Adams Chapter 10 Pregnancy 2013

PHARMACOLOGY
PHARMACOLOGY
CONNECTIONS TO NURSING PRACTICE
CONNECTIONS TO NURSING PRACTICE
Second Edition Second Edition
Pharmacology: Connections to Nursing Practice, Second Edition
Michael Patrick Adam ! Carol "#am Ur$an
CHAPTER
Pharmacotherapy During Pregnancy
and Lactation
%&
%&'% (omen )re*#entl+ #e dr#,
d#rin, -re,nanc+ and lactation'
Rationale )or .r#, Ue .#rin,
Pre,nanc+ and Lactation
N#re a/arene
0Ph+iolo,ical chan,e occ#rrin, d#rin,
-re,nanc+ to -re,nant /oman
0.e1elo-mental ta,e o) )et#
0Potential ad1ere dr#, e1ent in $oth
mother and )et#
Re-oni$le )or health and a)et+ o)

$oth the mother and )et#
.e-ite -otential rik to the )et#, )irt2

trimeter #e o) -recri-tion dr#, ha
increaed $+ more than 3&4 in the
-at 5& +ear
More than 64 o) -re,nant /omen take

a dietar+ or her$al #--lement other
than m#lti1itamin and )olic acid
Health care -ro1ider e7ercie ,reat

ca#tion /hen -recri$in, dr#, d#rin,
-re,nanc+
Pharmacothera-+ i -ot-oned #ntil

a)ter -re,nanc+ and lactation /hen
-oi$le
Sa)er alternati1e are #ed

Some condition m#t $e mana,ed

d#rin, -re,nanc+
0Some -ree7itin, condition
0Com-lication related to -re,nanc+
0Some condition #nrelated to the
-re,nanc+
Certain condition and com-lication

m#t $e treated d#rin, the -re,nanc+
)or the a)et+ o) the mother and
,ro/in, )et# im-erati1e
Goal i to treat mother /itho#t harmin,

)et#
Pharmacothera-+ cond#cted in an+ o)

)ollo/in, /a+8
0Recei1e ame dr#, and doa,e a
non-re,nant -atient
0Medication dicontin#ed
0Medication chan,ed to a lo/er doe
0Medication re-laced $+ a)er dr#,
0The thera-e#tic 1al#e o) dr#, $alanced
a,aint the -otential ad1ere e))ect
A$or-tion
Increaed le1el o) -ro,eterone ca#e

a decreae in ,atric tone and intetinal
motilit+, re#lt in dela+ed ,atric
em-t+in,
0.ela+ed ,atric em-t+in, re#lt in
e7tended a$or-tion time )or oral dr#,
Hi,h etro,en le1el ca#e increaed

h+drochloric acid -rod#ction
A$or-tion
Ma+ a))ect a$or-tion o) certain acid

la$ile dr#,
Gro/in, )et# rie in the a$domen and

-ree a,aint the tomach, leadin, to
lo/er ,atric em-t+in,
Increaed time in a$or-tion and

ditri$#tion -rolon, the onet and
d#ration time o) oral dr#,
.itri$#tion
A))ected d#rin, -re,nanc+ $+ chan,e

in total $od+ /ater 9/hich ma+
increae $+ o1er :&4;
Lead to ,reater hemodil#tion o)

-lama -rotein and dr#,
(hen -lama -rotein dil#ted, )e/er

are a1aila$le to $ind /ith dr#,
Hi,her concentration o) <)ree= dr#, in

the -lama
.itri$#tion
Re#lt in more dr#, molec#le

a1aila$le to tran)er acro the -lacenta
Un$o#nd )ree dr#, more readil+ -a

into $reat milk and to the in)ant
Meta$olim
Leat a))ected $+ -re,nanc+
CY>:& and other meta$olic en?+me

are -reent in -lacenta
Likel+ contri$#te to dr#, meta$olim
Placenta and )etal li1er contri$#te to

o1erall dr#, meta$olim
Increain, meta$olim o) certain dr#,

E7cretion
Enhanced d#rin, -re,nanc+

0Increaed renal -lama )lo/
0Increaed ,lomer#lar )iltration rate
0Increaed creatinine clearance
0Increaed renal t#$#lar rea$or-tion
Re#lt in increaed renal elimination o)

dr#,
.oa,e o) man+ medication m#t $e

ad@#ted
%&'5 Man+ dr#, -a )rom mother to
in)ant 1ia the -lacenta'
Pharmcothera-+ .#rin,
Pre,nanc+
Placenta
Placenta o))er de,ree o) -rotecti1e

)iltration o) maternal $lood
Pre1ent certain harm)#l #$tance

)rom reachin, )et#
Aitamin, )att+ acid, ,l#coe, and

electrol+te )reel+ -a )rom mother to
)et#
Placenta can deto7i)+ certain harm)#l

#$tance $e)ore the+ reach the )et#
Placental Tran)er o) .r#,
.r#, do not ha1e to cro the -lacenta

or enter )etal $lood to ca#e )etal
a$normalitie
.r#, ma+ ca#e contriction o)

-lacental $lood 1eel, im-airin,
n#trient e7chan,e
Bactor Im-actin, Tran)er o)
.r#, Acro Placenta
Plama dr#, le1el in the mother

0The hi,her the doe taken $+ mother,
the more dr#, circ#late thro#,h the
-lacenta
0Rationale )or -recri$in, lo/et e))ecti1e
doe
.r#, Acro Placenta
Sol#$ilit+ o) the dr#,

0Hi,hl+ li-id2ol#$le dr#, cro -lacenta
more eail+ than /ater2ol#$le dr#,
.r#, Acro Placenta
Clood )lo/ to the -lacenta

0Ca#e dr#, acc#m#lation in )et#
0.#rin, la$or -atient ##all+ remain
lateral d#rin, #terine contraction
0Pre1ent -re#re on aorta and 1ena
ca1a
%&'> The United State Bood and .r#,
Adminitration -re,nanc+ rik
cate,orie are #ed a ,#ide in
-recri$in, medication d#rin,
-re,nanc+'
Pre,nanc+
B.A Betal Rik Cate,orie
Bederal Bood and .r#, Adminitration

9B.A; -re,nanc+ cate,orie
Rate medication related to rik d#rin,

-re,nanc+
B.A -re,nanc+ rik cate,orie #ed a

,#ide /hen -recri$in, medication
d#rin, -re,nanc+
Table 10.1 C#rrent B.A Pre,nanc+ Cate,or+ Ratin, /ith E7am-le
Table 10.1 (continued C#rrent B.A Pre,nanc+ Cate,or+ Ratin, /ith E7am-le
.r#, o) A$#e and E))ect on
Pre,nanc+
Am-hetamineDmetham-hetamine
Canna$iDmari@#ana
Cl#$ dr#, 9PCP, ketamine, LS.;
Cocaine
Heroin
Inhalant 9,l#e, ol1ent;

Ad1ere .r#, E))ect .#rin,
Pre,nanc+
E))ect o) dr#, on the )et# de-end on

doa,e recei1ed $+ )et# and ta,e o)
)etal de1elo-ment
The 1at ma@orit+ o) medication

a--ro1al $+ B.A ha1e in#))icient
in)ormation re,ardin, a)et+ rik
d#rin, -re,nanc+
Lack o) kno/led,e doe not mean a)e

Terato,en
A #$tance, or,anim, or -h+ical

a,ent that ca#e a -ermanent
a$normalit+ in tr#ct#re or )#nction,
,ro/th retardation, or death to em$r+o
or )et#
Terato,en
Potential )etal cone*#ence

0Intra#terine )etal death
0Ph+ical mal)ormation
0Gro/th im-airment
0Ceha1ioral a$normalitie
0Neonatal to7icit+
Terato,en
Incident o) terato,enic e1ent occ#r in

a--ro7imatel+ 54 o) all -re,nancie
No <a$ol#te= terato,en
Terato,enic e))ect de-end #-on

m#lti-le, com-le7 )actor
.oe re-one relationhi- /ith rik

increain, /ith hi,her doe
Terato,en
Timin, o) dr#, thera-+ and ta,e o)

)etal de1elo-ment criticall+ a))ect the
rik
.#e to contant chan,e occ#rrin,

d#rin, )etal de1elo-ment
S-eci)ic rik i de-endent on time in

,etation -eriod
Tran)er o) .r#, Into Creat Milk
Bor dr#, that are a$ol#tel+

contraindicated d#rin, lactation,
e*#all+ e))ecti1e, a)er alternati1e are
##all+ a1aila$le
Mot dr#, ca#e no harm to the in)ant

0C#t e))ect ha1e not $een )#ll+ t#died
.r#, enter $reat milk $+ -ai1e

di))#ion
Once .r#, In,eted $+ In)ant
In)antE tomach content i *#ite acidic
Some dr#, are detro+ed
Some dr#, are inacti1ated /hen

in,eted /ith calci#m and -rotein2rich
)ood
Once .r#, In,eted $+ In)ant
Some dr#, remo1ed $+ )irt2-a

meta$olim
In)antE or,an re-oni$le )or

meta$oli?in, and eliminatin, dr#, are
immat#re
%&'F .r#, -reent in $reat milk ma+
ca#e ad1ere e))ect in the $reat2
)eedin, in)ant'
Lactation
.r#, Ad1ere E))ect .#rin,
Lactation
E1en /ith mall concentration 9le

than 54;, e))ect in in)ant can $e
erio#
Non-eci)ic dr#, e))ect een in $reat2

)eedin, in)ant
0.iarrhea
0Conti-ation
0Sedation
0Irrita$ilit+
.r#, Ad1ere E))ect .#rin,
Lactation
Monitor in)ant )or ad1ere dr#, e))ect
Ed#cate ne/ mother to do ame
See Ta$le %&'> 9ne7t lide;, )or dr#,

that enter $reat milk and ha1e ho/n
to -rod#ce ad1ere e))ect in $reat2
)eedin, in)ant

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PHARMACOLOGY

Re-oni$le )or health and a)et+ o)

.e-ite -otential rik to the )et#, )irt2

More than 64 o) -re,nant /omen take

Health care -ro1ider e7ercie ,reat

Pharmacothera-+ i -ot-oned #ntil

Sa)er alternati1e are #ed

Some condition m#t $e mana,ed

Certain condition and com-lication

Goal i to treat mother /itho#t harmin,

Pharmacothera-+ cond#cted in an+ o)

Increaed le1el o) -ro,eterone ca#e

Hi,h etro,en le1el ca#e increaed

Ma+ a))ect a$or-tion o) certain acid

Gro/in, )et# rie in the a$domen and

Increaed time in a$or-tion and

A))ected d#rin, -re,nanc+ $+ chan,e

Lead to ,reater hemodil#tion o)

(hen -lama -rotein dil#ted, )e/er

Hi,her concentration o) <)ree= dr#, in

Re#lt in more dr#, molec#le

Un$o#nd )ree dr#, more readil+ -a

Leat a))ected $+ -re,nanc+

CY>:& and other meta$olic en?+me

Likel+ contri$#te to dr#, meta$olim

Placenta and )etal li1er contri$#te to

Increain, meta$olim o) certain dr#,

Enhanced d#rin, -re,nanc+

Re#lt in increaed renal elimination o)

.oa,e o) man+ medication m#t $e

Placenta o))er de,ree o) -rotecti1e

Pre1ent certain harm)#l #$tance

Aitamin, )att+ acid, ,l#coe, and

Placenta can deto7i)+ certain harm)#l

.r#, do not ha1e to cro the -lacenta

.r#, ma+ ca#e contriction o)

Plama dr#, le1el in the mother

Sol#$ilit+ o) the dr#,

Clood )lo/ to the -lacenta

Bederal Bood and .r#, Adminitration

Rate medication related to rik d#rin,

B.A -re,nanc+ rik cate,orie #ed a

Cl#$ dr#, 9PCP, ketamine, LS.;

Inhalant 9,l#e, ol1ent;

E))ect o) dr#, on the )et# de-end on

The 1at ma@orit+ o) medication

Lack o) kno/led,e doe not mean a)e

A #$tance, or,anim, or -h+ical

Potential )etal cone*#ence

Incident o) terato,enic e1ent occ#r in

Terato,enic e))ect de-end #-on

.oe re-one relationhi- /ith rik

Timin, o) dr#, thera-+ and ta,e o)

.#e to contant chan,e occ#rrin,

S-eci)ic rik i de-endent on time in

Bor dr#, that are a$ol#tel+

Mot dr#, ca#e no harm to the in)ant

.r#, enter $reat milk $+ -ai1e

In)antE tomach content i *#ite acidic

Some dr#, are detro+ed

Some dr#, are inacti1ated /hen

Some dr#, remo1ed $+ )irt2-a

In)antE or,an re-oni$le )or

E1en /ith mall concentration 9le