INTRODUCTION:

GTD: H-MOLE, COMPLETE

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in
the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which
grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble
grapes. A molar pregnancy can develop when a fertilized egg does not contain an original maternal
nucleus. The products of conception may or may not contain fetal tissue. It is characterized by the
presence of a hydatidiform mole (or hydatid mole, mola hydatidosa). Molar pregnancies are categorized
as partial moles or complete moles, with the word mole being used to denote simply a clump of growing
tissue, or a growth.

TWO TYPES OF H-MOLE:

1. Complete molar pregnancy: Most commonly arise from fertilization of an empty ovum by a single
sperm that undergoes duplication of its chromosomes. The placental tissue is abnormal and swollen and
appears to form fluid-filled cysts. There's also no formation of fetal tissue.

2. Partial molar pregnancy: arise from two sperm fertilizing a single ovum. There may be normal
placental tissue along with abnormally forming placental tissue. There may also be formation of a fetus,
but the fetus is not able to survive, and is usually miscarried early in the pregnancy.

SYMPTOMS
A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific
signs and symptoms, including:

– Dark brown to bright red vaginal bleeding during the first trimester

– Severe nausea and vomiting

– Sometimes vaginal passage of grapelike cysts

– Pelvic pressure or pain

– Rapid uterine growth — the uterus is too large for the stage of pregnancy

– High blood pressure

– Preeclampsia

– Anemia

– Overactive thyroid (hyperthyroidism)

Risk Factors
– Low protein intake. Women with low protein intake have a possibility of developing a
hydatidiform mole because protein is needed for the development of the trophoblastic villi.

– Asian women. Asians have a higher chance of acquiring this disease because of their genetic
formation.

– Women with a blood group of A who marry men with blood group O. these blood groups, when
combined together, results in unfavorable conditions like H-mole.

– Maternal age. A molar pregnancy is more likely in women older than age 35 or younger than age
20.

– Previous molar pregnancy. If you've had one molar pregnancy, you're more likely to have
another. A repeat molar pregnancy happens, on average, in 1 out of every 100 women.

Complications
Gestational trophoblastic neoplasia (GTN)- After a molar pregnancy has been removed, molar tissue
may remain and continue to grow.

Choriocarcinoma -a cancerous form of GTN that may spreads to other organs

Prevention
It is recommended to wait for six months to one year before trying to become pregnant. The risk of
recurrence is low, but higher than the risk for women with no previous history of molar pregnancy.
During any subsequent pregnancies, your care provider may do early ultrasounds to monitor your
condition and offer reassurance of normal development. Your provider may also discuss prenatal
genetic testing, which can be used to diagnose a molar pregnancy.

Diagnosis

- Pregnancy test

- BLOOD TEST (HCG MONITORING)

- ULTRASOUND

- BIOPSY

- OTHER TEST: X-RAYS, BLOOD CHEM

Treatment
– Dilation and curettage (D&C): SUCTION CURETTAGE

– Hysterectomy

– CHEMOTHERAPY ). Chemo will also be needed if the pathologist finds choriocarcinoma in the
tissue sample. Chemotherapy may consist of only one drug (methotrexate or dactinomycin). If
this treatment is ineffective, a combination of chemotherapy drugs (such
as etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine) may be used, or
hysterectomy may be done.

Patient’s Profile:

Mrs. Eve is a 36 year old married woman, a plain housewife and a devoted catholic. She was
admitted at the hospital last January 4, 2019, with chief complain of vaginal bleeding soaking 3-4
pads per day with a presence of blood clots for 4 days. Her physician Dr. Met diagnosed her with
g2p1 (1001) 13 weeks age of gestation, h-mole, anemia severe.

– OBSTETRIC HISTORY:
– G2P1 (1001)

– LMP= OCTOBER 03, 2018

– AOG= 13 WEEKS 2 DAYS

– PNCU= RHU

– PREGNANCY TEST DONE AT HOME

HISTORY OF PRESENT ILLNESS:

3 weeks prior to admission, Mrs. Eve experienced vaginal spotting and severe nausea and
vomiting while at home, she also noticed enlargement of his abdomen differently from her previous
pregnancy. This prompted her to sought consultation at the hospital, she was then seen and
examined by obstetrician on duty and was advised to undergo pelvic ultrasound. The ultrasound
was done and it revealed h-mole. She was then advised to have her examined for beta human
 chorionic gonadotropin before scheduling her for operative management. Due to financial problem
the examination was not done then she wasn’t able to come back at the hospital.

4 days prior to admission, she experienced vaginal bleeding soaking 3-4 pads a day with the
presence of blood clots, despite of it, she never consulted a physician. The bleeding continued for
the succeeding days causing her to become weak and pale. Thus, her nephew took her at the
hospital and let her admitted. Intravenous fluid were started, laboratories stat were done, and was
advised to secure 2 units of blood prior to surgical management (suction curettage).

PAST MEDICAL HISTORY:

Mrs Eve denied having a family history of hypertension, diabetes mellitus, cancer and heart disease. She
claimed having colds and flu in the past and took over the counter drugs for treatment, such as biogesic
and symdex. She denied having medical and surgical problems in the past as well. She said she never
had an abortion in the past nor having h-mole.

ANATOMY AND PHYSIOOGY

REPRODUCTIVE SYSTEM
The reproductive system of a female produces gametes and allows her body to support a developing
fetus. The ovaries are the primary reproductive organs of a female; they produce the female gametes
and the sex hormones estrogen and progesterone.

FEMALE’S REPRODUCTIVE: EXTERNAL GENITALIA

Vulva
– The external female genitalia is referred to as vulva. It consists of the labia majora and labia
minora (while these names translate as "large" and "small" lips, often the "minora" can protrude
outside the "majora"), mons pubis, clitoris, opening of the urethra (meatus), vaginal vestibule,
vestibular bulbs, vestibular glands.

– The term "vagina" is often improperly used as a generic term to refer to the vulva or female
genitals, even though - strictly speaking - the vagina is a specific internal structure and the vulva
is the exterior genitalia only. Calling the vulva the vagina is akin to calling the mouth the throat.
Mons Veneris
– The mons veneris, Latin for "mound of Venus" (Roman Goddess of love) is the soft mound at the
front of the vulva (fatty tissue covering the pubic bone). It is also referred to as the mons pubis.
The mons veneris protects the pubic bone and vulva from the impact of sexual intercourse.
After puberty, it is covered with pubic hair, usually in a triangular shape. Heredity can play a role
in the amount of pubic hair an individual grows.

Labia Majora
– The labia majora are the outer "lips" of the vulva. They are pads of loose connective and
adipose tissue, as well as some smooth muscle. The labia majora wrap around the vulva from
the mons pubis to the perineum. The labia majora generally hides, partially or entirely, the other
parts of the vulva. There is also a longitudinal separation called the pudendal cleft. These labia
are usually covered with pubic hair. The color of the outside skin of the labia majora is usually
close to the overall color of the individual, although there may be some variation. The inside skin
is usually pink to light brown. They contain numerous sweat and oil glands. It has been
suggested that the scent from these oils are sexually arousing.

Labia Minora
– Medial to the labia majora are the labia minora. The labia minora are the inner lips of the vulva.
They are thin stretches of tissue within the labia majora that fold and protect the vagina,
urethra, and clitoris. The appearance of labia minora can vary widely, from tiny lips that hide
between the labia majora to large lips that protrude. There is no pubic hair on the labia minora,
but there are sebaceous glands. The two smaller lips of the labia minora come together
longitudinally to form the prepuce, a fold that covers part of the clitoris. The labia minora
protect the vaginal and urethral openings. Both the inner and outer labia are quite sensitive to
touch and pressure.

Clitoris
– The clitoris, visible as the small white oval between the top of the labia minora and the clitoral
hood, is a small body of spongy tissue that functions solely for sexual pleasure. Only the tip or
glans of the clitoris shows externally, but the organ itself is elongated and branched into two
forks, the crura, which extend downward along the rim of the vaginal opening toward the
perineum. Thus the clitoris is much larger than most people think it is, about 4" long on average.

– The clitoral glans or external tip of the clitoris is protected by the prepuce, or clitoral hood, a
covering of tissue similar to the foreskin of the male penis. However, unlike the penis, the
clitoris does not contain any part of the urethra.
 – During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral
glans more accessible. The size of the clitoris is variable between women. On some, the clitoral
glans is very small; on others, it is large and the hood does not completely cover it.

Urethra
– The opening to the urethra is just below the clitoris. Although it is not related to sex or
reproduction, it is included in the vulva. The urethra is actually used for the passage of urine.
The urethra is connected to the bladder. In females the urethra is 1.5 inches long, compared to
males whose urethra is 8 inches long. Because the urethra is so close to the anus, women should
always wipe themselves from front to back to avoid infecting the vagina and urethra with
bacteria. This location issue is the reason for bladder infections being more common among
females.

The hymen is a thin fold of mucous membrane that separates the lumen of the vagina from the
urethral sinus. Sometimes it may partially cover the vaginal orifice. The hymen is usually
perforated during later fetal development.

– A tear to the hymen, medically referred to as a "transection," can be seen in a small percentage
of women or girls after first penetration. A transection is caused by penetrating trauma.
Masturbation and tampon insertion can, but generally are not forceful enough to cause
penetrating trauma to the hymen. Therefore, the appearance of the hymen is not a reliable
indicator of virginity or chastity.

Perineum
– The perineum is the short stretch of skin starting at the bottom of the vulva and extending to
the anus. It is a diamond shaped area between the symphysis pubis and the coccyx. This area
forms the floor of the pelvis and contains the external sex organs and the anal opening. It can be
further divided into the urogenital triangle in front and the anal triangle in back.

– The perineum in some women may tear during the birth of an infant and this is apparently
natural. Some physicians however, may cut the perineum preemptively on the grounds that the
"tearing" may be more harmful than a precise cut by a scalpel. If a physician decides the cut is
necessary, they will perform it. The cut is called an episiotomy.
INTERNAL GENITALIA
Vagina
– The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the
uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches
long in a grown woman. The muscular wall allows the vagina to expand and contract. The
muscular walls are lined with mucous membranes, which keep it protected and moist. A thin
sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of the
vagina. The vagina receives sperm during sexual intercourse from the penis. The sperm that
survive the acidic condition of the vagina continue on through to the fallopian tubes where
fertilization may occur.

– The vagina is made up of three layers, an inner mucosal layer, a middle muscularis layer, and an
outer fibrous layer. The inner layer is made of vaginal rugae that stretch and allow penetration
to occur. These also help with stimulation of the penis. microscopically the vaginal rugae has
glands that secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The
outer muscular layer is especially important with delivery of a fetus and placenta.

Cervix
– The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the
top end of the vagina. Where they join together forms an almost 90 degree curve. It is
cylindrical or conical in shape and protrudes through the upper anterior vaginal wall.
Approximately half its length is visible with appropriate medical equipment; the remainder lies
above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".

Uterus
– The uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located
near the floor of the pelvic cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant
and grow. It also allows for the inner lining of the uterus to build up until a fertilized egg is
implanted, or it is sloughed off during menses.Fallopian Tubes

– At the upper corners of the uterus are the fallopian tubes. There are two fallopian tubes, also
called the uterine tubes or the oviducts. Each fallopian tube attaches to a side of the uterus and
connects to an ovary. They are positioned between the ligaments that support the uterus. The
fallopian tubes are about four inches long and about as wide as a piece of spaghetti. Within each
tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube
is a fringed area that looks like a funnel. This fringed area, called the infundibulum, lies close to
the ovary, but is not attached. The ovaries alternately release an egg. When an ovary does
ovulate, or release an egg, it is swept into the lumen of the fallopian tube by the fimbriae.
– Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow
passageway toward the uterus. The oocyte, or developing egg cell, takes four to five days to
travel down the length of the fallopian tube. If enough sperm are ejaculated during sexual
intercourse and there is an oocyte in the fallopian tube, fertilization will occur. After fertilization
occurs, the zygote, or fertilized egg, will continue down to the uterus and implant itself in the
uterine wall where it will grow and develop.

Ovum
– Ovum, plural ova, in human physiology, single cell released from either of the female
reproductive organs, the ovaries, which is capable of developing into a new organism when
fertilized (united) with a sperm cell.

– the outer surface of each ovary is covered by a layer of cells (germinal epithelium); these
surround the immature egg cells, which are present in the ovaries from the time of birth. A
hollow ball of cells, the follicle, encompasses each ovum. Within the follicle the ovum gradually
matures. It takes about four months for a follicle to develop once it is activated. Some follicles
lie dormant for 40 years before they mature; others degenerate and never develop. During
child-bearing years, 300 to 400 follicles mature and emit eggs capable of being fertilized. By the
time a woman reaches menopause, most remaining follicles have degenerated.

Structure of Formed Sperm

– Sperm are smaller than most cells in the body; in fact, the volume of a sperm cell is 85,000 times
less than that of the female gamete. Approximately 100 to 300 million sperm are produced each
day, whereas women typically ovulate only one oocyte per month as is true for most cells in the
body, the structure of sperm cells speaks to their function. Sperm have a distinctive head, mid-
piece, and tail region. The head of the sperm contains the extremely compact haploid nucleus
with very little cytoplasm. These qualities contribute to the overall small size of the sperm (the
head is only 5 μm long). A structure called the acrosome covers most of the head of the sperm
cell as a “cap” that is filled with lysosomal enzymes important for preparing sperm to participate
in fertilization. Tightly packed mitochondria fill the mid-piece of the sperm. ATP produced by
these mitochondria will power the flagellum, which extends from the neck and the mid-piece
through the tail of the sperm, enabling it to move the entire sperm cell. The central strand of the
flagellum, the axial filament, is formed from one centriole inside the maturing sperm cell during
the final stages of spermatogenesis.

Fertilization
– During coitus (sexual intercourse) between a male and a female, semen is released into the
vagina and transported through the uterus into the fallopian tube. Although many factors
 contribute to whether or not a single act of intercourse will result in pregnancy, most important
is whether or not a sperm cell will “meet” an ovum in the fallopian tube (fertilization).
Fertilization can only occur if intercourse takes place before the time of ovulation that usually
occurs “mid-cycle”, or about 14 days before the woman's next menstrual period. At the time of
ovulation, the ovum is released from the ovary and transported in the fallopian tube where it
remains for about 24-48 hours. Pregnancy is most likely to occur if fresh semen is present when
ovulation occurs.

Chorionic Villi and Placental Development

In the placenta, chorionic villi develop to maximize surface-area contact with the maternal blood for
nutrient and gas exchange.

Chorionic Villi
– Chorionic villi sprout from the chorion after their rapid proliferation in order to give a maximum
area of contact with the maternal blood. These villi invade and destroy the uterine decidua
while at the same time they absorb nutritive materials from it to support the growth of the
embryo .

– During the primary stage (the end of fourth week), the chorionic villi are small, nonvascular, and
contain only the trophoblast. During the secondary stage (the fifth week), the villi increase in
size and ramify, while the mesoderm grows into them; at this point the villi contain trophoblast
and mesoderm.

Placenta
– The placenta is a fetally derived organ that connects the developing fetus to the uterine wall to
allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The
placenta begins to develop upon implantation of the blastocyst into the
maternal endometrium.

– The placenta functions as a feto-maternal organ with two components: the fetal placenta
(chorion frondosum), which develops from the same blastocyst that forms the fetus; and the
maternal placenta (decidua basalis), which develops from the maternal uterine tissue.

Cytotrophoblast
– The cytotrophoblast (or layer of Langhans) is the inner layer of the trophoblast. It is interior to
the syncytiotrophoblast and external to the wall of the blastocyst in a developing embryo.

– The cytotrophoblast is considered to be the trophoblastic stem cell because the layer
surrounding the blastocyst remains while daughter cells differentiate and proliferate to function
in multiple roles. There are two lineages that cytotrophoblastic cells may differentiate through:
fusion and invasive. The fusion lineage yields syncytiotrophoblast and the invasive lineage yields
interstitial cytotrophoblast cells.

– Cytotrophoblastic cells play an important role in the implantation of a newly fertilized egg in the
uterus.
 DIAGNOSTIC RESULTS
REFERRENCE JAN 4, JAN 6, 2019 JAN 7, 2019
2019
RANGE Post bt: 2 ‘u’ Post bt 1 ‘u’

s/p suction
curettage

WBC 5.00-10.00 10^9/L 16.27 14.18 19.19

NEUTROPHILS 2.00-7.00 10^9/L 10.10 10.10 13.97

LYMPHOCYTES # 0.80-4.00 10^9/L 5.05 3.15 3.84

MONOCYTE # 0.12-1,20 10^9/L 0.68 0.57 0.84

EOSINOPHILS # 0.02-0.50 10^9/L 0.33 0.35 0.52

BASOPHILS# 0.00-0.10 10^9/L 0.11 0.01 0.02

NEUTROPHILS % 50.0-70.0 % 62.1 71.2 72.8

LYMPHOCYTES % 20.0-40.0 % 31.1 22.2 20.0

MONOCYTES % 3.0-12.0 % 4.2 4.0 4.4

EOSINOPHILS % 0.5-5.0 % 2.0 2.5 2.7

BASOPHILS % 0.0-1.0 % 0.6 0.1 0.1

RBC 3.50-5.50 10^9/L 2.34 Due to bleeding 2.86 3.36

HEMOGLOBIN 110-160 G/L 71 Due to bleeding 88 104

HEMATOCRIT 37.0-54.0 % 22.0 Due to bleeding 26.4 31.6

MCV 80.0-100.0 fL 94.0 92.2 94.1

MCH 27.0-34.0 pg 30.4 30.8 31.0

MCHC 320-360 g/L 323 333 329

RDW-CV 11.0-16.0 % 13.2 11.8 12.2

PLATELET 150-450 10^9/L 280 248 299

COMPLETE BLOOD COUNT

– DONE TO DETERMINE abnormal deviation of results from normal range, basically to determine
anemia.
PELVIC UTZ RESULT:
UTERUS IS ENLARGED SHOWING SNOW STORM PATTERN.

IMPRESION: H-MOLE

PELVIC ULTRASOUND-

Ultrasonography is the criterion standard for identifying both complete and partial molar
pregnancies.

RADIOLOGIC FINDINGS:
LUNG FIELDS ARE CLEAR

HEART IS NORMAL IN SZE

AORTA IS UNREMARKABLE

BOTH HEMIDIAGPHRAGMS AND COSTOPHRENIC SUCI AND

VISUALIZED BONES ARE INTACT

IMPRESSION: ESSENTIALLY NEGATIVE

CHEST X-RAY

- baseline chest radiograph should be taken. The lungs are a primary site of metastasis for
malignant trophoblastic tumors.

NORMAL RANGE RESULT INTERPRETATION

BETA HCG <6.15 IU/L >15,000 IU/L INCREASED:

COMPLETE MOLE

BETA HUMAN CHORIONIC GONADOTROPIN

A complete mole usually releases more HCG than a normal placenta, so finding higher than
expected HCG levels in the blood can be a sign that a complete mole is present.

Blood typing:

essential for cross-matching prior to blood transfusion

 BLOOD TYPE: O rh POSITIVE
REFERRENCE VALUE RESULTS

COLOR AMBER/LIGHT YELLOW LIGHT YELLOW

TRANSPARECY CLEAR OR CLOUDY TURBID

PUS CELLS 0-5 HPF 2-3 /HPF

RBC 0-2 HPF NUMEROUS

EPITHELIAL CELLS 0-15 HPF FEW

BACTERIA - FEW

MUCUS THREAD - -

YEAST CELLS - -

URATES - -

PHOSPHATE - --

LEUKOCYTES - -

NITRITE - -

UROBILINOGEN - -

PROTEIN - -

PH 4.5-8 6.5

Blood 3+

GRAVITY 1.010-1.030 1.010

Ketone - -

BILIRUBIN - -

GLUCOSE - -

URINALYSIS:
to determine presence of glucose in the urine and deviation of results from normal values. To
determine the presence of glucose in the urine.
BLOOD TEST
RESULT REFERENCE RANGE

SGPT 12.58 U/L 0.00- 45.00 U/L

SGOT 23.57 U/L 0.00- 35.00 U/L

UREA 2.224mmol/L 2.8-7.2 mmol/L

CREATININE 64.5 umol/L 55.00-96.00 umol/L

IMPRESSION: NORMAL

PHYSICAL ASSESSMENT
HEIGHT: 5’1” WEIGHT: 52.9 KG January 5, 2019

GENERAL CONDITION:

Mrs. Eve was lying on her bed. She was awake and coherent, but she was weak and pale in skin
color including her conjunctiva. With vaginal bleeding soaking 3 pads a day.

SYSTEMIC REVIEW

Vital Signs

a. Blood Pressure: 150/110 mmhg

b. Pulse: 115 bpm

c. Respiratory Rate: 20 breaths / min

d. Temperature: 37.3°C

Impression: hypertensive, tachycardia, normal body temperature.

General No seizure, afebrile, with mild dizziness

CVS Mild palpitation, increase cardiac rate (CR=113), No pedal edema, delayed capillary refill

Respiratory RR=20 no difficulty of breathing, + exertional discomfort(dyspnea when exerting effort)

Urinary No painful urination, (+)frequent, scanty urination

GIT No diarrhea, (+ )nausea, mild abdominal distention

Reproductive Vaginal bleeding (4days) soaking 3-4 pads per day.

MSK Body weakness, needs mild assistance in adl’s

CNS No headache, no blurred vision, no seizure

Endocrine No excessive sweating, no tremors

Head

Conjuctiva: pale

Sclera: White and no sign of jaundice

Mouth: Lips were pale

Thyroid: Not enlarged

Lymph node: Not palpable

Breast

– Both breasts were symmetrical and nipples were normally averted. No fungal infection beneath
the breast, no masses, no retraction of the nipples, no leakage and other abnormalities were
noted.
Impression: Normal

Cardiovascular System
a. Inspection: The chest was symmetrical and normal in shape. There was no scar, no precordial
bulging, no visible apex beat and no prominent dilated veins.
b. Palpation: The apex beat was located in the 5th intercostal space, at the midclavicular line.
There was mild palpitation noted. The peripheral pulses were present with regular rhythm but
fast and bounding.
c. Auscultation: The first and second heart sounds were normal. There were no murmurs heard.
Increased heart rate was noted.

Impression: tachycardia was noted

Respiratory System
a. Inspection: The chest moved symmetrically with respiration with no deformity seen. There was
no sign respiratory distress. There were no scar, prominent dilated.

b. Palpation: The chest expansion and vocal fremitus were equal anteriorly and posteriorly at all
three zones of the lung.

c. Percussion: The lung was resonant bilaterally, anteriorly and posteriorly. There were normal
liver and cardiac dullness.

d. Auscultation: There were vesicular breath sound anteriorly and posteriorly at all three zones.
No added sounds heard

Abdominal ExaminationInspection: On examination, the abdomen was distended

by gravid uterus. There was stretch marks seen. The umbilicus was centrally located and inverted.
No fetal movement.

Auscultation: no fetal heart tone

Light palpation: The abdomen was soft and non-tender. There was singleton mass. Liver, spleen
and kidney were not palpable.

> Leopold Maneuver : fundal height was 22 cm.

Impression: Uterus larger than date

PATHOPHYSIOLOGY: COMPLETE H-MOLE
 DRUG STUDY

DRUG ACTION INDICATION SIDE EFFECTS CONSIDERATION

GENERIC INHIBITS INDICATED FOR  DIZZINESS  DRUGS CAN BE USE

NAME: VASOCONSTRICTIVE HYPERTENSION ALONE OR WITH
LOSARTAN AND ALDOSTERONE OTHER
POTASSIUM SECRETING ACTION CONTRAINDICATION ADVERSE EFFECT ANTIHYPERTENSIVE
OF ANGIOTENSIN II S
 CONTRAINDIC  ANGIOEDEMA
BY BLOCKING
ATED TO  MONITOR
BRAND NAME: ANGIOTENSIN II
PATIENTS PATIENT’S BLOOD
RECEPTOR ON THE
COZAAR HYPERSENSITI PRESSURE CLOSELY
SURFACE OF
VE YO DRUG. TO EVALUATE
VASCULAR
BREAST EFFECTIVENESS OF
SMOOTH MUSCLE
DOCTOR’S FEEDING IS THERAPY
AND OTHER TISSUE
ORDER: NOT
 MONITOR PATIENT
RECOMMEND
LOSARTAN 50 WHO ARE ALSO
ED DURING
MG 1 TAB OD TAKING DIURETICS
LOSARTAN
FOR SYMPTOMATIC
THERAPY.
HYPOTENSION
CLASSIFICATIO  USE
 REGULARLY
N: CAUTIOUSLY
MONITOR
TO PATIENT
ANTIHYPERTE PATIENT’S RENAL
WITH
NSIVES FUCTION
IMPAIRED
RENAL AND  ADVISED PATIENT
HEPATIC TO IMMEDIATELY
FUNCTION. REPORT SWELLING
OF FACE, EYES,
LIPS, OR TONGUE
OR ANY DIFFICULTY
BREATHING
DRUG ACTION INDICATION SIDE EFFECTS NURSING CONSIDERATION

GENERIC NAME: UNKNOWN. INDICATED FOR ESSENTIAL  DROWSINESS  DRUG MAY BE

CLONIDINE THOUGHT TO AND RENAL GIVEN TO LOWER
 DIZZINESS
HYDROCHLORIDE STIMULATE HYPERTENSION BLOOD PRESSURE
ALPHA2  SEDATION IN SOME
RECEPTORS AND HYPERTENSIVE
INHIBIT THE  WEAKNESS EMRGENCIES\
BRAND NAME:
CENTRAL  CONSTPATIO
CATAPRES  MONITOR BP AND
VASOMOTOR N PR FREQUENTLY.
CENTERS,
 DRY MOUTH DOSAGE USUALLY
DECREASING
DOCTOR’S ORDER: SYMPATHETIC ADJUSTED TO
PATIENT’S BP AND
CLONIDINE OUTFLOW TO THE
TOLERANCE
75mcg/tab 1 tab HEART, KIDNEYS, CONTRAINDICATION ADVERSE EFFECT
SL now repeat BP AND PERIPHERAL  OBSERVE PATIENT’S
 CONTRAINDICATE  BRADYCARDI
after 20 mins x 3 CASCULATURE, TOLERANCE TO
D TO PATIENTS A
doses if BP more AND LOWERING DRUG’S
PERIPHERAL HYPERSENSITIVE THERAPEUTIC
than or equal to  SEVERE
RESISTANCE, YO DRUG EFFECTS, WHICH
140/90 mmhg REBOUND
BLOOD PRESSURE  TRANSDERMAL HYPERTENSIO MAY REQUIRE
AND HEART RATE. FORM: N INCREASES DOSAGE
CLASSIFICATION:  WHEN STOPPING
CONTRAINDICATED IN
ANTIHYPERTENSIV PATIENT HYPERSENTIVE THERAPY IN
ES TO ANY COMPONENT OF PATIENTS
THE ADHESIVE LAYER OF RECEIVING BOTH
TRANSDERMA SYSTEM CLONIDINE ND
MBETA BLOCKER
 EPIDURAL FORM: FIRST GRADUALLY
WITHDRAW BETA
CONTRAINDICATED IN
PATIENTS RECEIVING BLOCKER FIRST TO
MINIMIZE ADVERSE
ANTICOAGULANT
THERAPY, IN THOSE WITH REACTIONS
BLEEDING DIATHESIS, IN  ELDERLY PATIENTS
THOSE WITH AN MAY BE MORE
INJECTION SITE SENSITIVE THAN
INFECTION, IN THOSE YOUNGER ONE’S TO
WHO ARE DRUG’S
HEMODYNAMICALLY HYPOTENSIVE
UNSTABLE OR HAVE EFFECTS.
SEVERE CV DISEASE.
DRUG ACTION INDICATION SIDE EFFECTS NURSING
CONSIDERATION

GENERIC NAME: COMPETES ITH  INDICATED FOR ALLERGY  DROWSINESS  STOP DRUG 4
HISTAMINE FOR SYMPTOMS DAYS BEFORE
DIPHENHYDRAMI  SLEEPINESS
H1 RECEPTOR DIAGNOSTIC SKIN
NE
SITES,  DIZZINESS TESTING
HYDROCHLORIDE PREVENTS, BUT
 NAUSEA  ALTERNATE
DOESN’T
INJECTION SITES
REVERSE,  DRY MOUTH TO PREVENT
BRAND NAME: HISTAMINE-
 EPIGASTRIC IRRITATION. GIVE
MEDIATED
DIPHENHIST DISTRESS IM INJECTION
RESPONSES,
DEEP INTO LARGE
PARTICULARLY  TICKENING MUSCLE
THOSE OF THE OF
DOCTOR’S BRONCHIAL  DIZZINESS,
BRONCHIAL
ORDER: TUBES, GI EXCESSIVE
SECRETIONS
TRACT, UTERUS, SEDATION,
DIPHENHYDRAMI
AND BLOOD CONTRAINDICATION ADVERSE EFFECT SYNCOPE,
NE 1 AMP IM
VESSELS. TOXICITY,
NOW
STRUCTURALLY  CONTRAINDICATED TO  SEIZURES PARADOXICAL
RELATED TO PATIENTS STIMULATION,
 THROMBOCY
LOCAL HYPERSENSITIVE YO AND
CLASIIFICATION: TOPENIA
ANESTHETICS, DRUG, NEWBORNS, HYPEOTENSION
ANTIHISTAMINE DRUG PREMATURE NEONATES,  AGRANULOC ARE MORE LIKELY
PWOVIDES BREASTFEEDING WOMEN, YTOSIS TO OCCUR IN
LOCAL PATIENTS WITH ANGLE- ELDERLY.
ANESTHESIA CLOSURE GLAUCOMA,  ANAPHYLACT
AND SUPRESSES STENOSIS PEPTIC ULCER, IC SHOCK  WARN PATIENT
COUGH REFLEX. SYMPTOMATIC TO AVOID
PROSTATIC HYPERPLASIA, ALCOHOL AND
BLADDER NECK HAZARDOUS
OBSTRUCTION, OR ACTIVITIES THAT
PYLORODUODENAL REQUIRE
OBSTRUCTION AND ALERTNESS
THOSE HAVINF
ASTHMATIC ATTACK

 AVOID USE IN PATIENT

TAKING MAOI
 Republic of the Philippines
Province of Quirino
QUIRINO STATE UNIVERSITY
Cabarroguis Campus

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

BACHELOR OF SCIENCE IN MIDWIFERY
CP-106
Submitted to the
Faculty of the Bachelor of Science in Midwifery

Submitted by:
Group III

Aimee Glenn M. Masangcay Joliebeth Tangid

Analyn Derota Sylvie Wigan
Geralgine Gano Elena Tulingan
DRUG ACTION INDICATION SIDE EFFECTS CONSIDERATION
GENERIC NAME: INHIBITS CELL-  TO PREVENT  NAUSEA  BEFORE GIVING DRUG,
AMPICILLIN WALL SYNTHESIS ENDOCARDITI  DIARRHEA ASK PATIENT ABOUT
DURING S IN PATIENTS ALLERGIC REACTIONS TO
BRAND NAME: BACTERIAL HAVING PENICILLIN. A NRGATIVE
AMPICIN MULTIPLICATION DENTAL, GI, HISTORY OF PENICILLIN
GENITOURINA ALLERGY IS NO
DOCTOR’S RY GUARANTEE AGAINST A
ORDER: PROCEDURES FUTURE ALLERGIC
AMPICILLIN 2g REACTION.
IV CONTRAINDICATION ADVERSE EFFECT  GIVE DRUG IM OR IV
ANST PRIOR TO ONLY IF PRESCRIBED,
 CONTRAINDIC  SEIZURES
OR AND THE INFECTION IS
ATED TO  PSEUDOM
SEVERE, OR IF PATIENT
PATIENTS EMBRANE
CLASIIFICATION: CAN’T TAKE ORAL MEDS
HYPERSENSITI OUS
ANTI-  IF LARGE DOSES ARE
VE YO DRUG COLITIS
INFECTIVES/ GIVEN OR IF THERAPY IS
OR TO OTHER  THROMB
ANTIBIOTICS PROLONGED BACTERIAL
PENICILLINS OCYTOPE
OR FUNGAL
 USE NIA
SUPERINFECTION MAY
CAUTIOUSLY  THROMB
OCCUR, ESPECIALLY IN
IN PATIENTS OCYTOPE
ELDERLY, DEBILITATED OR
WITH OTHER NIA
IMMUNOSUPPRESSED
DRUG PURPURA
PATIENTS
ALLERGIES  LEUKOPE
 WATCH OUT FOR SIGNS
(ESPECIALLY NIA
AND SYMPTOMS OF
TO  AGRANUL
HYPERSENSITIVTY, SUCH
CEPHALOPORI OCYTOSIS
AS ERYTHEMATOUS
N) BECAUSE
MACULOPAPULAR RASH,
OF POSSIBLE
URTICARIA, AND
CROSS-
ANAPYLAXIS
SENSITIVITY
 IN PATIENTS WITH
AND IN
IMPAIRED RENAL
THOSE WITH
FUNCTION, DECREASE
MONONUCLE
DOSAGE
OSIS BECAUSE
OF A HIGH
RISK OF
MACULOPAP
ULAR RASH