Medication during pregnancy

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Medication during pregnancy

  1. 1. Prepared by Mohammad Alauddin Pharmacist – United Hospital LTD.
  2. 2. MEDICATION DURING PREGNANCY During pregnancy, some medications are safe and some are not. Some require a higher than usual dose, and some doses change with the advancing pregnancy. Drugs should be given only if the potential benefit justifies the potential risk to the fetus."
  3. 3. CATEGORIES The pregnancy category of a drug is an assessment of the risk of fetal injury occurred by that drug.
  4. 4. CATEGORIES The U.S. Food and Drug Administration has generated a grading system for medications used during pregnancy. The categories are A, B, C, D, and X. The significance of these categories are :-
  5. 5. CATEGORY A Definitions Drugs that have been tested for safety during pregnancy and have been found to be safe.
  6. 6. CATEGORY A Clinical Application For all practical purposes, there are no Category A drugs. Drugs, and some multivitamins This includes folic acid, vitamin B6, and thyroid medicine classified as Category A.
  7. 7. CATEGORY B Definitions Drugs that have been used a lot during pregnancy and do not appear to cause major birth defects or other problems.
  8. 8. CATEGORY B Clinical Application • Category B drugs include vitamins, acetaminophen (Napa), famotidine (famotid), prednisolone (cortan), insulin (for diabetes), and ibuprofan (inflam) before third trimester, ibuprofen should not take during the last three months of
  9. 9. CATEGORY C Definitions • Drugs that are more likely to cause problems for the mother or fetus. Also includes drugs for which safety studies have not been finished. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.
  10. 10. CATEGORY C Clinical Application • There are some reasons to be more concerned about these drugs than Category B drugs. If the pregnant patient will benefit from a Category C drug, it is generally used. These drugs include fluconazole (Fluda), and ciprofloxacin (Xirocip), some antidepressants are also included in this group.
  11. 11. CATEGORY D Definitions • Drugs that have clear health risks for the fetus. but the benefits from use in pregnant woman may be acceptable despite the risk (e.g., if the drug is needed in a lifethreatening situation or for a serious disease.)
  12. 12. CATEGORY D Clinical Application • Category D drugs includes alcohol, lithium (used to treat manic depression), phenytoin (eptoin), and most chemotherapy drugs to treat cancer. They should be used during pregnancy only when no alternatives available.
  13. 13. CATEGORY X Definitions • Drugs that have been shown to cause birth defects and should never be taken during pregnancy. The drug is contraindicated in women who are or may become pregnant."
  14. 14. CATEGORY X Clinical Application • Category X drugs should not be used during pregnancy. This includes drugs to treat skin conditions like cystic acne (Accutane), a sedative (thalidomide) etc.
  15. 15. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Analgesics and Antipyretics (zydol) B and C Acetaminophen(Napa) B Phenacetin(vicks) B Aspirin(Ecosprin) C Antiemetics(Emistat) B and C Doxylamine(gestrenol) B Meclizine(emezin) B
  16. 16. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Cyclizine(marezine) B Dimenhydrinate(pedeamine) B Antibiotics B, C and D Penicillin, Ampicillin, Amoxycillin, B Cloxacillin Cephalosporins B Erythromycin(erocine) B Gentamicin(gentin) C
  17. 17. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Amikacin(kacin) C/D Streptomycin D Sulphonamides(burnsil) B/D Tetracyclines(tetrax) D Amoebicides(Filmet) Anthelmentics -
  18. 18. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Albendazol B Mebendazole B Antimalarials C Antifungals C Anti TB Drugs B and C Ethambutol B INH C
  19. 19. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Pyrazinamide C Vitamins - B,C,D,E,folic acid A Hormones - Thyroxin A Androgens X Estrogens X
  20. 20. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Drugs Categories Progestogens - Hydroxyprogestrone D Medroxyprogestrone D Norethindrone X Norgestrel X Bronchodilators C
  21. 21. COMMONLY USED DRUGS IN PREGNANCY AND THEIR CATEGORIES Since it is not a complete list, patients are advised to check the drug label of each drug before taking them during pregnancy.
  22. 22. SAFE MEDICATION TO TREAT DURING PREGNANY • Allergy Benadryl (diphenhydramine). • Cold and Flu Tylenol (acetaminophen) Saline nasal drops or spray Warm salt/water gargle • Constipation Colace Metamucil
  23. 23. SAFE MEDICATION TO TREAT DURING PREGNANY • First Aid Ointment Bacitracin J&J First-Aid Cream Neosporin Polysporin. • Rashes Benadryl cream Caladryl lotion or cream Hydrocortisone cream or ointment.
  24. 24. WHAT CAN I EAT IF I AM NOT FEELING WELL? Pregnancy symptoms vary. Some woman may have difficulty with morning sickness, diarrhea, or constipation. Here are a few suggestions on how to deal with these symptoms.
  25. 25. Morning sickness For morning sickness, try eating crackers, before you get out of bed. Eat small meals more frequently throughout the day. Avoid fatty, fried foods. Constipation Increase your fiber intake by eating high fiber and fresh fruits and vegetables. Also, make sure you are drinking plenty of water - at least eight glasses per day. Diarrhea Increase your intake of foods containing pectin and gum fiber to help absorb excess water. Good choices include: applesauce, bananas, white rice, refined wheat bread, and smooth peanut butter. Heartburn Eat small frequent meals throughout the day. Try drinking a glass of milk before your meal. Avoid caffeine. Try not to lie down after eating a meal.
  26. 26. MEDICATIONS SAFE IN PREGNANCY • Some antibiotics namely Amoxycillin, Ampicillin, Cephalosporins, Erythromyc in. • Levothyroxine. • Acetaminophen. • Folic Acid and Vitamin B6. • Methyl dopa, and hydralazine. • Insulin. • Heparin.
  27. 27. MEDICATIONS CONTRAINDICATED IN PREGNANCY • Some drugs in category X that are contraindicated in pregnancy and their effects on the fetus are listed below:• Vitamin A and its derivatives Accutane(Isotretinoin), can cause Birth defects. • Thalidomide – Seal like limbs and other defects.
  28. 28. MEDICATIONS CONTRAINDICATED IN PREGNANCY • Diethylstilbestrol – Causes cancer of the vagina or cervix in female children during their teenage years. • Warfarin (Warin) – Causes multiple birth defects. • Danazol (Danzol) – Causes malformations in sex organs of female fetus.
  29. 29. MEDICATIONS CONTRAINDICATED IN PREGNANCY • Simvastatin (Avastin)and other statins – Cholesterol is needed for fetal growth and its reduction by statins could harm the fetus • Finasteride (pronor) – Though finasteride is normally not prescribed to women, pregnant women should not handle broken or crushed tablets since it can get absorbed through the skin and affect the sex organ.
  30. 30. MEDICATIONS CONTRAINDICATED IN PREGNANCY • Testosterone (Testanon) – Can cause birth defects. • Oral contraceptivesCan cause birth defects. • Dutasteride (Urodart) – Affects the sex organ development of the fetus. • Methotrexate (Trexonate)– Causes cleft palate along with multiple defects.
  31. 31. MEDICATIONS CONTRAINDICATED IN PREGNANCY • Aspirin – Aspirin and other drugs containing salicylate are not recommended during pregnancy, especially during the last three months. Acetylsalicylate, a common ingredient in many OTC painkillers, may make a pregnancy last longer and may cause severe bleeding before and after delivery.
  32. 32. NSAIDs causes patent ductus arteriosus (PDA). (PDA)- failure of closure of ductus Arteriosus usually present in every fetus before birth, infants after birth.
  33. 33. Lithium salts (Lithosan SR) causes
  34. 34. Ebstein's anomaly Congenital heart defect in which the opening of the tricuspid valve is displaced towards the right
  35. 35. Thalidomide causes
  36. 36. Thalidomide caused Phocomelia
  37. 37. Folic acid deficiency caused Neural tube defects. (Spina bifida, Encephaly, Encephalocele) Valproic acid(epilim) causes decreased absorption of Folic acid and leads to deficiency of folic acid which may results in neural tube defects in the fetus.
  38. 38. Spina bifida is a developmental conge nital disorder caused by the incomplete closing of the embryonic neural tube Some vertebrae overlying the spinal cord are not fully formed and remain infused and open. Spina bifida
  39. 39. Anencephaly (without brain) is a neural tube defect that occurs when the head end of the neural tube fails to close, usually during the 23rd and 26th days of pregnancy. Encephaly
  40. 40. Encephalocele are Encephaloceles characterized by the skull that are sac-like and covered with membrane. They can be a groove down the middle of the upper part of the skull, between the forehead and nose, or the back of the skull.
  41. 41. Paroxetine (oxat) (Selective serotonin re-uptake inhibitor). Causes cardiac defects.
  42. 42. Paroxetine causes cardiac defects in fetus
  43. 43. Alcohol induced Fetal Alcohol Syndrome Fetal alcohol syndrome (FAS) is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, which can result in psychological or behavioral problems, and cause other physical damage.
  44. 44. Valproic acid induced Fetal Valproate Syndrome Valproate syndrome include facial features, tall forehead, medial deficiency of eyebrows, lat nasal bridge, broad nasal root. Valproic acid is contraindicated in pregnancy, as it decreases the intestinal reabsorption of folate (folic acid), which leads to neural tube defects.
  45. 45. If taken by a pregnant mother, Carbamazepine can cause birth defects that include:- cardiovascular and urinary tract anomalies, cleft palate, fingernail hypoplasia, developmental delays, and intrauterine growth restrictions.
  46. 46. Phenytoin induced Fetal Hydantoin Syndrome Fetal hydantoin syndrome, also called fetal dilantin syndrome is a group of defects caused to the developing fetus by exposure to the teratogenic effects of phenytoin or carbamazepine.
  47. 47. Opoid analgesic induced Drug withdrawal syndromes
  48. 48. Drug withdrawal syndromes
  49. 49. Isotretinoin (Vitamin A derivative) induced Fetal defects
  50. 50. Fetal defects
  51. 51. Smoking Induced Fetal defects like Cleft palate, Premature births, Low birth weight, Abortions.
  52. 52. Smoking Induced
  53. 53. This Presentation is Dedicated to My Mother

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