Drugs Used in Pregnancy

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Drugs used in pregnancy

Presented by nitasha choudhary



Administration of drugs to pregnant patient is of significant Concern.Two main concerns must be addressed when considering whether to give a drug to pregnant patient.

The first is that the drug may be teratogenic. The second is that drug may affect the near term fetus.

p

Pregnancy trimesters
It involves three trimesters: First trimester – in this different body organs in the fetus are forming .it is the most critical time for teratogenicity. Dental prophylaxis with detailed instructions and visual examination of oral cavitywithout xrays should be performed if the patient is pregnant.  Second trimester- it is an excellent time for dental prophylaxis if needed. The patients periodontal status should be carefully
 

Evaluated during this period.  Third trimester –the women begin to feel uncomfortable and it is difficult for her to lie in prone position for long time . Drugs that may affect the newborn should not be given during this trimester. Positioning of patient on dental chair can cause hypotension due to the compression of gravid uterus on inferior vena cava.


Pharmacokinetics in pregnancy
◦ Drug absorption level of progesterone

gastric emptying

Drug absorption So parentral drug administration is preferred to obtain quick response.

Drug metabolism- hepatic drug metabolizing enzymes are induced during pregnancy probably by high concentration of circulating progestrone.this can lead to more rapid metabolic degradation especially of highly lipid soluble drugs.  Drug excretion –during pregnancy renal plasma flow increases by 100% and glomerular filtration rate by 70%.Hence drugs which depend for their elimination mainly on kidney are eliminated more rapidly than in non pregnant stage .e.g Ampicillin ,cephalosporin.


Increase total blood volume – there is increased total blood volume because increased fluid retention ,which leads to change in cardiac output , blood pressure and glomerular filtration rate resulting in changes in the metabolism,absorption and excretion of drug as well as their passage through placenta.  Teratogenicity – It refers to the capacity of drug to cause fetal abnormalities when administered to pregnant mother.


  

Drugs Thalidomide Anti –cancer drug

  



Tetracycline



   

phenytoin
Carbamazepine Retinoids Alcohol

   

Abnormalities Phocomelia. Multiple defects,fetal death. Discoloured &deformed tooth,retarded bone growth. Craniofacial and limb defect,cleft lip and palate. CNS defect Various abnormalities Fetal alcohol embryopathy

Food and drug administration classification system
A B
fetus .This group is limited to multivitamins and prenatal vitamins,not megavitamins. risk to the fetus,but there are no controlled human studies during pregnancy or animal studies have shown adverse effects that was not confirmed in controlled studies during first trimester.
there are no adequate studies or animal studies have shown adverse effects.

-controlled studies showed no risk to

-either animal studies have shown no

C





Potential benefit must be greater than the risk to the fetus if these are used.

D E

potential benefit must be thought to outweighs the risks.

-evidence of fetal risk is proven ,but

proven fetal risk clearly outweighs any potential benefit.

-

Commonly used drugs and their effects in pregnant women
Drugs FDA
Crosses placenta Effects in first trimester

Analgesi cs
Paraceta B mol Aspirin C
Yes Yes Yes Yes Yes No Limited dose No

Effects in 2nd and 3rd trimester

Yes No Limited dose Can produce neonatal respiratory failure.

Codeine C Morphin e B

ibuprofe B n Ampicilli B n Penicilli C n Erythro mycin B

Yes Yes

Yes no {cautiou sly} No No

Yes
Yes

No
Hepatot oxicity during pregnan cy . No

No

Hepatot oxicity during pregnan cy. Stains teeth and affects

tetracycl ine

Yes

Clindam B ycin Metrani dazole

Yes

o.1 -10% risk of pseudome mbranous colitis No

Same

B

Yes

No

Local anesthe tics Lidocain C e Bupivica C ine Mepivic aine C

Yes
Yes Yes

No

High dose cause cns depression Same

Cause cvs collapse No

No

Adrener

Dental management of pregnant women


treatment is to eliminate the source of pain . Thus for removal of caries ,an infected pulp or tooth surgical procedure should be done under small doses of local anaesthesia to minimize the use of systemic drugs .  First trimester- it is roughly of 12-13 weeks ,in the 1st 12 days exposure to harmful drugs can kill the embryo,from the 13th day the period of organogenesis starts and the fetus is susceptible to injury and insult resulting in malformation.  2nd and 3rd trimester- there is considerable development of structures like teeth , bone,cns,endocrine ,etc. so, malformation is less but drugs like streptomycin can still be harmful causing retardation of physical and mental growth and premature labor .

Elective treatment –the best method of

     

Preventive dental prophylaxis Radiographs Reduce chair time Position Fainting Severe complications

 Guidelines for prescribed drugs  Don’t use drug unless it is absolutely necessary.  Ruling out possibility of pregnancy.  Risk and benefit ratio .  Lower doses.

Thank you

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