Professional Documents
Culture Documents
Objectives
To introduce concepts related to administration of drugs to pregnant women
To understand how drugs are classified to guide use during pregnancy To be able to provide appropriate guidance on drug use during pregnancy
To understand drug use during breastfeeding To be able to provide appropriate guidance on drug use during breastfeeding
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Reading
Chapter - Pregnancy and Lactation Pharmacotherapy Handbook 6th Ed. Barbara G Wells (Editor), Joseph T DiPiro (Editor), Terry L Schwinghammer (Editor), Cindy W Hamilton (Editor) Chapter - Pregnancy and Lactation: Therapeutic considerations McCombs J and Cramer MK IN: Pharmacotherapy: a pathophysiological approach. 6th Edition. Ed. Joseph T. Dipiro et al. Elsevier Science Publishing Co. Inc., New York 1999.
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Normal pregnancy
40 weeks from date of conception
Generally divided into 3 trimesters
1:25 babies born in Australia has a birth defect General health advice
Smoking Folic acid supplementation
> Neural tube defects
Diet
During first 2 weeks (conception to first missed period) embryo is thought to be resistant to teratogenic effects Critical period of development is 17 days70 days post conception
Exposure during this period can cause major birth defects
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What is a teratogen?
A chemical which has the capability to produce congenital abnormalities Factors influencing teratogenicity of a drug include:
Genotype of mother and fetus Embryonic stage at exposure Dose Specificity of drug
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Case 1
Mrs McDonald enters the pharmacy and says that she needs to take regular medication but would like to become pregnant. What effect will it have on the baby?
What do you tell her? Where will you find the information?
Case 2
28yr old women asks the pharmacist for advice on whether she can still take her antiepileptic drug whilst she is pregnant.
What are her options? Where can you find the information you need? What should you tell her?
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> Calcium channel blockers Potential to cause fetal hypoxia due low maternal BP > Statin hypolipidaemics Cholesterol is necessary for fetal development > Opiod analgesics May cause fetal respiratory depression or withdrawal symptoms in newborn > Aspirin Avoid in last trimester Inhibits prostaglandin synthesis
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Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.
> Carbamazepine (Tegretol), phenytoin (Dilantin), sodium valproate (Epilim) > Doxycycline > most anticancer agents > ACE inhibitors (eg.enalapril) and AII antagonists (e.g.losartan)
Intereferes with renal development in second and third trimester, resulting in renal dysfunction
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Add a supplement
If continuing with necessary drug therapy then may need to add supplements to reduce chance of teratogenic effects
Folic acid supplementation Vit K (prevent haemorrhagic disease of the newborn) Both could be used in antiepileptic agentssome have been implicated in above condition)
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Hyperthyroidism
> Consider surgery prior to pregnancy > either methimazole or propylthiouracil (PTU)can be continued through pregnancy using the smallest possible dose
High doses may cause congenital goitre
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