pharmacology pregnancy and nursery women.pptx

8/11/2019 pharmacology pregnancy and nursery women.pptx

1/26

DRUG THERAPY FOR

PREGNANCY AND

NURSERY WOMEN

Anggelia Puspasari, MD

Pharmacology and Therapeutic Dept.

Medical Faculty University of Jambi


2/26

DRUG THERAPY IN

PREGNANCY


3/26

FACTORSAFFECTINGPLACENTALDRUG

TRANSFERANDDRUGEFFECTSONTHEFETUS(PHARMACOKINETIC)

a. Physicochemical drug

b. Rate drug crosses placenta amount

of drug reaching fetus

c. Duration drug exposure

d. Distribution in different fetal tissues

e. Placental and fetal development stage

f. Effects of drugs used in combination


4/26

PHARMACOKINETIC (DRUG)

LIPID SOLUBILITY

Lipophilic drug diffuse readily across the placenta andenter the fetal circulation

exe: thiopental

Highly ionized cross the placenta slowly and achievevery low concentrations in the fetus

Exe : succinylcholine and tubocurarine

MOLECULAR SIZE

Cross placenta easly 600 kDa,,,poorly cross placenta

1000 kDa.Placenta transporter can carry drug to fetus.

Exe: heparin safe than warfarin as anticoagulant forpregnancy women.


5/26

PHARMACOKINETIC (PLASENTAAND

FETUS)

PLACENTAL TRANSPORTER

P-glycoprotein transporter low fetalconcentrationantiviral, protease inhibitor

PROTEIN BINDING

Drug very lipid soluable more depend on placenta bloodflow.

Poorly lipid-soluble and ionized, impeded by its binding tomaternal plasma proteins.

PLACENTAL DAN FETAL DRUG METABOLISM

Placenta is semipermeable barrier and as a site ofmetabolism.

Drugs that have crossed the placenta enter the fetalcirculation via the umbilical vein ( fetal liver metabolism)


6/26

PHARMAKOKINETIC (PREGNANCY

PHYSIOLOGY)

GASTRO INTESTINAL TRACT Gastric emptying and small intestine motility are reduced in

pregnancy due to elevation of progesterone increaseTmax and reduce Cmax

Increase in gastric pH absorption weak acid reduced than

weak base Reduced efficacy of single dose drug

RESPIRATORY & CARDIOVASCULAR Increased cardiac output and tidal volume increased

absorbing inhale drug

Increased plasma volume and extravascular waterincreasing Vd hydrofilic drug, decreasing Cmax

Decreased plasma albumin concentration Increasingfree drug (albumin bound)


7/26

PHARMAKOKINETIC (PREGNANCY

PHYSIOLOGY)

HEPATIC METABOLISM

Hepatic cytochrome P-450 system are induced by

oestrogen/progesterone, resulting in a higher rate of

metabolismexe: phenytoin.

RENAL CLEARANCE

RBF is increased by 6080%, GFR rises by 50%,

leading to enhanced elimination of drugs that are

normally excreted unchanged. penicillin and

digoxin


8/26

PHARMACODYNAMIC

MATERNAL DRUG ACTION

Reproductive tissues (breast, uterus, etc) are

sometimes altered

Other maternal tissues (heart, lungs, kidneys, central

nervous system, etc) are not changed significantly

THERAPEUTIC DRUG ACTIONS IN THE FETUS

Drug administration to the pregnant woman with the

fetus as the target of the drug.

Corticosteroid, phenobarbital, zidovudin


9/26

PHARMACODYNAMIC

PREDICTABLE TOXIC DRUG ACTIONS IN THE

FETUS

ACEI..renal damage

DES..adenocarcinoma vagina

OPIOIDwithdrawl syndrom

TERATOGENIC DRUG ACTIONS

Teratogen:

Result in a characteristic set of malformations,

indicating selectivity for certain target organs

Exert its effects at a particular stage of fetal

development

show a dose-dependent incidence


10/26

TERATOGENIC DRUG


11/26

FOODANDDRUGADMINISTRATIONSYSTEM

FORTERATOGENICPOTENTIAL

A

Controlled studies in women fail to demonstrate a risk to the fetus in the first

trimester (and there is no evidence of a risk in late trimesters), and the possibility

of fetal harm appears remote.

B

Either animal-reproduction studies have not demonstrated a fetal risk, but there

are no controlled studies in pregnant women, or animal-reproduction studies

have shown an adverse effect (other than a decrease in fertility) that was not

confirmed in controlled studies in women in the first trimester (and there is no

evidence of a risk in later trimesters).

C

Either studies in animals have revealed adverse effects on the fetus (teratogenic

or embryocidal or other) and there are no controlled studies in women or studies

in women and animals are not available. Drugs should be given only if the

potential benefit justifies the potential risk to the fetus.

D

There is positive evidence of human fetal risk, but the benefits from use in

pregnant women may be acceptable despite the risk (eg, if the drug is needed ina life-threatening situation or for a serious disease for which safer drugs cannot

be used or are ineffective).

X

Studies in animals or human beings have demonstrated fetal abnormalities or

there is evidence of fetal risk based on human experience or both, and the risk of

the use of the drug in pregnant women clearly outweighs any possible benefit.

The drug is contraindicated in women who are or may become pregnant.


12/26

Because any medication can present risks in

pregnancy, and because not all risks are known,

the safest pregnancy-related pharmacy is as little

pharmacy as possible.


13/26

NURSERY WOMEN


14/26

INTRODUCTION

As most drugs are excreted into the milk by passive

diffusion, the drug concentration in milk is directly

proportional to the corresponding concentration in

maternal plasma.

The milk to plasma (M:P) ratio, which compares milk

with maternal plasma drug concentrations, serves as

an index of the extent of drug excretion in the milk.

For most drugs the amount ingested by the infant

rarely attains therapeutic levels.


15/26

PHARMACOKINETIC ( DRUG)

Greater Vd (Volume distribution) lower plasma drugcoencentration lower breast milkcoencentration..1-20L/kg, compatible for breastfeeding women.

High PB (protein binding) reduced infantexposure..90%, compatible

800kDa less likely pass into breast milk

Greater pH drug, increased breast milk coencentration

Water soluable drug, decreased breast milk

coencentration Shorter T1/2, decreased infant exposure

M/P ratio < 1, safe for nursery women

Passive transport


16/26

PHARMACOKINETIC (INFANT &

MATERNAL)

Infant should be categorized low (6-18 mo) risk,

moderate (younger 6 mo), or high (preterm infant,

unstable infant, who have poor renal output) risk for

the medication interest.

Infant can absorbed, metabolized and secreted the

drug, altough extensively different.

Infant have higher body water percentage

Immature stratum corneum

Clearance of teophilin, phenytoin higher than adult

GIT less acidic transit time longer than adult


17/26

PHARMACOKINETIC (INFANT &

MATERNAL)

Maternal factor (breast milk) secretion higher in the

morning but breast milk late at the morning rich of

fat.

Milk production in 1stor 2ndday post partum is so

low that the overall dose of medication transferred

is usually insignificant.

Drug that are not absorbed by the mother generally

(topically, inhaled or applied to the eye) dont

produced significant level in the plasmacompartement.


18/26

MINIMIZING THE RISK TO THE INFANT

Avoid feeding infant at Cmax (this only work with shortT1/2 and only useful in few case)

Choose medication that produced minimal level in milk

Choose medication that are used commonly in pediatricpatient and are considered safe

Choose medication that have high protein binding (lowerlevel at milk)

Choose medication that have poor blood/brainpenetration (lower level at milk)

Choose medication that have higher molecular weight

With really hazardous medication temporarily withholdbreast feeding for brief exposure (elimination T1/2). Milkproduced during the exposure should be pumpout/discard.


19/26

DRUG THERAPY

Drug coencentration in breast milk lower than in

plasma.

Infant dosage can minimized by breast feeding just

prior to drug administration, when maternal drug

serum in lowest.


20/26


21/26


22/26


23/26


24/26


25/26

Maternal medication usually compatible for with

breast feeding read more at

Official American academic of pediatric


26/26

THAX FOR Ur ATTENTION

pharmacology pregnancy and nursery women.pptx

Documents