Pregnency Special Case No 2.Various problem pregnant women.

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Pregnency Special Case No 2.Various problem pregnant women.

প্রেগন্যান্সির সময় অনেক ছোট ছোট সমস্যার মধ্যে দিয়ে একজন মা কে যেতে হয়। এসব সমস্যার অধিকাংশই তারা সহ্য করে যায় কেউ কেউ কিছু কিছুর জন্য ডাক্তারের কাছে আসে। সেগুলো নিয়েই অল্প আলোচনা।

Morning Sicknesses

এটা প্রেগন্যান্সির একদম শুরুর সিম্পটম। মূল কারণ শরীরে Beta HCG বেড়ে যাওয়া। তবে ২০ সপ্তাহের মধ্যে অনেকখানি এর সাথে মায়েরা মানিয়ে নেন। আর কারও বেশী অসুবিধা হলে এন্টি এমেটিক সাথে ভাজাপোড়া,মসলা তেল কম খাওয়া ও বেশী বেশী পানি খাবার উপদেশ দেব।

Tablet: Motigut 10 mg( As a Anti emetic or motility stimulants or Dopamine antagonist or prokinetic drug).

1+0+1 BM

What is Anti emetic drug ?

Answer is: An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may be used for severe cases of gastroenteritis, especially if the patient is dehydrated.Antiemetic drugs are prescribed to help with nausea and vomiting reduce or stopped.

Heart Burn/ GORD

Pregnancy এর সময় যে হরমোন সবচেয়ে কাজ করে তার নাম Progesterone. প্রোজেস্টেরন এর কাজ আমাদের শরীরের Smooth Muscle গুলো রিলাক্স করে দেয়া। আর যখন ইসোফেগাল স্ফিংটার কে সে রিলাএক্স করে দেয় আর সাথে প্রেগন্যান্সির কারণে এবডমিনাল প্রেশার ও বেশী হওয়ায় গ্যাস্ট্রিক এসিড রিফ্লাক্স হয়। বিশেষত থার্ড ট্রাইমেস্টারে প্রচুর হয় এই সমস্যাটি।

এরকম রোগীকে বলব বাম কাত হয়ে ঘুমাবেন,রাতে খাবার ২ ঘন্টা পর ঘুমাতে যাবেন। এবং Alginates & PPI প্রেসক্রাইব করতে পারি।

Tablet: Pantonix 20 mg (As a PPI best pregnancy safe medicine).

1+0+1 for 1 month.

Tablet1:Abicon (500+100)mg Chewable tablet (As a Alginate).AS A Sodium Alginate+Potassium Bicarbonate AS A Antacids.

Indications of Tablet:Abicon (500+100)mg Chewable tablet (As a Alginate).AS A Sodium Alginate+Potassium Bicarbonate AS A Antacids.

Abicon is indicated for the treatment of symptoms resulting from the reflux of acid, bile and pepsin into the esophagus such as acid regurgitation, heartburn, indigestion for instance, after gastric surgery, as a result of hiatus hernia, during pregnancy, accompanying reflux esophagitis, including symptoms of laryngopharyngeal reflux such as hoarseness and other voice disorders, sore throats and cough. Abicon can also be used to treat the symptoms of gastroesophageal reflux during concomitant treatment with or following the withdrawal of acid suppressing therapy.

Pharmacology of Tablet:Abicon (500+100)mg Chewable tablet (As a Alginate).AS A Sodium Alginate+Potassium Bicarbonate AS A Antacids.

This is the combination of Sodium Alginate and Potassium Bicarbonate. Sodium Alginate is a naturally occurring substance. It reacts with the acid in the stomach to form a gel. Potassium Bicarbonate also reacts with the acid in the stomach to form bubbles of carbon dioxide. These bubbles are trapped by the gel formed by Sodium Alginate and they allow the gel to float like a raft on top of the stomach contents. The raft prevents acid in the stomach from flowing back into the esophagus. This relieves the symptoms of reflux such as heartburn. The mode of action of this is physical and does not depend on absorption into the systemic circulation. The raft lasts for up to 4 hours on top of the stomach contents and is then broken down in the digestive system and excreted in the feces.

Dosage & Administration

Tablet:

Adults and children over 12 years: 1-2 tablets 3-4 times daily, after meals and before bedtime.
Children 6-12 years: ½-1 tablet 3-4 times daily, after meals and before bedtime.

Suspension:

Adults and children 12 years and above: 5-10 ml (1-2 teaspoonfuls) 3-4 times daily, after meals and before bedtime.
Children 2-12 years: 2.5-5ml (½-1 teaspoonful) 3-4 times daily, after meals and before bedtime.

Use in children: This is not recommended under 2 years of age.
Elderly: No dose modifications are necessary for this age group.
Hepatic Impairment: No dose modifications are necessary.
Renal Insufficiency: Caution if a highly restricted salt diet is necessary.

Interaction

A time interval of 2 hours should be considered between this intake and the administration of other medicinal products, especially tetracyclines, fluoroquinolones, iron salts, thyroid hormones, chloroquine, bisphosphonates, and estramustine.

Contraindications

Sodium alginate and potassium bicarbonate is contraindicated in patients with known hypersensitivity to these.

Side Effects of Tablet:Abicon (500+100)mg Chewable tablet (As a Alginate).AS A Sodium Alginate+Potassium Bicarbonate AS A Antacids.

In addition to the desired effect of the drug, some side effects may appear such as: nausea, constipation, diarrhea or headache. In these cases consult a physician In case too big dosage has been taken, there might appear a sensation of swelling. In this case it is advisable to consult a physician.

Pregnancy & Lactation

This combination (Sodium Alginate and Potassium Bicarbonate) can be used during pregnancy, if clinically needed. No known effect on breast-fed infants. This combination can be used during breastfeeding.

Precautions & Warnings

Sodium Alginate and Potassium Bicarbonate should be prescribed with caution in patients with renal impairment and congestive cardiac failure. Care needs to be taken in treating patients with hypercalcemia, nephrocalcinosis and recurrent calcium-containing renal calculi. There is a possibility of reduced efficacy in patients with very low levels of gastric acid. If symptoms do not improve after seven days, the clinical situation should be reviewed.

Overdose Effects

Overdosage with this formulation is a rare case. In case of overdose please consult with a registered physician.

Therapeutic Class of Tablet:Abicon (500+100)mg Chewable tablet (As a Alginate).AS A Sodium Alginate+Potassium Bicarbonate AS A Antacids.

Antacids

1+0+1 AFM for 1 month.

What is Alginate medicine?

Alginates are medications that work through an alternative mechanism, by displacing the postprandial gastric acid pocket. It’s used as Gastric reduce problem,The acid pocket is a short zone of unbuffered highly acidic gastric juice that occurs below the esophagogastric junction after meals.

Constipation:

আরেকটা কমন সমস্যা এবং অনেক রোগী এসে এটাও বলেন বাচ্চা পেটে আসার পর আমার বাথরুম আর ক্লিয়ার হয় না! এর জন্য দায়ী সেই প্রোজেস্টেরন, সে Gut motility কমিয়ে দেয়, আর আয়রন সাপ্লিমেন্ট যা প্রেগন্যান্সির শুরু থেকে দেয়া হয়।

এসব রোগীকে বলব পানি এবং ফাইবার বেশী খাবেন এবং Lactulose Syrup দিতে পারি।

Syrup:1:- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Indications of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Constipation (Chronic Constipation): In every case of chronic constipation, initial treatment should consist of a diet rich in fiber (vegetables, salads, fruits etc.) a generous amount of liquids and much physical exercise. Laclose is only to be taken when these measures prove insufficient.

Intestinal flora disturbances:

In damaged to intestinal flora (e.g. following long-term antibiotic treatment)
Gall bladder diseases
Intestinal diseases (Colitis, Diverticulosis, Megacolon)

Increased blood ammonia levels (hyper ammoniemia in hepatopathy, portal-systemic encephalopathy)

Description of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Laclose is a hyperosmolar laxative which is used as an effective treatment approach for constipation. It is a non-absorbable disaccharide which draws water into the bowel; causes distention through fluid accumulation, thus promotes soft stool and accelerates bowel motion.

Pharmacology of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Lactulose is a synthetic disaccharide. Lactulose is metabolized in the colon by the saccharolytic bacteria, producing low molecular weight organic acids (mainly lactic acid), which lowers the pH of the colon contents, promote the retention of water by an osmotic effect; thus increasing peristaltic activity. Lactulose is minimally absorbed; therefore, the pharmacokinetics of the absorbed material are not relevant to the principal therapeutic action.

Dosage & Administration of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

In constipation ( chronic constipation):

Adults: Initially 3-6 tea-spoons daily, In long-term therapy 1½-6 tea-spoons daily
Children up to 14 years: Initially 3 tea-spoons daily, In long-term therapy 1-2 tea-spoons daily
Infants and toddlers: Initially 1-2 tea-spoons daily, In long-term therapy 1 tea-spoon daily

In damaged intestinal flora:

Adults: 1-2 tea-spoons daily
Children: 1 tea-spoon daily

For reduction of blood ammonia level:

Hyper-ammoniemia in hepatopathy: a maximum of 18-30 tea-spoons daily.
In portal systemic encephalopathy: hourly doses of 6-9 tea-spoons of Lactulose solution may be used to induce the rapid laxation. When the laxative effect has been achieved, the dose may then be reduced.

Interaction

There is no significant drug interactions with Laclose. The glycosidic effect of cardiac glycosides can be intensified by potassium deficiency in abuse.

Contraindications of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Hypersensitivity to either galactose and or lactose; galactose-free diet, gastro-cardial symptom complex, suspected intestinal obstruction.

Side Effects of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Occasionally flatulence, cramp and abdominal discomfort can occur at the beginning of treatment; this is rapidly eliminated by reducing the dose. Overdose can result in diarrhoea. In abuse, loss of electrolytes (primarily potassium).

Pregnancy & Lactation

US FDA Pregnancy Category of Lactulose is B. Studies show that Lactulose has no adverse effects. Decisions regarding use during pregnancy and lactation must be made by registered physician.

Precautions & Warnings

Laclose should be administered with care to patients who are intolerant to Laclose. The dose used in the treatment of (pre) coma hepaticum is usually much higher and may need to be taken into consideration for diabetics.

Overdose Effects

There have been no reports of accidental overdosage. In the event of acute overdosage it is expected that diarrhoea and abdominal cramps would be the major symptoms.

Therapeutic Class of Syrup::- Laclose 3.35gm/5ml 100ml bottle (As a Lactulose Osmotic purgatives).

Osmotic purgatives

2 চামচ করে দিনে দুইবার .

Backache/Sciatica

এর জন্যেও দায়ী প্রোজেস্টেরন! সে পেলভিক লিগামেন্টস গুলোকে সফট করে আর Gravid Uterus এর ওজনের কারণেই Backache হয়। এক্ষেত্রে রোগীকে Reassure করতে হবে, নাপা জাতীয় ওষুধ দিতে পারি, হাল্কা স্ট্রেচিং এক্সারসাইজ করতে পারে।

Varicose Vein

Progesterone →Relaxes vascular smooth muscle

&Fetal Weight এই দুই কারণে পেলভিক ভেনাস রিটার্ন কমে যায়, যেকারণে সেকেন্ড বা থার্ড ট্রাইমেস্টারের দিকে ভ্যারিকোজ ভেইন দেখা যায়।

Urinary Symptoms

যেমন – Urinary Frequency →Irritation of bladder by gravid uterus

– UTI also common. রোগীকে UTI এর জন্য কিন্তু Ciprofloxacin দিতে পারব না। আমরা Nitrofurantoin অথবা Cefuroxim দিতে পারি।

Capsule 1. Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective

)

1+0+1 AM for 14 days( As a Nitrofurantoin)

Indications of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Umactin is specifically indicated for the treatment & prophylaxis of urinary tract infections caused by susceptible strains of Escherichia coli, Enterococci, Staphylococcus aureus, Staphylococcus saprophyticus and certain susceptible strains of Klebsiella and Enterobacter species.

Composition of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

50 mg capsule: Each capsule contains Nitrofurantoin (as macrocrystal) USP 50 mg.

100 mg capsule: Each capsule contains Nitrofurantoin (as macrocrystal) USP 100 mg.

Oral suspension: Each 5 ml suspension contains Nitrofurantoin Monohydrate USP equivalent to Nitrofurantoin 25mg.

Pharmacology of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Nitrofurantoin is an antibacterial agent specific for urinary tract infections. Nitrofurantoin is highly soluble in urine, to which it may impart a brown color. Nitrofurantoin inactivates or alters bacterial ribosomal proteins and other macromolecules. Nitrofurantoin has been shown to be active against the following bacteria: Gram-Positive Aerobes Staphylococcus saprophyticus, Coagulase-negative staphylococci (including Staphylococcus epidermidis), Enterococcus faecalis, Staphylococcus aureus, Streptococcus agalactiae, Group D streptococci, Viridans group streptococci. Gram-Negative Aerobes- Escherichia coli, Citrobacter amalonaticus, Citrobacter diversus, Citrobacter freundii, Klebsiella oxytoca, Klebsiella ozaenae.

Dosage & Administration of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Nitrofurantoin tablet (In adults):

Uncomplicated urinary tract infections: 50-100 mg four times a day- the lower dosage level is recommended. Therapy should be continued for one week or for at least 3 days after sterility of the urine is obtained.
For long-term suppressive therapy: In adults, a reduction of dosage to 50-100 mg at bedtime may be adequate.

Nitrofurantoin capsule (In adults):

Acute Uncomplicated Urinary Tract Infections (UTIs): 50 mg four times daily for 7 days.
Long term suppression: 50-100 mg once a day.
Prophylaxis: 50 mg four times daily for the duration of procedure and for three days thereafter.

Nitrofurantoin SR capsule:

Adults and Children over 12 years: One 100 mg capsule every 12 hours for seven days.
Genito-urinary surgical prophylaxis: One capsule twice daily on day of procedure and for next 3 days.

Nitrofurantoin suspension: Children: 5-7 mg/kg/day in four divided doses (contraindicated under one month of age). The average dose of Nintoin suspension for pediatric patients are as follows-

7 to 11 kg: ½ (2.5 ml) teaspoonfuls 4 times daily.
12 to 21 kg: 1 (5 ml) teaspoonfuls 4 times daily.
22 to 30 kg: 1½ (7.5 ml) teaspoonfuls 4 times daily.
31 to 41 kg: 2 (10 ml) teaspoonfuls 4 times daily.

Therapy should be continued for one week or for at least 3 days after sterility of the urine is obtained. For long-term suppressive therapy in children, doses as low as 1 mg/kg per 24 hours, given in a single dose or in two divided doses, may be adequate.

Interaction of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Antacids containing Magnesium Trisilicate, when administered concomitantly with Umactin, reduce both the rate and extent of absorption of Uricosuric drugs, such as Probenecid and Sulfinpyrazone, can inhibit renal tubular secretion of Umactin.

Contraindications of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Anuria, oliguria or significant impairment of renal function are contraindications. This drug is contraindicated in pregnant patients at 38-42 weeks, during labor and delivery. Nitrofurantoin is also contraindicated in those patients with known hypersensitivity to Nitrofurantoin.

Side Effects of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

The most frequent clinical adverse events are nausea, headache, and flatulence. Other less occurred adverse events are diarrhea, dyspepsia, abdominal pain, constipation, emesis, dizziness and drowsiness.

Pregnancy & Lactation

Pregnancy Category B. There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed. Nitrofurantoin has been detected in human breast milk in trace amounts. Because of the potential for serious adverse reactions from Nitrofurantoin in nursing infants under one month of age, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings

If acute, sub-acute or chronic pulmonary reactions occur, Umactin should be discontinued. Antacid preparations containing magnesium trisilicate should not be taken while taking Umactin.

Overdose Effects of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Occasional incidents of acute overdosage of Umactin have not resulted in any specific symptoms other than vomiting. Induction of emesis is recommended.

Therapeutic Class of Capsule:- Umactin BD 100 mg (AS A Nitrofurantoin AS A Systemic Urinary Anti- infective).

Systemic Urinary Anti- infective

Or Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

1+0+1 AM for 10 days As a cefuroxim Axetil

Indications of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

It is indicated for the treatment of infections caused by sensitive bacteria.

Pharyngitis/Tonsillitis caused by Streptococcus pyogenes.
Acute Bacterial Otitis Media caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis (beta-lactamase producing strains) or Streptococcus pyogenes.
Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenzae (non beta-lactamase producing strains)
Lower respiratory tract infections including pneumoniae, caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta lactamase-producing strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pyogenes, E. coli
Acute bacterial exacerbation of chronic bronchitis and Secondary bacterial infections of Acute bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (beta-lactamase negative strains) or Haemophilus parainfluenzae (beta-lactamase negative strains).
Skin and skin-structure infections caused by Staphylococcus aureus (including beta-lactamase producing strains) or Streptococcus pyogenes.
Urinary tract infections caused by E.coli or Klebsiella pneumoniae.
Bone and Joint Infections caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains).
Gonorrhoea caused by penicillinase-producing and non-penicillinase producing strains of Neisseria gonorrhoeae.
Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi.

Pharmacology of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

Cefuroxime is a well-characterized and effective antibacterial agent, which has broad-spectrum bactericidal activity against a wide range of common pathogens, including β-lactamase producing strains. Cefuroxime has good stability to bacterial β-lactamase and consequently, is active against many ampicillin-resistant and amoxycillin-resistant strains.

Dosage of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

Tablet or Suspension-

Adolescents and adults (13 years and older)-

Pharyngitis/tonsillitis: 250 mg b.i.d. for 5-10 days
Acute bacterial maxillary sinusitis: 250 mg b.i.d. for 10 days
Acute bacterial exacerbation of chronic bronchitis: 250-500 mg b.i.d. for 10 days
Secondary bacterial infections of acute bronchitis: 250-500 mg b.i.d. for 5-10 days
Uncomplicated skin and skin structure infections: 250-500 mg b.i.d. for 10 days
Uncomplicated urinary tract infections: 250 mg b.i.d. for 7-10 days
Uncomplicated Gonorrhoea: 1000 mg Single dose
Community acquired pneumonia: 250-500 mg b.i.d. for 5-10 days
MDR Typhoid Fever: 500 mg b.i.d. for 10-14 days
Early Lyme disease: 500 mg b.i.d. for 20 days

Paediatric Patients (3 months to 12 years)-

Pharyngitis/Tonsillitis: 20 mg/kg/day b.i.d for 5-10 days
Acute otitis media: 30 mg/kg/day b.i.d for 10 days
Acute bacterial maxillary sinusitis: 30 mg/kg/day b.i.d for 10 days
Impetigo: 30 mg/kg/day b.i.d for 10 days

Parenteral-

Adult: 750 mg three times daily by IM or IV injection. In severe infections, dose can be increased upto 1.5 gm three times daily by IV injection. The frequency may be increased to four times daily, if necessary, giving total daily doses of 3 to 6 gms.
Children (above 3 months of age): 30 – 100 mg/kg/day given in 3 or 4 equally divided doses. A dose of 60 mg/kg/day is appropriate for most infections.
Neonate: 30 – 100 mg/kg/day given in 2 or 3 equally divided doses.
Surgical prophylaxis: 1.5 gm by IV injection at induction of anaesthesia; up to 3 further doses of 750 mg may be given by IV/IM injection every 8 hours for high risk procedures.
Pneumonia: 1.5 gm IV injection twice daily for 2-3 days, followed by 500 mg twice daily (oral) for 7-10 days.
Acute exacerbations of chronic bronchitis: 750 mg twice daily (IM or IV injection) for 2-3 days, followed by 500 mg twice daily (oral) for 5-10 days. (Duration of both parenteral and oral therapy is determined by the severity of the infection and the clinical status of the patient.)
In Gonorrhoea: Adult: 1.5 gm as a single dose (as 2 x 750mg injections intramuscularly with different sites, e.g. each buttock).

In Meningitis:

Adult: 3 gm IV injection three times daily.
Children (above 3 months of age): 200-240 mg/kg/day by IV injection in 3 or 4 divided doses reduced to 100 mg/kg/day after 3 days or on clinical improvement.
Neonate: 100 mg/kg/day by IV injection at initial dose, reduced to 50 mg/kg/day, When clinically indicated.

In bone and joint infections:

Adult: 1.5 gm IV injection four times daily.
Children (above 3 months of age): 150 mg/kg/day (not to exceed the maximum adult dose) in equally divided doses every 8 hours.

Administration

The use of freshly reconstituted solution is recommended. However, it maintains potency for at least 24 hours at room temperature or 48 hours at 5^o C

Interaction

No potentially hazardous interactions have been reported.

Contraindications of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

Cefuroxime is contraindicated in patients with known allergy to Cephalosporins.

Side Effects of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

Adverse effects to Cefotil have occurred infrequently and have been generally mild and transient in nature. Effects reported include rashes and gastrointestinal disturbances. As with other antibiotics, prolonged use may result in the overgrowth of non susceptible organisms e.g. Candida.

Pregnancy & Lactation

US FDA pregnancy category of Cefuroxime is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Cefuroxime have been shown to be excreted in human milk. So, caution should be exercised when Cefuroxime is administered to a nursing woman.

Precautions & Warnings

Cefotil should be given with care to patients receiving concurrent treatment with potent diuretics & who has history of colitis. Cephalosporin antibiotics may in general be given safely to patients who are hypersensitive to penicillin although cross reactions have reported. Cefotil has shown, that is not likely to be a problem at the recommended to dose levels.

Therapeutic Class of Tablet:Cefotil 500 mg (As a cefuroxim Axetil AS A Second generation Cephalosporins).

Second generation Cephalosporins

Itching& Rashes –

প্রেগন্যান্সির সময় খুব কমন। হরমোনাল ইমব্যালেন্স এর কারণে হয়। তবে এসব রোগীর কোন ইনফেকশান যেমন হার্পিস/ ভ্যারিসেলা আছে কিনা অথবা Obstetric Cholestasis আছে কিনা অবশ্যই এক্সক্লুড করে ইমোলিয়েন্টস এবং সাধারণ Anti itching drugs যেমন deslor, fexo দিতে পারি।

খুব কমন গুলোই বললাম।এছাড়া Tiredness, Headache, insomnia, Calf pain সহ অনেক সিম্পটম দেখা যেতে পারে।

এসব গুলো দেখে ভাবি সৃষ্টিলগ্ন থেকেই একজন মেয়ের সহ্যশক্তি কতটা বেশী!

Raiyyan Tahsan Date:-06-02-2025 Thursday Time:10-29-34 Pm

Raiyyan Tahsan

Raiyyan Tahsan