Montelukast sodium (Singulair)

-LTD4 receptor antagonist leukotrienes result from the action of 5-lipoxygenase on arachidonic acid and are synthesized by a variety of inflammatory cells in the airways, including eosinophils, mast cells, macrophages, and basophils. Leukotriene B4 (LTB4) is a potent neutrophil chemoattractant, and LTC4 and LTD4 exert many effects known to occur in asthma, including bronchoconstriction, increased bronchial reactivity, mucosal edema, and mucus hypersecretion. Indication Chronic asthma and allergic rhinitis Dose: Asthma: Adults & Peds > 15 y. 10 mg/d PO taken in PM. Peds. 25 y: 4 mg/d PO taken in PM. 614 y: 5 mg/d PO in PM. Rhinitis: Adults & Peds > 15 y. 10 mg qd Peds. 25 y: 4 mg qd. 614 y: 5 mg qd Caution: [B, M]Contra: Component allergy Supplied: Tabs 10 mg; chew tabs 4, 5 mg SE: hepatitis A, dizziness, fatigue, rash, GI upset, ChurgStrauss syndrome Notes: Not for acute asthma

Ketotifen H1 receptor antagonist Not used in acute asthma attack Proper Use Make certain your health care professional knows if you are on any special diet, such as a low-sugar diet. The syrup contains carbohydrates. Ketotifen is used to help prevent asthma attacks. It will not relieve an asthma attack that has already started. Ketotifen must be taken continuously in order to be effective. Continue taking your current asthma medications until instructed otherwise by your doctor. Ketotifen may be taken with or without food. Dosing The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. o For oral dosage form (tablets and syrup): For asthma: Adults and children 3 years of age and olderThe usual dose is 1 milligram (mg) (1 tablet or 5 milliliters [mL] of syrup) twice daily, once in the morning and once in the evening. Infants and children from 6 months to 3 years of age Dose is based on body weight and must be determined by the doctor. It is usually 0.25 mL (50 mcg or 0.05 mg) of syrup per kilogram (kg) (110 micrograms [mcg] or 0.110 mg per pound) of body weight twice daily, once in the morning and once in the evening. Missed Dose If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed.

Uterine Prolaspe- nerve supply Uterine prolapse is defined as the propulsion of the uterus through the pelvic floor or vaginal introitus. In first-degree prolapse, the cervix descends into the lower third of the vagina; in second-degree prolapse, the cervix usually protrudes through the introitus; whereas in third-degree prolapse, or procidentia, the entire uterus is externalized with inversion of the vagina. Symptoms include a sensation of inguinal traction, low back pain, urinary incontinence, and the presence of a vaginal mass. Uterine prolapse can occasionally be confused with a cystocele (discussed below), enterocele, or soft tissue tumor.

EMERGENCY DEPARTMENT TREATMENT AND DISPOSITION

Patients with first- or second-degree prolapse should be referred to a gynecologist for pessary placement or surgical correction. With procidentia, the uterus should be manually reduced into the vaginal vault and the patient placed at bed rest until evaluated by a gynecologic consultant.

Uterus blood supply- from uterine artery main branch of internal iliac artery

Nerve supply

Uterine artery divides into cervicovaginal artery- for lower cervix and vagina

Ligament attached