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Drugs in Pregnancy and Lactation

Drugs in Pregnancy and Lactation 

Drug use during Pregnancy and lactation requires special consideration because both the mother and the child are affected. The selection of appropriate drug and tailoring their dosages in pregnant women is is most important.

Few drugs are considered safe, and drug use is generally contraindicated. Many pregnant or lactating women take drugs for acute or chronic disorders or habitual use of alcohol and tobacco.

It is advisable the drug so selected should have a long history of being safety rather than usage of new drug with unlimited experience.

Example: Methyldopa frequently used in pregnant women to treat chronic hypertension state in pregnant women due to its long history of being safe.

Few general guidelines that should be followed while prescribing the drug to pregnant women which is as follows:

  1. The drug should be completely avoided or atleast minimise during the first trimester.
  2. Usage of possible lowest effective dose.
  3. Drug combination of drugs should be avoided.
  4. Usage of tropical drugs are recommended as these do not undergo systemic absorption.
  5. Usage of drugs with considerable risk should be made only then the potential benefit out weight the risks.

One must always be aware of the teratogenic, toxic or otherwise harmful effects of the drug on the developing fetus. The physiologic changes during pregnancy and the consequent alteration in the pharmacokinetics lead to changes in drug absorption, distribution, metabolism and excretion.

As a general rule, it is best that no drug should be given during pregnancy, especially during the first trimester as it is period of organogenesis. Fortunately, most of drugs commonly used in dentistry are not contraindicated during pregnancy. Tetracycline and streptomycin are notably exceptions.

Pregnancy Trimesters:

First trimester: in this trimester, different body organs in the fetus are forming.

It is most critical time for teratogenicity.

Dental prophylaxis with detailed instructions and a visual examination of the oral cavity without X-rays should be performed if the patient is pregnant.

Elective dental treatment should be avoided in the morning as women may feel nauseated in the morning.

Second trimester:  it is an excellent time for the patient to undergo dental prophylaxis if needed. The patient’s 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 period 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 compression of gravid uterus on the inferior vena cava,resulting in syncope.

Stress can precipitate premature labor.

Due to hormonal changes, gingival tissue shows exaggerated response to local irritants.

Drug Categories Used in Pregnancy – FDA

 Category A:

  1. Adequate studies in human demonstrate no risk.

Category B:

  1. Animal studies indicate no risk, but there are no adequate studies in human.
  2. Animal studies show adverse effects, but adequate studies in human have not demonstrated a risk.

Category C:

A potential risk, when:

  1. Animal studies have been performed or
  2. Animal studies indicated adverse effects and,
  3. There are no data from human studies.
  4. These drugs may be used when potential benefits outweigh the potential risks.

Category D:

  1. There is evidence of human fetal risk, but the potential benefits to the mother may be acceptable.

Category X:

  1.  Studies in animals or humans show adverse reaction reports or both have demonstrated fetal abnormalities.
  2. The risk of use in a pregnant woman clearly outweighs any possible benefit.

Tractors governing pharmaco therapy in pregnancy pregnant state is characterized by certain physiological changes which bring about alteration in pharmacokinetics expects of a drug does the selection of appropriate drug in the pregnant women demand adequate consideration of following factors.

Pharmacokinetics expect expect absorption of drug in pregnant women the high systemic levels of progesterone delay gastric emptying time and also reduce that motility does increase intestinal transit of drug prescription of certain drugs like antacids and iron maybe retard the absorption of Other Drugs does possible interaction should be evaluated Priya to describing the drugs in pregnant womens distribution of drugs in pregnant women and total body water and plasma increases but plasma album in decreases therefore in pregnant women the video of lipophilic drug and protein bound drug also increases hence during pregnancy usage of the depending upon plasma protein binding demand a reduced in their dosage.

Metabolism of drug the high level of progesterone also induce hepatic metabolism haddock metabolizing enzyme due to which specialise lipophilic drug are subjected to Rapid degradation however this effect does not seem to be clinically significant significant in pregnancy pregnancy is also characterized by hundred percent increase in Renal perfusion and 70% increase in glomerular filtration rate this result in relative Rapid renal clearance of those drug that are eliminated by the kidney example Lithium Fino barbitone carbamazepine.
Total pharmacodynamics generally the experience executed by the foetus to a particular drug maybe similar or slide lesser than that of maternal tissue however they are certain drugs universally known to result in considerable harm to the foetus due to various variations in response example a growth and development of foetus teeth and bones are retarded by tetracyclines when the mother is admin status salicylate it result in neonatal hemorrhage usual of, in derivative result in fetal hemorrhage.

Category A drug like antiemetics laxatives antidiarrheal methyldopa digitoxin lidocaine proximate pensiline Azithromycin clindamycin isoniazid chloroquine 13 battalion Paracetamol indomethacin insulin ferrous sulphate.

Are configurable as relative safe drug category A drugs with considerable risk category b, c and d examples are antacids few emetics clindamycin Ranitidine AC ine habitez beta blockers retinal all metoprolol metoprolol Calcium channel blockers Tamil thiazide diuretics aminoglycoside metronidazole tetracyclines Prime MI 2 Prime prime prime try MI 2 Prime try MI 2 Prime theophylline pregnant alone are screen repairing oral sulphonyl urea disappear on carbamazepine nicotine.

Contraindicated drugs category X examples are atropine Misoprostol nitroprusside kama pirenzepine, q9 warfarin Meetha techstreet I mean not telling Meetha techstreet vitamin A estrogens cocaine ethanol LSD.

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