Gynecology Case No16. Endrometriosis Fibroid Adenomyosis PID.

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Gynecology Case No16. Endrometriosis Fibroid Adenomyosis PID.

20y yrs old female presented with painful Menstruation for 3month—–

কি কি কারনে হতে পারে?

-Endrometriosis

-Fibroid

-Adenomyosis

-PID

•USG করে নরমাল আসলে further investigation – TVS করতে হবে।

তারপরেও নরমাল আসলে বুঝতে হবে primary dysmenorrhea

•যখন টেস্ট করার সুযোগ থাকবে না(In medical camp) তখন ৫টা পয়েন্ট দেখে বুঝতে হবে—-

1.Young age (early menstrual life

2.upper socio economic condition— কারন এদের স্ট্রেস ম্যানেজমেন্ট স্কিল কম

3.Sharp pain,sharp rise,sharp fall অর্থাৎ পিরিয়ড শুরুর ২/৩দিন আগে থেকে পেইন শুরু হবে,ব্লিডিং শুরু হওয়ার /২দিনের মধ্যে পেইন আস্তে আস্তে কমে যাবে।

4.Intral abdominal কোন Lump থাকবে না

5.Irregular menstrual history দিবে না

কি কি মিনিমাম examination করতে হবে?

-Anemia

-Lump

-Menorrhagia

-PV(Cervical Muscle tenderness আছে কিনা দেখতে হবে)

what is PV Exam

Answer is:Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.

Investigation

•CBC (Anemia exclude করার জন্য)

•USG(সব ঠিকঠাক থাকলে,then TVS for further investigation )

Management :-

★NSAIDs

Tablet 1:-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Indications of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Myfocin is indicated for-

Fever
Toothache
Headache
Migraine
Primary dysmenorrhoea
Menorrhagia
Mild to moderate pain in rheumatoid arthritis and osteoarthritis
Traumatic pain
Low-back pain
Juvenile chronic arthritis in children etc.

Pharmacology of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Mefenamic acid contains Mefenamic Acid which is a nonsteroidal agent with demonstrated analgesic, anti-inflammatory and antipyretic activity due to its dual action on prostaglandins. It inhibits the enzymes of prostaglandin synthetase and also antagonizes the actions of prostaglandin at the receptor sites.

Dosage & Administration of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Adult:

500 mg dose should be given to adults upto three times (1.5 gm total) per day with meals. The dosage may be reduced to 1 tablet (250 mg) three times daily.
In case of menorrhagia: 500 mg three times daily with meals and from the onset of menses and continued according to the judgement of the physician.

Children:

6 months to 1 year: 5 ml three times/day.
2-4 years: 10 ml three times/day.
5-8 years: 10 ml four times /day.
9-12 years: 15 ml four times/day.

Treatment should not be continued for more than 7 days except on the advice of a physician.

Side Effects of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

The most frequently reported adverse experiences occurring in approximately 1-10% of patients are gastrointestinal: abdominal pain, constipation, diarrhoea, dyspepsia, flatulence, nausea, Gl ulcers, vomiting, dizziness, abnormal renal function, pruritus, rashes.

Pregnancy & Lactation of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

The safety of Mefenamic acid on reproductive capacity and pregnancy has not been established. Thus, mefenamic acid should be used in women of childbearing potential and during pregnancy only when the potential benefits are expected to outweigh the potential risks. Trace amounts of Mefenamic acid may be present in breast milk and transmitted to the nursing infant. Thus Mefenamic acid should not be taken by the nursing mother because of the effects of this class of drugs on the infant’s cardiovascular system.

Therapeutic Class of Tablet :-Myfocin 500mg (AS A Mefenamic acid AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)).

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Mefenamic acid or

Naproxen (more effective than mefenamic acid)

Tablet 2:-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Indications of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Ecless is indicated for the relief of sign and symptoms of-

rheumatoid arthritis
osteoarthritis
ankylosing spondylitis
juvenile arthritis
tendonitis
bursitis
acute gout

It is also indicated for the management of primary dysmenorrhea & pain.

Pharmacology of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

As with other non-selective NSAIDs, naproxen exerts it’s clinical effects by blocking COX-1 and COX-2 enzymes leading to decreased prostaglandin synthesis. Although both enzymes contribute to prostaglandin production, they have unique functional differences. The COX-1 enzymes is constitutively active and can be found in normal tissues such as the stomach lining, while the COX-2 enzyme is inducible and produces prostaglandins that mediate pain, fever and inflammation. The COX-2 enzyme mediates the desired antipyretic, analgesic and anti-inflammatory properties offered by Naproxen, while undesired adverse effects such as gastrointestinal upset and renal toxicities are linked to the COX-1 enzyme.

Dosage & Administration of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Naproxen oral preparations should be taken with water preferably after meals.

Naproxen Enteric Coated Tablet: Adult:

For rheumatoid arthritis/ osteoarthritis/ ankylosing spondylitis: For adults 500-1000 mg per day taken in two devided doses at 12- hour intervals. The maintenance dose is usually 500 mg per day taken in two devided doses at 12 – hour intervals. The total daily dose of Naproxen should not exceed 1000 mg maintaining 12-hour intervals.
For acute gout: 750 mg should be given initially, then 250 mg every 8 hours until the attack has passed. Children under 16 years are not recommended.
For dysmenorrhoea: For adults 500 mg should be given initially, followed by 250 mg at 6-8 hour intervals for upto 5 days, if necessary.
For other indications like analgesia and acute musculoskeletal disorders: 500 mg should be given initially, followed by 250 mg at 6-8 hour intervals, if necessary.

Naproxen Enteric Coated Tablet: Children: Children under 16 years are not recommended.

Naproxen Suspension: Children:

For juvenile rheumatoid arthritis: The usual dose for children over 2 years is 10 mg/kg/day given as two divided doses at 12-hour intervals. Therapy in children under 2 years of age is not recommended. The following may be used as a guide for dosage of suspension:

13 kg (29 lb) 2.5 mL b.i.d.
25 kg (55 lb) 5 mL b.i.d.
38 kg (84 lb) 7.5 mL b.i.d.

Naproxen Gel: Is to be applied 2-6 times a day as required and is not recommended for use in children.

Side Effects of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Most frequently reported side effects include following:

Gastrointestinal: Heartburn, abdominal pain, nausea, diarrhea, dyspepsia.
Central Nervous System: Headache, vertigo, drowsiness.
Dermatological: Pruritus (itching), purpura.
Cardiovascular: Edema, palpitation.
Others: Visual disturbances, hearing disturbances.

Pregnancy & Lactation of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Most non-steroidal anti-inflammatory drugs may have an adverse effect on the fetus through their pharmacological properties. Naproxen causes a delay in parturition in animals and has been associated with premature closure of the ductus arteriosus and severe pulmonary hypertension in infants born to mothers taking Naproxen. The use of Naproxen in the first and third trimesters requires careful balancing of the benefits to the mother against the possible risks to the fetus. Naproxen is excreted in small amounts in the breast milk for nursing mothers. The amount of Naproxen distributed into breast milk is considered by some authorities to be too small to be harmful to a breast-fed infant although some manufacturers recommend that breast feeding should be avoided during Naproxen therapy.

Therapeutic Class of Tablet :-Ecless 500mg AS A Naproxen Sodium AS A Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).

Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)

•PPI

★Naproxen plus দিলে আলাদা করে PPI দেয়া লাগবে না ★

General Quaries:-

1.unmarried pt der ki TVS suggest kora Jabe frequently?

Answer is:-

TVS indicated for married person…

Unmarried der khetre avoid korbo…unmarried der khetre 5ta point dekhe bujhbo is it primary dysmenorrhea or secondary dysmenorrhea.

Raiyyan Tahsan Date:19-01-2025 Sunday Time:-1-00-35 PM

Raiyyan Tahsan

Raiyyan Tahsan