Eclampsia Meds

ECLAMPSIA
MEDICATION OF ECLAMPSIA
1)MAGNESIUM SULPHATE (MGSO4)
2)HYDRALAZINE
1
Brand name: MgSO4
Generic name: Magnesium sulphate
Drug class: Antidysrhythmic
• Also commonly known as antiepileptic

drugs.
• Used in the treatment of epileptic seizures.
• Prevent the spread of the seizure within the
brain.
• Also increasingly being used in the
treatment of bipolar disorder. 1 ampule MgSo4 =
2.5 gm in 5mls
2
Pharmacokinetics
• Absorption: – completed bioavailability
- onset immediate
- peak unknown
- duration 30min
• Distribution: Distributed widely throughout the body. Can cross into
placenta
• Metabolism: Not metabolized.
• Excretion: Excreted in urine and breastmilk. Clears the body within

24H of discontinuation. 3
Mechanism of action
▪ Decrease acetylcholine in motor nerve
terminals which is responsible for
anticonvulsant properties, there by reduces
neuromuscular irritability.
▪ Decrease intracranial edema and helps in
diuresis.
▪ Its peripheral vasodilation effect improves
uterine blood supply.
4
Indication
▪ Toxemia of Pregnancy - Indicated to prevent seizures associated
with pre-eclampsia, and for control of seizures with eclampsia
▪ Preterm Labor (Off-label) - Used as a tocolytic to stop preterm
labor.
▪ Hypomagnesemia
▪ Status asthmatics not responsive to beta adrenergic drug.
Contraindication
▪ Myocardial damage
▪ Heart block 5
Dosage & Administration :
Via intravenous
▪4gm slow bolus over 10min
▪Followed by 1-2gm/hour maintenance infusion
given via a controlled infusion pump.
Via intramuscular (deep)

▪10gm loading dose
▪Followed by 5gm every 4 hours in alternate
buttock. 6
7
Route Intramuscular
Loading dose
10gm MgSo4 + 1ml 2% lignocaine
Maintenance
5gm MgSo4 every 4 hourly ( alternate

buttocks ) without lignocaine
Recurrent seizure
Given 5gm MgSo4 again without lignocaine after 1 hour

post loading dose or maintenance dose.
8
Stop magnesium sulphate if :
1)Respiration rate < 16/min
2)Urine output < 25ml/hr
3)Knee jerk are sluggish/absent
4)If magnesium toxicity is suspected (suggested absence of
reflexes), an antidote for MgSO4 is given.
Antidote
IV Calcium gluconate 10% ,10 ml given slowly in 10min by
medical officer. (If patient in cardiorespiratory collapse after
given MgS04). 9
Maternal Side effect
• Severe respiratory depression and circulatory collapse
• Poor reflexes (lost of patellar reflex)
• Confusion
• Drowsiness
• Flushing (warmth, redness, or tingly feeling),
• Sweating
• Visual changes
10
Fetal Side Effect
• Decreased fetal heart rate variability
• Respiratory depression
• Motor depression
• Low apgar score at birth
• Osteopenia and/or fractures
11
Precaution
i. Renal impairment patient – urine output

maintained at a level of 100ml every 4
hours.
ii. Serum magnesium level monitoring.
iii.Slow infusion rate to avoid producing
hypermagnesemia.
12
Demonstration skills in
performing
pharmacological
intervention
13
Before The Procedure
1.Doctor / midwife will explain the procedure to the
mother .
2.Doctor / midwife must ask the mother where her
sensitive to or allergic to any medication.
3.Monitor vital sign . Blood pressure , pulse rate,
respiratory rate , temperature and sign and
symptom of eclampsia.
4.Prepared the IM MgSo4.
5.Positioning mother .
6.Localized part for injection intramuscular ( given 14
at buttock - upper outer quadrant )

Before The Procedure
Preparation for im mgso4
Magnesium sulphate 10gm Syringe 10cc/50cc Alcohol swab/dry cotton
Lignocaine 2% Needle 21G/Branula 21G/infusion Infusion pump 15
tubing
During The Procedure
1.Monitor the vital sign every 30 min to detected
sign and symptom of toxicity post MgSo4.
• respiratory rate < 16 / min
• no patellar reflex
• urine output < 25ml / hour or 100 mls / 4 hour.
• B/p monitoring
2.Monitor fetal heart rate .
3.Monitor sign and symptom of eclampsia. 16
After The Procedure
1.Position mother with left lateral or recovery position.
2.Maintain airway and give oxygen if needed.
3.Continue monitor vital sign, urine output and fetal
heart rate.
4.Prepared extra im MgSo4 5gm without lignocaine .
Give extra im MgSo4 5gm post 1 hour after loading
dose or maintenance dose if mother get eclampsia.
5.If mother in cardiorespiratory collapse after im
MgSo4 . Antidote I/V calcium Gluconate 10% in 10mls 17
must be given slowly in 10mins by medical officer.

Hydralazine
Brand Name : Apresoline
Class : Vasodilator
Pharmacokinetics:
Absorption: Rapidly absorbed from the gastrointestinal tract.
Distribution: Crosses placenta, enters breastmilk (small

amounts).
Metabolism: Undergoes extensive first-pass metabolism in

the liver via acetylation.
18
Excretion: Via urine as metabolites.

Mechanism Of Action
• Hydralazine is a direct-acting vasodilator which acts
predominantly on the arterioles.
• The exact mechanism of action is unknown, but it is

thought to exert its vasodilating effect through direct
relaxation of vascular smooth muscle by inhibition of
Ca release from the sarcoplasmic reticulum and
inhibition of myosin phosphorylation in the arterial
smooth muscle cells.
19
Indication
• Moderate to severe hypertension
• Or when oral treatment is not possible
Contraindications and precautions

• Coronary artery diseases, mitral valvular rheumatic
heart disease.
• Because of variable sodium retention, diuretics
should be used.
• To control arrhythmias, propranolol may be
administered intravenously 20
• TABLETS:
• 10MG, 25MG, 50MG, 100MG
• IV:
• 20MG/ML
• Onset: 10-80 minutes (IV).

21
Dosage :
ORALLY
• 40-50 mg /day orally in 4 divided doses
• Maximum 200mg/day
INTRAVENOUS
• Pregnancy-associated
• Initial: 5-10 mg via slow inj, may repeat after 20-30 min.
Alternatively, as a continuous infusion, initial dose of
0.2- 0.3 mg/min.
• Maintenance: 0.05-0.15 mg/min. 22
23
THANK YOU
FOR YOUR ATTENTION
24

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ECLAMPSIA

• Also commonly known as antiepileptic

• Metabolism: Not metabolized.

• Excretion: Excreted in urine and breastmilk. Clears the body within

Via intramuscular (deep)

10gm MgSo4 + 1ml 2% lignocaine

5gm MgSo4 every 4 hourly ( alternate

Given 5gm MgSo4 again without lignocaine after 1 hour

i. Renal impairment patient – urine output

at buttock - upper outer quadrant )

Magnesium sulphate 10gm Syringe 10cc/50cc Alcohol swab/dry cotton

Lignocaine 2% Needle 21G/Branula 21G/infusion Infusion pump 15

must be given slowly in 10mins by medical officer.

Distribution: Crosses placenta, enters breastmilk (small

Metabolism: Undergoes extensive first-pass metabolism in

Excretion: Via urine as metabolites.

• The exact mechanism of action is unknown, but it is

Contraindications and precautions

• Onset: 10-80 minutes (IV).

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