Drugs in Pregnancy Lactation

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Presentation Transcript

Drugs in Pregnancy & Lactation: 

Drugs in Pregnancy and Lactation Brooke Y. Patterson, PharmD, BCPS NU 7080 Advanced Pharmacology Research College of Nursing

Introduction: 

Introduction 4 million live births in the United States annually 50% unplanned Failure to seek pre-natal care Drug-induced teratogenicity FDA Drug Classification System Lack of clinical trial evidence Animal studies vs. human studies

Physiology: 

Physiology First 2 weeks after conception Cell division Implantation in uterus 2-8 weeks after conception Embryonic period Organogenesis 8 weeks after conception to delivery Growth Development

Physiologic Changes in Pregnancy: 

Physiologic Changes in Pregnancy Gastrointestinal Reduced motility Increased pH Decreased serum albumin binding capacity Hepatic metabolism Renal drug clearance Placental drug transfer

Exposure to Medication During Pregnancy: 

Exposure to Medication During Pregnancy Organogenesis First trimester Deformity Death Growth 2nd and 3rd trimester Growth suppression Development 3rd trimester Improper development of vital systems

FDA Drug Categories for Pregnancy: 

FDA Drug Categories for Pregnancy Created based on clinical data Animal vs. human Limited Controversial Comparison to other systems

FDA Drug Categories for Pregnancy: 

FDA Drug Categories for Pregnancy

Category X Medications: 

Category X Medications HMG CoA Reductase Inhbitors (Statins) Cholesterol synthesis important in fetal development Oral Contraceptives Controversial Ergotamines Convulsions, vomiting, diarrhea, gangrene Ethanol Fetal Alcohol Syndrome Isotretinoin Abnormalities, spontaenous abortion Methotrexate Immune system dysfunction Raloxifene Spontaneous abortion

Category D Medications: 

Category D Medications ACE Inhibitors 2nd and 3rd trimester Renal defects Benzodiazepines Neonatal withdrawal, respiratory problems ASA Doses >81 mg/day Closure of the ductus arteriosus, inhibit labor Atenolol Intrauterine growth retardation

Category D Medications: 

Category D Medications Carbamazepine Neural tube defect, BMS(?) Divalproex Neural tube defect, facial abnormalities Doxycycline 2nd and 3rd trimester Tooth abnormalities Angiotensin Receptor Blockers 2nd and 3rd trimester Renal abnormalities Lithium Cardiovascular dysfunction

Category D Medications: 

Category D Medications NSAIDs Use near term may cause peramture closure of the ductus arteriosus, inhibits labor SSRIs Congenital malformations, neonatal behavior syndrome, persistent pulmonary hypertension Phenobarbital Sedation, withdrawal, blood dyscrasias Phenytoin Fetal Hydantoin Syndrome Warfarin Facial abnormalities, fetal hemorrhage

Selecting Medications in Pregnancy: 

Selecting Medications in Pregnancy FDA Pregnancy Category Drugs used most commonly in pregnancy Timing of medication use 1st trimester vs. 2nd or 3rd trimester Lowest effective dose Resources Briggs et al. Drugs in Pregnancy and Lactation FDA

Lactation: 

Lactation

Breastfeeding & Maternal Medication: 

Breastfeeding and Maternal Medication Few drugs Medication Properties Lipophilicity Non-ionized Small molecular weight Resources Briggs et al. Drugs in Pregnancy and Lactation WHO Breastfeeding and Maternal Medication

Breastfeeding Classifications: 

Breastfeeding Classifications Compatible with breastfeeding No known or theoretical contraindications for use Compatible with breastfeeding. Monitor infant for side-effects. Drugs that theoretically could cause side-effects in infant, but have either not been observed to do so or have only occasionally caused mild side-effects. Avoid if possible. Monitor infant for side-effects. Has been reported to cause side effects in the infant. Avoid if possible. May inhibit lactation Avoid. Drugs that have dangerous side-effects on the infant.

Breastfeeding Contraindicated: 

Breastfeeding Contraindicated Radioactive substances Chemotherapy

Avoid Use: 

Avoid Use Tetracycline Metronidazole Quinolone antibiotics

Monitor Baby For Sleepiness: 

Monitor Baby For Sleepiness Psychiatric medications Anticonvulsants

Monitor Baby for Jaundice: 

Monitor Baby for Jaundice Sulfonamides Dapsone TMP/SMX

May Inhibit Lactation: 

May Inhibit Lactation Estrogens Progesterone Thiazide diuretics

Slide21: 

If pregnancy were a book, they would cut the last two chapters -Nora Ephron

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