Drugs in Pregnant FK Warmadewa

8/10/2019 Drugs in Pregnant FK Warmadewa

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http://upload.wikimedia.org/wikipedia/commons/b/b5/Pregnancy_26_weeks.jpg


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Teratogens

A substance, organism, physical agents ordeficiency state capable of inducing abnormalstructure or function such as:

Gross structural abnormalities

Functional deficiencies

Intrauterine growth restriction

Behavioral aberrations


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Drug Transfer to the Fetus Placental transfer may occur by:

Passive diffusion

Facilitated diffusion

Active transport

Placental surface area

Placental metabolism


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Drug Passage into Breast Milk

Diffusion from maternal plasma into milk

Higher maternal plasma levels mean higher

breast milk concentrations Equilibrium will be established with most

drugs between milk and plasma


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STADIUM EMBRIOGENESISWeek II- late week VIII

Most sensitive stadiumOrgan development


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STADIUM FETOGENESIS

Late week VIII

Growth and development stadium

Histogenesis CNS


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DRUGS GIVEN AFTER THE

FIRST TRIMESTER

1. Heparin

- Vertebral compression fractures- Osteoporosis

2. Warfarin

- Bleeding into the fetal brain

3. Anticonvulsants- Neonatal coagulation defect

- Sedation


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4. Cloramphenical

- Gray baby syndrome

- Cardiovascular collapse

5. Tetracycline

- Tooth discoloration- Enamel hypoplasia

- Bone dysplasia

6. Aminoglycosides

- Fetal ototoxicity


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7. Sulfonamide- Neonatal jaundice

- Hemolytic anemia

8. Ciprofloxacin

- Fetal cartilage damage

9. -Blockers

- Intrauterine growth retardation,

hypoglycemia, hypotension,bradycardia, death


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PHARMACOKINETICS

1. Molecular Size

- 250-500 can cross easily

- 500-1000 cross with moredifficulty

- Greater than 1000 cross very

poorly


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2. Lipid solubility- Lipophilic drugs readily cross placenta(thiopental)

3. Ionization- Highly ionized cross the placentaslowly (succinylcholine,tubocurarrine)

- anionized is highly lipid soluble


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4. Protein binding

Only unbound drug is capable ofcrossing the placenta

Drugs with low protein binding reachhigher concentrations in the fetus thanmom

Ex: Ampicillin, digoxin


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2. Therapeutic drugs actions in the fetus- Corticosteroid lung maturation

- Phenobarbital Jaundice is lower

3. Predictable toxic drugs action in the fetus

- Chronic use of opioids

- ACE-inhibitor

- Diethylstilbestrol

4. Teratogenic drugs actions


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DRUGS IN THE FIRST

TRIMESTER

1. AnticonvulsantsPoor growth, nail hypoplasia, microcephaly,cleft lip or palate

2. Phenytoin

- Craniofacial- Limb

- Growth deficiencies


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3. Sodium valproate- CNS

4. Carbamazepine

- Craniofacial

- Fingernail

5. Sex hormone

- Cardiac defects

- Multiple anomalies


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Drug classification for pregnancy

Category AControlled studies in pregnant women fail to

demonstrate a risk to the fetus in the first trimesterwith no evidence of risk in later trimester.

EX: Paracetamol

Category B

Presumed safety based on animal studies, with no

controlled studies in pregnant, or animal studies haveshown an adverse effect that was not confirmed incontrolled studies in women in the first trimester andthere is no evidence of a risk in later trimesters

EX: Penicilline


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Category C

Studies in women and animals are not available orstudies in animals have revealed adverse effects on thefetus and there are no controlled studies in women.Drugs should be given only if the potential benefitsjustify the potential risk of the fetus

EX: Corticosteroid, Vitamin D, Vitamin B12

Category DThere is positive evidence of human fetal risk (unsafe),

however in some cases such as a life-threatening illness

the potential risk may be justified if there are no otheralternatives

EX: Warfarin, Fenitoin, Sodium Valproat, Diazepam,obat kanker


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Penicillins Category B in pregnancy

Crossthe placenta easily and rapidly

Concentrations equal maternal levels

Lactation

Crosses in low concentrations

Compatible with breastfeeding


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Aminoglycosides

(amikacin, gentamicin, tobramycin) Pregnancy Category C

Rapidly cross placenta

Enter amniotic fluid through fetal circulation

Lactation

Compatible with breastfeeding Not absorbed through GI tract


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Sulfonamides

Pregnancy Category C

Readily cross the placenta

Concerns of use at term

Lactation

Excreted into breastmilk in low levels Use should be avoided in premature infants


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Tetracyclines

(doxycycline, minocycline, tetracycline) Pregnancy Category D

Can cause problems with teeth and bone and

other defects/effects Have been linked to maternal liver toxicity

Lactation

Compatible with breastfeeding

Serum levels in infants undetectable


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Drugs in Pregnant FK Warmadewa

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