drugs in pregnant fk warmadewa
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http://rds.yahoo.com/_ylt=A0S0201422JICzgBBQyJzbkF;_ylu=X3oDMTByZjdvaWd2BHBvcwMxOQRzZWMDc3IEdnRpZANJMDgyXzEwNA--/SIG=1m48r0214/EXP=1214524664/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253F_adv_prop%253Dimage%2526fr%253Dyfp-t-501%2526va%253Dpregnancy%252Bfunny%2526sz%253Dall%26w=333%26h=500%26imgurl=static.flickr.com%252F2321%252F2460925544_2a47d03bc4.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fwishshaper%252F2460925544%252F%26size=115.4kB%26name=C%2527s%2Bbelly%2Bafter%2BHenna%26p=pregnancy%2Bfunny%26type=JPG%26oid=c48a64a197fa2378%26fusr=wishshaper%26tit=C%2527s%2Bbelly%2Bafter%2BHenna%26hurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fwishshaper%252F%26no=19%26sigr=11jgvclal%26sigi=11g8q7apo%26sigb=1330u1rr6%26sigh=118lvb08i&tt=3699 -
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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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