DRUG THERAPY DURING PREGNANCY - PowerPoint

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					         INTRODUCTION

   http://www.youtube.com/watch?v=h
    WWsfrfq69A
DRUG THERAPY
DURING PREGNANCY


      Developed By
      D. Ann Currie , R.N.,M.S.N.
      2012
   PHYSIOLOGICAL CHANGES DURING
    PREGNANCY AND THEIR IMPACT ON
    DRUG THERAPY
   EVERY SYSTEM IN THE BODY IS
    EFFECTED BY PREGNANCY
   PHARMACOKENETICS OF DRUGS IS
    EFFECTED BY PREGNANCY
    PHARMACOKENETICS OF
    DRUGS DURING
    PREGNANCY
   ABSORPTION- DECREASED GI
    MOTILITY CAUSES INCREASED DRUG
    ABSORPTION.
   DISTURBUTION- PROTIEN BINDING IS
    DECREASED CAUSES INCREASED FREE
    DRUG TO BE AVAILABLE.
   METABOLISM-INCREASED HEPATIC
    METABOLISM OCCURS FOR SOME
    DRUGS
PHARMACOKENETICS

   EXCRETION- IN THE 3RD TRIMESTER
    INCREASED RENAL BLOOD FLOW &
    GFR CAUSES SOME DRUGS TO CLEAR
    THE BODY FASTER.
DRUG THERAPY IN THE
CHILDBEARING CLIENT
   REQUIRES SPECIAL      CENTERED ON
    CONSIDERATIONS         BENEFIT/RISK
   IS CHALLENGING         RATIO
    TO PROVIDE            EFFECTS OF
    EFFECTIVE TX           DRUGS NOT
    WHILE AVOIDING         ALWAYS KNOWN
    HARM TO
    EMBRYO,FETUS OR
    NEONATE
ANY DRUG TAKEN BY
THE PREGNANT OR
BREASTFEEDING
CLIENT HAS THE
POTENTIAL TO REACH
THE FETUS BY WAY OF
MATERNAL
CIRCULATION OR
NEONATE BY WAY OF
BREASTMILK
    EFFECTS OF DRUGS ON
    THE EMBRYO, FETUS, OR
    NEONATE
   MAY VARY---
   NO EFFECT.
   LITTLE
   SERIOUS- FETAL TOXICITY
   SPONTANEOUS ABORTION
   DEATH
   FETAL MALFUNCTION
   FETAL MALFORMATIONS.
DRUG THERAPY DURING
PREGNACY
   CENTERED ON BENEFIT/RISK RATIO
   EFFECTS OF SOME MEDICATION ARE
    KNOWN
   UNKNOWN- NEW MEDICATIONS,
    DIFFERENT COMBINATIONS,
    DEFICIENCY IN MATERNAL
    METABOLISM
   NO DRUG IS ABSOLUTELY SAFE.
RECENT STUDIES

   75% OF PREGNANT CLIENTS USE 3-
    10 DIFFERENT DRUGS(PRESCRIPTION
    OR OTC’S) OTHER THAN
    VITAMINS/MINERAL SUPPLEMENTS
    DURING THEIR PREGNANCY.
   OTC’S WERE USED 4 TIMES THAT OF
    PRESCRIPTION DRUGS.
TYPES OF DRUGS USED
IN THE STUDY BY
PREGNANT CLIENTS
   DIETARY             ANALGESICS
    SUPPLEMENTS         DIURETICS
   ANTIEMETICS         ETOH
   ANTACIDS            CNS DEPRESSANTS
   TRANQUILIZERS       CNS STIMULANTS
   HYPNOTICS
   ANTIBIOBIOTICS
   ANTIHISTAMINES
DRUG LEVELS IN THE
FETUS REACHED 50-
100% OF THE
MATERNAL BLOOD
LEVELS
    SELF TREATMENT WITH
    DRUGS DURING
    PREGNANCY
   SELF TX OF MINOR ILLNESSES OR
    DISCOMFORTS SHOULD BE
    DISCOURAGED
   *SELFTREATMENT OF ANY ILLNESSES
    SHOULD BE DISCOURAGED
   WOMEN SHOULD BE INSTRUCTED TO
    KEEP A COMPLETE RECORD OF ALL
    MEDICATIONS TAKEN .
    THE CHALLENGE OF
    PROVIDING EFFECTIVE
    CARE/TX FOR THE
    CHILDBEARING CLIENT
   AVOID HARM TO EMBRYO, FETUS,
    NEONATE.
   DILEMMA UNFORTUNATELY THE RISK
    OF MOST DRUGS HAVE NOT BEEN
    ESTABLISHED.
   DESPITE NOT KNOWING DRUG
    THERAPY DURING PREGNANCY
    DESPITE NOT KNOWING DRUG
    THERAPY DURING PREGNANCY
   CANNOT OR SHOULD NOT BE AVOIDED
    BECAUSE THE HEALTH OF THE FETUS
    DEPENDS ON THE HEALTH OF THE
    MOTHER.
   FOR EXAMPLE: SEIZURES ,DM, MG,
    SLE,OR INFECTIONS.
BIRTH DEFECTS

   INCIDENCE OF MAJOR STRUCTURAL
    DEFECTS(ABNORMALITIES) IS ABOUT
    6% OF ALL PREGNANCIES.
   3% ARE CAUSED BY DRUGS OR
    ENVIRONMENTAL
    FACTORS/EXPOSURE
   3% HAVE A UNKNOWN CAUSES
BIRTH DEFECTS

   1/2 OF THE BIRTH DEFECTS ARE
    OBVIOUS AT BIRTH.
   1/2 OF THE BIRTH DEFECTS AREN’T
    DISCOVERED UNTIL LATER IN LIFE
    OR DISCOVERED DURING AN
    AUTOPSY
   INCIDENCE OF MINOR STRUCTURAL
    ABNORMALIES IS NOT KNOWN.
BIRTH DEFECTS

   INCIDENCE OF FUNCTIONAL
    ABNORMALITIES IS NOT KNOWN-
    GROWTH RESTRICTIONS, MENTAL
    RETARDATION, AND LEARNING
    DISABLITIES
   SOME ABNORMALITIES HAVE
    MULTIPLE CAUSES-GENETIC
    FACTORS, ENVIRONMENTAL
    FACTORS, CHEMICALS OR DRUGS.
TERATOGENIC
TERATOGENESIS
   TERAS-”MONSTER”
   GENSIS-”PRODUCING”
   BIRTH DEFECTS/DISTORTION OF
    GROSS ANATOMY.
   EXAMPLES- CLEFT LIP/PALATE,
    CLUBFOOT, NEURAL TUBAL DEFECTS,
    MISSING OR MALFORMED
    LIMBS/FINGERS.
Birth Defects
TERATOGENIC

   ALSO-BEHAVORIAL AND/ OR
    BIOCHEMICAL ABNORMALITIES.
   TERATOGENESIS MAYBE DIRECT-IE-
    MALFORMATIONS OF STRUCTURES
   OR INDIRECT-SUCH AS INTERFERING
    WITH O2 OR NUTRIENTS.
TERATOGENIC

   EXAMPLE OF KNOWN TERATOGENIC
    AGENTS:
   ONE TIME EXPOSURE IS
    THALIDOMIDE-CAUSES MISSING
    LIMBS.
   CONT. OR PROLONG EXPOSURE IS
    ETOH-CAUSES FAS.
   SEE HANDOUT FOR OTHER AGENTS.
Fetal Alcohol Syndrome-
FAS
    FETAL EFFECTS FROM
    DRUGS DEPEND ON
    SEVERAL FACTORS
   TIME- WHEN DRUG IS TAKEN IN
    PREGNANCY.
   PREIMPLANTATION/PRESOMITE
    PERIOD-CONCEPTION TO 2 WEEK
   HIGH DOSE- MAYBE
    LETHAL/DEATH/ABORTIONS.
   LOW DOSE-MAYBE NOTHING.
   EMBRYONIC PERIOD-3-8 WEEKS
    *FIRST TRIMESTER*
   GROSS MALFORMATIONS
   FETAL PERIOD-9-40 WEEKS(TERM)
   FUNCTION PROBLEMS RATHER THAN
    GROSS ANATOMY-
    *LEARNING DEFICITS &/OR
    BEHAVORIAL ABNORMALIES
Slides of pregnancy

   http://www.medicinenet.com/fetal_de
    velopment_pictures_slideshow/article.
    htm
WHY IS IDENTIFICATION
OF TERATOGENIC
AGENTS SOMETIMES
DIFFICULT TO IDENTIFY?
   INCIDENCE OF CONGENITAL
    ANOMALIES IS GENERALLY LOW.
   ANIMAL TESTS MAY NOT BE RELIABLE
   PROLONGED OR INCREASED
    EXPOSURE MAYBE REQUIRED.
   EFFECTS MAYBE DELAYED OR NOT
    RECONIZED.
   BEHAVIORAL EFFECTS ARE DIFFICULT
    TO DOCUMENT.
   CONTOLLED EXPERIMENTS CANNOT BE
    DONE ON HUMANS.
   DOCUMENTATION IS INCOMPLETE
   ONLY IN A LIMITED NUMBER OF
    DRUGS IS THE TERATOGENIC EFFECTS
    KNOWN OR PROVEN.
   LACK OF PROOF OF TERATOGENICITY
    DOES NOT MEAN A DRUG IS SAFE IN
    PREGNANCY
   MAY MEAN THERE IS A LACK OF
    RESEARCH OR INFORMATION.
PROVING A DRUG IS A
TERATOGEN
   3 CITERIA MUST BR MET:
   1. DRUG MUST CAUSE A
    CHARACTERISTIC SET OF
    MALFORMATIONS.
   2. IT MUST ACT ONLY DURNIG A
    SPECIFIC WINDOW OF
    VULNERABILITY-3-8 WEEKS OF
    GESTATION
   3.THE INCIDENCE OF
    MALFORMATIONS SHOULD INCREASE
    WITH INCREASED DOSAGE &
    DURATION OF EXPOSURE.
PLACENTAL DRUG
TRANSFER
   THE PLACENTA IS NOT A COMPLETE
    BARRIER.
   SOME DRUGS ARE STOPPED.
   SOME DRUGS(IN FACT MOST) ARE
    NOT.
   WAYS DRUGS ARE TRANSFER
    ACROSS- SIMPLE DIFFUSION-ACTIVE
    TRANSPORT.
TRANSFER DEPENDS ON
SEVERAL FACTORS

   CHEMICAL PROPERTY OF THE DRUG
   MOLECULAR WEIGHT.
   PROTEIN BINDING CAPABILITIES.
   CHEMICAL CONFIQURATION.
   LIPID SOLUBILITY.*
   PERIOD OF TIME DRUG REMAINS IN
    MATERNAL BLOODSTREAM
   HALFLIFE OF THE DRUG.
TRANSFER DEPENDS ON
SEVERAL FACTORS
   CONT.
   AMOUNT OF THE DRUG.
   PATHOLOGICAL PROCESSES OF THE
    PLACENTA.
   WHEN IN THE PREGNANCY-
    INCREASED BLOOD FLOW TO THE
    PLACENTA IN LAST PART OF
    PREGNANCY.
MOST DRUGS TRANSFER
AND ARE AT 50-100%
THAT OF THE MATERNAL
LEVELS * SOME DRUG
LEVELS ARE MORE THAN
THE MATERNAL LEVELS
   DRUGS THAT TRANSFER EASILY ARE
    LIPID SOLUBLE.
   DRUGS THAT ARE DIFFICULT/HARD TO
    TRANSFER ARE IONIZED DRUGS-
    HIGHLY POLAR-OR PROTEIN BOUND.
    HOW IS DATA COLLECTED
    ON DRUGS WHICH CAUSE
    PROBLEMS IN
    PREGNANCIES?
   NO HUMAN EXPERIMENTATION
   SYSTEMATIC COLLECTION AND
    ANALYZING OF DATA ON DRUGS
    TAKEN BY PREGNANT CLIENTS.
   REPORTING OF INFORMATION BY
    HEALTH PROFESSIONALS.
   SEE FORM.
    THE NURSE’S ROLE AND
    RESPONSIBILITY IN
    DRUG THERAPY IN THE
    CHILDBEARING CLIENT
   KNOWLEDGE (CURRENT &ACCURATE
    INFORMATION)-
   PREGNANCY
   MEDICAL CONDITIONS
   MEDICAL TREATMENTS
   DRUGS AND CLIENT
    EDUCATION OF
    PREGNANT/PREPREGNAN
    T CLIENTS
   PROVIDE ACCURATE INFORMATION
    WITH RATIONALES
   INFORMATION SOULD BE CURRENT
    AND BASED ON EVIDENCE.
   * ESTABLISH ENVIRONMENT
    CONDUCIVE TO EXCHANCE OF
    INFORMATION*- TRUST.
   POTENTIAL HARM/RISKS.
EDUCATION

   BENEFITS
   COMMON SUBSTANCES & OTC DRUGS
    TO AVOID IN PREGNANCY-
    ASA,ETOH,INCREASED DOSES OF
    MULTVITAMINS,CAFFIENE,CIGARETTE
    SMOKING,ETC.
   AVOID SELF TX-OTC’S, DRUGS FORM
    MEXICO.
   ADVOCATE FOR CLIENTS AND
    GENERAL PUBLIC.
   * SUPPORT*
   ASSIST WITH COPING IF CLIENT HAS
    TAKEN A TERATOGENIC AGENT..WITH
    GUILT OR FEAR…ASSOCIATED WITH
    DRUGS TAKEN IN PREGNANCY.
PREGNANT CLIENT’S
BILL OF RIGHTS

“RIGHT TO KNOW”
QUESTIONS
         Thank you




http://www.youtube.com/watch?v=YIkoSP
qjaU4
For individual drugs see
handout.

				
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