Drug Use During Preg And Lact

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SOME DRUGS GIVEN TO MOM FOR THERAPEUTIC EFFECT ON FETUS

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DIG-fetal tachy/heart failure
LEVOTHYROXINE-HYPOthyroidism
PENICILLIN-maternal syphillis
CORTICOSTERIODS-promote surfactant production;improve lung fnx/decrease resp distress in preterm infants

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SUPPLEMENT ESPECIALLY IMPORTANT FOR THE PREVENTION OF NEURAL-TUBE DECECTS (SPINAL BIFIDA)

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Folic Acid-woman of child bearing age should be encouraged to take400-600 mcg daily

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CATOGORY C MEANS:

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inadequate studies in pg women and effects on the fetus are unknown (FDA)
should only be used in potential benefit to mom justifies potential harm to fetus

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ADRENERGICS: CATEGORY C
CARDIAC STUM. INCREASE HR AND F.O.C., MAY INCREASE BP

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po & iv: may inhibit uterine contractions in labor, cause HYPOkalemia, HYPOglycemia, pulm edema in mom=HYPOglycemia in neonate
inhaled: (albuteral) effects unlikely

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ANALGESICS, OPIOID: CAT C

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cross placenta rapidly. codeine is assos. c congenital defects
decrease contractility; slow progress to delivery
resp depress. in neonate
narcan is opioid antagonist

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ACE-I: CAT C 1ST TRI, CAT D 2ND AND 3RD TRI.
DISCONTINUE WHEN PG IS DETECTED

SAME GOES FOR ARBs 11
(angiotension receptor blockers)

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DEATH IN FETUS AND NEONATE. MAY CAUSE HYPOTENSION, SKULL HYPOPLASIA, ANURIA, RENAL FAILURE
OBSERVE NEONATE C HX OF EXPOSURE FOR HYPERKALEMIA, OLIGURIA HYPOTENSION

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ANTIANGINAL

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DECREASE BLOOD SUPPLY
USE ONLY IF NECCESSARY

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BENZOS:
AVOID

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IF TAKEN DURING LABOR MAY CAUSE SEDATION, RESP DEPRESSION, HYPOTONIA, LETHARGY, TREMORS, IRRITABILITY AND SUCKING DIFF IN NEONATE

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ABTIBACTERIALS:
AVOID MOST BUT PENICILLINS OK, EVEN THO THEY CROSS PLACENTA, ALSO CSPHALOSPORINS SAFE
WHAT ARE SOME OTHER SAFE AND UNSAFE .....

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AMINOGLYCOSIDES=CAT D NEPHRO AND OTOTOXIC

FLUORQUINOLONES: CAT C CONTRATINDICATED; POSS JOINT DAMAGE

CLINDAMYCIN=CAT B USE C PENICILLIN ALLERGY

MACROLIDES: CAT B CROSS PLACENTA, SAFE CLARITHROMYCIN CONTRA IF SAFER ALTERN IS AVAIL
NITROFURANATION: CAT B CONTRA IN LATE PG, HEMOLYTIC ANEMIA NEONATE
SULFONAMIDES: CAT C CONTRA IN 3RD TRI, KERNICTERUS IN NEONATE
TETRACYLINES: CAT D CONTRA. TEETH AND BONE GROWTH ISSUES
VANCO: CAT C FETAL EFFECTS UNKOWN

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ANTICHOLINERGICS: CAT C

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ATROPINE=EFFECTS DEPEND ON MATURITY OF PARASYMPATHETIC NERV. SYS.
SCOPOLAMINE=NEONATE HEMORRHAGE D/T REDUCED K

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ANTICOAGS: CAT C/D

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HEPARIN= CAT C DOES NOT CROSS PLACENTA SAFE
WARFARIN= CAT D CROSS PLACENTA UNSAFE-BLEEDING, SPONT.ABORT. STILLBORN

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ANTIDIABETICS: MOST CAT B
INSULIN ASPART AND GLARGINE ARE CAT C=ONLY ONES RECOMM. FOR PG

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SULFONYLUREAS CAT C EXCEPT GLYBURIDE, UNSAFE

ACROBOSE,METFORMIN,MIGLITOL ARE CAT B
NATEGLIDIDE, PIOGLITAZONE,REPAGLIDIDE,
ROSIGLITAZONE ARE CAT C

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ANTIEMETIC

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ALL UNSAFE, IF NEEDED, ANTIHISTAMINE cyclizine and dimenhydrinate ARE CAT B

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ANTIEPILEPTICS (AEDs)

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Older drugs such as carbamazepine, phenytoin, and valproate are known teratogens and FDA risk category D. Valproate can produce neural-tube defects such as spina bifida.
Newer drugs (eg, gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, zonisamide) are FDA risk category C, and their effects on human fetuses are largely unknown

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Antifungals

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Amphotericin B, including lipid formulations, is risk category B
Caspofungin, fluconazole, itraconazole, and ketoconazole are risk category C
Voriconazole is risk category D

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Antihistamines
cimetidine and ranitidine are risk CATEGORY B and considered acceptable for treatment of gastroesophageal reflux disease that does not respond to dietary and other lifestyle changes

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Azatadine, cetirizine, chlorpheniramine, clemastine, cyproheptadine, dexchlorpheniramine, diphenhydramine, and loratadine are CATEGORY B

Brompheniramine, carbinoxamine, desloratadine, fexofenadine, hydroxyzine, pheniramine, phenytoloxamine, promethazine, pyrilamine, and triprolidine are CATEGORY C

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Antihypertensives

ACE inhibitors (eg, captopril and others) and ARBs (eg, losartan and others) are CONTRAINDICATED during pregnancy

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Methyldopa (oral, risk CATEGORY B; IV, risk CATEGORY C) crosses the placenta no teratogenic or other adverse fetal effects

Hydralazine (risk CATEGORY C) has also been widely used during pregnancy and is considered safe.
Clonidine and guanabenz are risk CATEGORY C; guanfacine is CATEGORY B.
Clonidine crosses the placenta

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Antimanic Agent: CATEGORY D

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Lithium (risk CATEGORY D) crosses the placenta Cardiac and other birth defects may occur. may cause bradycardia, cyanosis, diabetes insipidus, hypotonia, hypothyroidism, and electrocardiographic (ECG) abnormalities. Most of these effects resolve within 1 to 2 weeks.

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Antipsychotics: CATEGORY B,C

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Phenothiazines (eg, chlorpromazine) are risk CATEGORY C not teratogenic

Clozapine is risk CATEGORY B
olanzapine, quetiapine, risperidone, and ziprasidone are risk CATEGORY C

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Thyroid Hormone:

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Levothyroxine is risk category A. It does not readily cross the placenta does caase tachycardia in the fetus

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Retinoids: CATEGORY X

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Oral retinoids are derivatives of vitamin A that are used for severe skin disorders. Acitretin (Soriatane), used for severe psoriasis, and isotretinoin (Accutane), used for severe acne,
known teratogens defects

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(NSAIDs): VARIES

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use of NSAIDs should generally be avoided, especially during the third trimester

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Dyslipidemics: CATEGORY B,C,X

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Colesevelam is risk CATEGORY B; cholestyramine and colestipol are risk CATEGORY C. These drugs are considered safe for use during pregnancy because they are not absorbed systemically

STATINS (eg, lovastatin) are risk CATEGORY X and contraindicated during pregnancy. They should be given to women of childbearing age only if they are highly unlikely to become pregnant and are informed of potential hazards

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Diuretics: Thiazides and related drugs vary in risk category/not effective in prevention or treatment of pregnancy-induced hypertension (preeclampsia). They may be used for treatment of pathologic edema.

LOOP diuretics also vary in risk category. Ethacrynic acid and torsemide are category B; bumetanide and furosemide are category C. The drugs are not considered teratogenic, but animal studies indicated fetal toxicity and death. Like the thiazides, loop diuretics may decrease plasma volume and blood flow to the placenta and fetus.

The K+-SPARING diuretics amiloride and triamterene are risk category B. The drugs cross the placenta in animal studies, but effects on the human fetus are unknown

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Chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, and metolazone are CATEGORY B. Bendroflumethiazide, hydroflumethiazide, methyclothiazide, and trichlormethiazide are CATEGORY C. These drugs cross the placenta/not associated with teratogenesis, but they may cause other adverse effects.(thrombocytopenia, hyperbilirubinemia, hemolytic jaundice, fluid and electrolyte imbalances, and impaired carbohydrate metabolism)
THE ABOVE REFERS TO THIAZIDE

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Digoxin: CATEGORY C,
but is considered safe for use during pregnancy. It crosses the placenta

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treatment of fetal tachycardia and heart failure

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Corticosteroids: CATEGORY C
cross the placenta

budesonide is risk CATEGORY B

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large doses early in pregnancy may produce cleft palate, stillbirth, and decreased fetal size.

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Calcium Channel Blocking Agents: CATEGORY C
Because these drugs decrease maternal blood pressure, there is a potential risk of inadequate blood flow to the placenta and the fetus.

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Felodipine Isradipine Nicardipine Amlodipine and bepridil Verapamil

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Beta-Adrenergic Blocking Agents
CATEGORY B,C,D

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Beta blockers vary in risk categories, and the safety of their use has not been established. Teratogenicity has not been reported in humans
Acebutolol, pindolol, and sotalol are risk CATEGORY B

Betaxolol, bisoprolol, carteolol, esmolol, metoprolol, nadolol, penbutolol, propranolol, and timolol are risk CATEGORY C

Atenolol is CATEGORY D; it crosses the placenta and can cause fetal harm.

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Aspirin: CATEGORY D

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Aspirin is risk CATEGORY D and contraindicated because of potential adverse effects on the mother and fetus. Maternal effects include prolonged gestation, prolonged labor, and antepartum and postpartum hemorrhage

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Antivirals:
CATEGORY B,C,X

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Acyclovir, atazanivir, didanosine, emtricitabine, enfuvirtide, famciclovir, nelfinavir, ritonavir, saquinavir, tenofovir, and valacyclovir are CATEGORY B. Abacavir, adefovir, amantadine, cidofovir, delavirdine, foscarnet, efavirenz, ganciclovir, indinavir, lamivudine, nevirapine, oseltamivir, rimantidine, stavudine, valganciclovir, zalcitabine, zanamivir, and zidovudine are CATEGORY C. Ribavirin is CATEGORY X and contraindicated;