemic circulation). Factors affecting absorption: Route of administration (e.g., oral, IV, IM, topical), drug formulation (e.g., tablet, solution), drug physicochemical properties (e.g., lipid solubility, ionization), blood flow to the absorption site, presence of food (for oral drugs), pH at the absorption site. Bioavailability: The fraction of an administered drug dose that reaches the systemic circulation unchanged. IV administration has 100% bioavailability.
• 2. Distribution: The reversible transfer of a drug from the bloodstream to various tissues and organs of the body, and back into the bloodstream. Factors affecting distribution: Blood flow to tissues, drug's ability to leave capillaries (lipid solubility, molecular size), plasma protein binding (only unbound/free drug is active and can distribute), tissue binding, barriers like the blood-brain barrier or placenta. Volume of Distribution (Vd): A theoretical volume representing the extent to which a drug distributes in body tissues rather than remaining in the plasma.
• 3. Metabolism (Biotransformation): The chemical alteration or transformation of a drug within the body, primarily by enzymes, usually leading to the formation of more water-soluble compounds (metabolites) that are easier to excrete. Primary site: Liver (hepatic metabolism by cytochrome P450 enzymes is very important). Other sites include kidneys, lungs, intestines, plasma. Purpose: Often inactivates the drug, but sometimes metabolism can convert an inactive prodrug into an active drug, or an active drug into another active metabolite. First-Pass Metabolism: For orally administered drugs, significant metabolism may occur in the liver or gut wall before the drug reaches systemic circulation, reducing bioavailability.
• 4. Excretion (Elimination): The irreversible removal of the drug and/or its metabolites from the body. Primary routes: > Kidneys (Renal Excretion): Most common route. Drugs are filtered by glomeruli, secreted by tubules, or reabsorbed by tubules, and eliminated in urine. > Liver (Biliary Excretion): Drugs or metabolites are secreted into bile, which then enters the intestine and can be eliminated in feces (some may undergo enterohepatic recirculation). Other routes: Lungs (for volatile anesthetics, alcohol), sweat, saliva, tears, breast milk. Clearance (CL): A measure of the rate at which a drug is eliminated from the body (volume of plasma cleared of drug per unit time). Half-life (t½): The time taken for the plasma concentration of a drug to reduce by half. Determines dosing interval and time to reach steady state.

Drug metabolism typically occurs in two main phases, aiming to make drugs more water-soluble (polar) for easier excretion.

• Phase I Reactions (Functionalization Reactions): These reactions introduce or unmask a functional group (e.g., -OH, -NH2, -SH) on the parent drug molecule, usually making it more polar and providing a site for Phase II reactions. Phase I reactions often involve oxidation, reduction, or hydrolysis. Oxidation: Most common type, primarily carried out by cytochrome P450 (CYP450) enzyme system in the liver. Involves addition of oxygen or removal of hydrogen. Examples: hydroxylation, N-dealkylation, O-dealkylation, sulfoxidation. Reduction: Less common than oxidation. Involves addition of hydrogen or removal of oxygen. Can be carried out by CYP450 enzymes or other reductases. Examples: reduction of nitro groups, azo groups, or carbonyl groups. Hydrolysis: Cleavage (breaking) of a drug molecule by the addition of water. Carried out by esterases (for ester drugs like aspirin) or amidases (for amide drugs like procainamide). Occurs in liver, plasma, gut. Outcome: Metabolites from Phase I may be active, inactive, or sometimes more toxic than the parent drug. They are often still somewhat lipid-soluble and may undergo Phase II reactions.
• Phase II Reactions (Conjugation Reactions): These reactions involve the covalent attachment (conjugation) of an endogenous (naturally occurring in the body), highly polar molecule (conjugating agent) to the parent drug or its Phase I metabolite (if it has a suitable functional group). This usually results in a larger, more water-soluble, and generally inactive compound that is readily excreted. Glucuronidation: Conjugation with glucuronic acid (derived from glucose). Most common Phase II reaction. Enzyme: UDP-glucuronosyltransferase (UGT). Substrates include drugs with -OH, -COOH, -NH2, -SH groups. Sulfation (Sulphation): Conjugation with sulfate. Enzyme: Sulfotransferase (SULT). Substrates include phenols, alcohols, amines. Acetylation: Conjugation with an acetyl group (from acetyl-CoA). Enzyme: N-acetyltransferase (NAT). Substrates include drugs with amine or hydrazine groups (e.g., isoniazid, sulfonamides). Genetic variations in NAT activity (fast vs. slow acetylators) can affect drug response. Methylation: Addition of a methyl group. Enzyme: Methyltransferase. Less important for increasing water solubility but can alter activity or target. Glutathione Conjugation: Conjugation with glutathione (a tripeptide). Enzyme: Glutathione S-transferase (GST). Important for detoxifying reactive electrophilic compounds (e.g., metabolites of paracetamol). Amino Acid Conjugation: Conjugation with amino acids like glycine or glutamine. Outcome: Phase II metabolites are almost always inactive and highly water-soluble, facilitating their excretion, primarily in urine or bile.

Note: Not all drugs undergo both Phase I and Phase II metabolism. Some may only undergo Phase I, some only Phase II, some both, and some may be excreted unchanged. The sequence can also vary.

Answer: (Researched)

Note: Dosages provided are general examples and can vary significantly based on specific patient factors, indication, age, weight, renal/hepatic function, and local prescribing guidelines. Always refer to current official drug formularies and guidelines.

• Indications:Mild to moderate pain relief (e.g., headache, muscle aches, toothache, menstrual pain); reduction of fever (antipyretic).
• Dose (Adults, general): Oral: 500mg to 1000mg every 4-6 hours as needed. Maximum 4 grams per 24 hours. IV: Dose varies by weight, typically 1g for adults >50kg. Pediatric doses are weight-based (e.g., 10-15 mg/kg/dose).
• Contraindications:Known hypersensitivity to acetaminophen; severe liver disease/impairment. Use with caution in patients with chronic alcoholism or malnutrition.
• Side Effects:Generally well-tolerated at recommended doses. > Rare: Skin rash, allergic reactions. > Overdose/Chronic High Doses: Severe liver damage (hepatotoxicity) is the most serious risk, potentially fatal. Kidney damage can also occur with chronic overuse.

• Indications: Prevention of NSAID-induced gastric ulcers. Medical termination of early intrauterine pregnancy (often in combination with mifepristone). Cervical ripening and labor induction. Management of postpartum hemorrhage (PPH) (especially where oxytocin is not available or for adjunctive therapy). Management of incomplete abortion or miscarriage.
• Dose (Varies widely by indication): Prevention of NSAID ulcers: e.g., 200 mcg orally four times daily. Labor induction/cervical ripening: e.g., 25-50 mcg vaginally every 4-6 hours. PPH prevention/treatment: e.g., 600-1000 mcg orally, sublingually, or rectally as a single dose. Always follow specific protocols.
• Contraindications:Known hypersensitivity to misoprostol or other prostaglandins; pregnancy when used for NSAID ulcer prevention (it's an abortifacient); previous cesarean section or major uterine surgery (for labor induction due to risk of uterine rupture - relative contraindication, use with extreme caution).
• Side Effects:Diarrhea (common), abdominal pain/cramps, nausea, vomiting, headache, fever, chills, shivering, uterine hyperstimulation (for obstetric use), uterine rupture (rare but serious).

• Indications:A potent corticosteroid with anti-inflammatory and immunosuppressive effects. > Inflammatory conditions: E.g., severe asthma, allergic reactions, arthritis, inflammatory bowel disease. > Cerebral edema (swelling of the brain, e.g., due to tumors or head injury). > Certain cancers (e.g., leukemia, lymphoma, multiple myeloma - as part of chemotherapy regimens). > Diagnosis of Cushing's syndrome (dexamethasone suppression test). > Prevention and treatment of nausea and vomiting associated with chemotherapy. > Antenatal use to promote fetal lung maturity in threatened preterm labor (usually betamethasone is preferred, but dexamethasone can be used). > COVID-19 (in hospitalized patients requiring oxygen or ventilation).
• Dose:Highly variable depending on the condition being treated, severity, and route of administration (oral, IV, IM). Can range from 0.5mg to much higher doses daily, often tapered.
• Contraindications:Systemic fungal infections; known hypersensitivity. Use with caution in patients with active untreated infections, peptic ulcer disease, diabetes, hypertension, osteoporosis, psychiatric disorders. Live virus vaccines should generally be avoided during high-dose therapy.
• Side Effects (Often dose-dependent and related to duration of use): Short-term: Insomnia, mood changes (euphoria, irritability, psychosis), increased appetite, weight gain, fluid retention, hyperglycemia, increased susceptibility to infection. Long-term: Cushingoid appearance (moon face, buffalo hump, central obesity), osteoporosis, muscle weakness, skin thinning/bruising, cataracts, glaucoma, peptic ulcers, adrenal suppression, impaired wound healing, growth suppression in children.

• Indications:A broad-spectrum penicillin antibiotic used to treat various bacterial infections. > Respiratory tract infections (e.g., sinusitis, otitis media, bronchitis, pneumonia caused by susceptible bacteria). > Urinary tract infections (UTIs). > Skin and soft tissue infections. > Dental infections. > Eradication of Helicobacter pylori (in combination with other drugs). > Prophylaxis against endocarditis in certain procedures. > Lyme disease (early stage).
• Dose (Adults, general for common infections):Oral: 250mg to 500mg every 8 hours, or 875mg every 12 hours. Higher doses for severe infections. Pediatric doses are weight-based.
• Contraindications:Known hypersensitivity to penicillin or other beta-lactam antibiotics (e.g., cephalosporins - cross-sensitivity can occur). History of cholestatic jaundice/hepatic dysfunction associated with amoxicillin/clavulanate.
• Side Effects:Generally well-tolerated. > Common: Diarrhea, nausea, vomiting, skin rash (can be non-allergic amoxicillin rash or true allergic reaction). > Less common: Allergic reactions (ranging from mild rash to severe anaphylaxis), superinfection (e.g., candidiasis), Clostridium difficile-associated diarrhea (antibiotic-associated colitis). > Rare: Reversible hepatitis, cholestatic jaundice, blood dyscrasias.

• Indications:A cardiac glycoside used primarily for: > Heart Failure: To increase the force of myocardial contraction (positive inotropic effect) and improve symptoms in certain types of heart failure with reduced ejection fraction. > Atrial Fibrillation and Atrial Flutter: To slow the ventricular rate by decreasing conduction through the AV node.
• Dose:Has a narrow therapeutic index, so dosing must be individualized and carefully monitored. Involves a loading dose (digitalization) followed by a maintenance dose. > Loading dose (Oral/IV): e.g., 0.5 - 1mg given in divided doses over 24 hours. > Maintenance dose (Oral): e.g., 0.125 - 0.25mg daily (lower in elderly or renal impairment). Therapeutic drug monitoring (digoxin levels) is often required.
• Contraindications:Ventricular fibrillation; known hypersensitivity. Use with extreme caution or avoid in patients with AV block (unless pacemaker present), hypertrophic obstructive cardiomyopathy, certain arrhythmias (e.g., Wolff-Parkinson-White syndrome with atrial fibrillation), acute myocardial infarction (unless heart failure present), electrolyte imbalances (especially hypokalemia, hypomagnesemia, hypercalcemia – these increase risk of toxicity).
• Side Effects / Signs of Toxicity (common due to narrow therapeutic index): Gastrointestinal: Anorexia (loss of appetite), nausea, vomiting, abdominal pain, diarrhea (often early signs of toxicity). Cardiac: Bradycardia (slow heart rate), various arrhythmias (e.g., AV block, ventricular bigeminy, ventricular tachycardia/fibrillation), palpitations. Neurological/CNS: Headache, fatigue, weakness, dizziness, confusion, drowsiness, visual disturbances (blurred vision, yellow/green halos around lights - xanthopsia). Psychiatric: Depression, psychosis (rare).

Answer: (Researched)

• Typical Antipsychotics (First-Generation / Conventional Antipsychotics): Primarily block dopamine D2 receptors. More likely to cause extrapyramidal side effects (EPS). 1. Haloperidol (e.g., Haldol, Serenace) 2. Chlorpromazine (e.g., Largactil, Thorazine) 3. Fluphenazine (e.g., Prolixin) Other examples: Thioridazine, Perphenazine, Trifluoperazine.
• Atypical Antipsychotics (Second-Generation Antipsychotics): Block dopamine D2 receptors more selectively and also block serotonin 5-HT2A receptors. Generally have a lower risk of EPS but are associated with metabolic side effects. 1. Risperidone (e.g., Risperdal) 2. Olanzapine (e.g., Zyprexa) 3. Clozapine (e.g., Clozaril) - often reserved for treatment-resistant schizophrenia due to risk of agranulocytosis. Other examples: Quetiapine (Seroquel), Aripiprazole (Abilify), Ziprasidone (Geodon), Paliperidone (Invega).

• 1. Management of Acute Mania or Agitation in Bipolar Disorder:Typical antipsychotics can be used to quickly control agitation, psychotic symptoms (delusions, hallucinations), and manic behavior in acute manic episodes of bipolar disorder, often as adjunctive therapy or while mood stabilizers take effect. Haloperidol is commonly used for acute agitation.
• 2. Treatment of Psychotic Symptoms in Other Disorders:Can be used to manage psychosis associated with conditions like severe depression with psychotic features, drug-induced psychosis, or delirium (to manage agitation and hallucinations).
• 3. Control of Severe Nausea and Vomiting (Antiemetic Effect):Some typical antipsychotics, particularly phenothiazines like prochlorperazine (Stemetil) or chlorpromazine, have antiemetic properties due to their dopamine blockade in the chemoreceptor trigger zone (CTZ) of the brain. They can be used for nausea and vomiting caused by various conditions, including chemotherapy or post-operatively.
• (Additional Use) 4. Management of Tics in Tourette's Syndrome:Drugs like haloperidol or pimozide (another typical antipsychotic) can be effective in reducing the frequency and severity of motor and vocal tics in Tourette's syndrome, although used cautiously due to side effect profile.
• (Additional Use) 5. Treatment of Intractable Hiccups:Chlorpromazine is sometimes used to treat persistent, severe hiccups that do not respond to other measures.

Management involves a combination of non-pharmacological strategies, dose adjustments, switching medications, or adjunctive medications. Always consult with the prescribing physician.

• i. Weight Gain: Common with many antipsychotics, especially atypicals like olanzapine and clozapine. Dietary Counseling: Refer to a dietitian for advice on a healthy, balanced, calorie-controlled diet. Encourage portion control. Promote Regular Physical Activity: Encourage at least 30 minutes of moderate exercise most days of the week. Behavioral Interventions: Support lifestyle changes through behavioral therapy or support groups. Medication Review: Discuss with the doctor if switching to an antipsychotic with a lower risk of weight gain is possible (e.g., aripiprazole, ziprasidone, lurasidone). Consider Adjunctive Medication: In some cases, medications like metformin may be considered off-label to help manage antipsychotic-induced weight gain, under specialist guidance. Regular Monitoring: Monitor weight, BMI, and waist circumference regularly.
• ii. Hypersalivation (Sialorrhea): Excessive production of saliva, particularly problematic with clozapine. Non-pharmacological: Chewing sugar-free gum (can help swallow saliva), positioning (e.g., sleeping with head slightly elevated), using a towel on pillow at night. Medication Review: Discuss with doctor. Dose reduction of the antipsychotic (if clozapine) might be attempted carefully. Pharmacological (under medical guidance): > Anticholinergic medications (e.g., glycopyrrolate, atropine sublingual drops, scopolamine patch) can reduce saliva production but have their own side effects (dry mouth, constipation, blurred vision). > Alpha-2 adrenergic agonists (e.g., clonidine) have also been used.
• iii. Constipation: Common side effect, especially with antipsychotics having anticholinergic properties (e.g., clozapine, olanzapine, some typicals). Dietary Measures: Increase dietary fiber intake (fruits, vegetables, whole grains). Adequate Fluid Intake: Encourage drinking plenty of water. Regular Physical Activity: Promotes bowel motility. Review Other Medications: Check if other concurrent medications contribute to constipation. Stool Softeners or Laxatives: If lifestyle measures are insufficient, prescribe stool softeners (e.g., docusate) or osmotic/stimulant laxatives (e.g., lactulose, senna, bisacodyl) as needed. Avoid long-term stimulant laxative use without medical advice. Establish Regular Bowel Habits.
• iv. Tongue Protrusion (Extrapyramidal Symptom - EPS): This can be a sign of an acute dystonic reaction (sudden, involuntary muscle spasm) or, if persistent and developing later, tardive dyskinesia (TD - involuntary, repetitive body movements). More common with typical antipsychotics. Acute Dystonia (including tongue protrusion): > This is a medical emergency and requires prompt treatment. > Administer an anticholinergic medication (e.g., benztropine/Cogentin IM/IV, procyclidine, or an antihistamine with anticholinergic properties like diphenhydramine/Benadryl IM/IV). Relief is usually rapid. > The prescribing doctor should review the antipsychotic dose or consider switching to one with lower EPS risk. Prophylactic anticholinergics may be considered with high-potency typicals. Tardive Dyskinesia (TD): > This is a more serious, potentially irreversible movement disorder that can develop after long-term antipsychotic use. Prevention is key (using lowest effective dose, preferring atypicals with lower TD risk). > If TD is suspected, the antipsychotic should be reviewed by the doctor. Options include stopping the drug (if possible, with gradual taper), reducing the dose, or switching to an antipsychotic with lower TD risk (like clozapine). > Specific treatments for TD approved in some regions include VMAT2 inhibitors (e.g., valbenazine, deutetrabenazine). > Regular monitoring for early signs of TD (e.g., using AIMS - Abnormal Involuntary Movement Scale) is important for patients on long-term antipsychotics.

Answer:

The following information is based on the Kumi School of Nursing and Midwifery answer sheet provided in the PDF (pages 102-107). Dosages are examples and should always be confirmed with current local guidelines and specific patient needs.

As listed in the provided answer sheet:

• 1. Misoprostol
• 2. Bromocriptine
• 3. Magnesium Sulphate
• 4. Salbutamol
• 5. Oxytocin

• Indications:Induction of labor, cervical ripening, prevention and treatment of postpartum hemorrhage (PPH), management of incomplete abortion/miscarriage, medical termination of pregnancy (often with mifepristone), prevention of NSAID-induced ulcers.
• Dosage (Examples from PDF/General Use): Labor Induction: e.g., 25 mcg vaginally every 3-6 hours (off-label use in PDF). PPH Prophylaxis: e.g., 600 mcg orally within 1 minute of delivery (PDF). PPH Treatment: e.g., 800 mcg orally once (PDF - if oxytocin not available). (Other routes: sublingual, rectal; dose 800-1000mcg). Prevention of NSAID ulcers: e.g., 200 mcg orally 4 times daily (PDF).
• Contraindications:Known hypersensitivity to misoprostol or prostaglandins; pregnancy (when used for ulcer prevention); previous C-section or major uterine surgery (for labor induction - relative contraindication, high risk of uterine rupture); suspected ectopic pregnancy; bleeding disorders; shock (as per PDF, likely in context of active severe bleeding before stabilization).
• Side Effects:Diarrhea, abdominal pain/cramps, nausea, vomiting, headache, fever, chills, shivering, uterine hyperstimulation, uterine rupture (rare but serious). (PDF mentions: diarrhea, abdominal cramps, nausea, vomiting, constipation, headache, dyspepsia, stomach pain, skin rash, flatulence).

• Indications:Suppression of lactation (e.g., after stillbirth or neonatal death, or if mother chooses not to breastfeed); treatment of hyperprolactinemia (high prolactin levels causing infertility, galactorrhea); Parkinson's disease; acromegaly.
• Dosage (for Lactation Suppression - from PDF): Prevention/Suppression: 2.5 mg on day one, then 2.5 mg twice daily for 14 days. (PDF also mentions initial 1.25mg at bedtime increased gradually for other indications).
• Contraindications (from PDF):Hypersensitivity to bromocriptine or ergot alkaloids; toxemia of pregnancy; uncontrolled hypertension; hypertension in postpartum women; peripheral vascular disease; severe ischemic heart disease.
• Side Effects (from PDF):Nausea, headache, fatigue, dry mouth, diarrhea, drowsiness, constipation, abdominal cramps, hypotension, dizziness, nasal congestion. (Serious: psychosis, stroke, MI - rare).

• Indications:Prevention and treatment of seizures in eclampsia and severe pre-eclampsia; tocolysis for preterm labor (neuroprotection for fetus <32 weeks); treatment of hypomagnesemia; bronchodilator in severe acute asthma (adjunctive).
• Dosage (for Eclampsia/Severe Pre-eclampsia - from PDF/common regimens): Loading Dose: 4g IV slowly over 15-20 minutes. Followed by Maintenance Dose: > IV Infusion: 1-2g per hour. OR > IM: 10g IM (5g in each buttock) initially after loading dose, then 5g IM every 4 hours. Continue for 24 hours after last seizure or delivery.
• Contraindications (from PDF):Severe renal failure/impairment; myasthenia gravis; heart block; myocardial damage; known hypersensitivity. (PDF also mentions: intestinal obstruction, hypermagnesemia, appendicitis, acute vaginal bleeding, acute fetal distress, dilation >37wks, fetal weight >2500g, respiratory depression - some of these relate to tocolytic use rather than eclampsia).
• Side Effects / Signs of Toxicity (from PDF):Nausea, vomiting, flushing of the skin, warmth, respiratory depression, muscle weakness, loss of deep tendon reflexes (patellar reflex - key sign of toxicity), hypotension, confusion, coma, cardiac arrest.

• Indications:Bronchodilator for asthma and COPD. Tocolytic agent to relax uterine muscle and delay preterm labor (less commonly used for this now due to side effects and better alternatives).
• Dosage (for Preterm Labor - from PDF, but use is now limited): IV infusion: e.g., start 10 mcg/min, increase gradually. Oral: e.g., 4mg every 6-8 hours (PDF). Use for asthma is via inhaler or nebulizer.
• Contraindications (for Tocolytic Use - from PDF):Cardiac failure/disease; known hypersensitivity; placenta previa; intrauterine infections; intrauterine fetal death; ruptured membranes; eclampsia/severe pre-eclampsia; antepartum hemorrhage; significant maternal medical conditions (e.g., uncontrolled hyperthyroidism, diabetes). Generally not recommended beyond 32-34 weeks for tocolysis.
• Side Effects (Systemic, esp. with IV/oral for tocolysis - from PDF):Maternal and fetal tachycardia, palpitations, tremors, headache, nausea/vomiting, flushing, sweating, muscle cramps, pulmonary edema (serious), hyperglycemia, hypokalemia, hypotension.

• Indications:Induction or augmentation (strengthening) of labor; prevention and treatment of postpartum hemorrhage (PPH) by promoting uterine contraction; management of incomplete or inevitable abortion (to aid expulsion of uterine contents).
• Dosage (Examples from PDF/General Use): Labor Induction/Augmentation: IV infusion via pump, starting at a low dose (e.g., 1-2 milliunits/min) and gradually titrated upwards based on uterine response and fetal condition. (PDF: Dilute 5 IU in 500ml, start 5 drops/min, increase carefully). PPH Prevention (Active Management of Third Stage): e.g., 10 IU IM after delivery of anterior shoulder or baby, or 5-10 IU IV slowly after delivery of placenta. PPH Treatment: e.g., 10-40 IU in 500ml-1L IV infusion, or 10 IU IM.
• Contraindications (from PDF/General):Significant cephalopelvic disproportion (CPD); fetal malpresentation (e.g., transverse lie, uncorrected breech) precluding vaginal delivery; fetal distress where delivery is not imminent; placenta previa; cord prolapse; history of uterine rupture or previous classical C-section; hypertonic uterine contractions; known hypersensitivity. Severe pre-eclampsia (PDF context) - caution needed.
• Side Effects (from PDF/General):Uterine hyperstimulation (tachysystole, hypertonus) leading to fetal distress or uterine rupture; water intoxication (antidiuretic effect at high doses with prolonged infusion of large fluid volumes) leading to hyponatremia, convulsions, coma; nausea, vomiting; headache; maternal arrhythmias, hypotension or hypertension; fetal bradycardia/hypoxia (due to hyperstimulation). Anaphylactic reaction (rare).

Source: Primarily based on Kumi School of Nursing and Midwifery answer sheet provided in the PDF (pages 102-107), with some adaptations for clarity and common understanding. Specific drug information should always be cross-referenced with current, local, and official formularies.