GANGGUAN KEHAMILAN DAN

FARMAKOTERAPINYA

Jutti Levita
Department of Pharmacology and Clinical Pharmacy
Faculty of Pharmacy Universitas Padjadjaran
2017
CONTRACEPTION
 PREGNANCY
Fertilization occurs when a sperm joins to an egg by attaching to a
receptor on the outer protein layer of the egg, the zona pellucida,
and releases enzymes that cause the eggs chromosomes to
mature and allow the sperm to penetrate the zona pellucida.

The membranes of the sperm and egg are then fused to create a
new single cell. Approximately 6 days after fertilization, the cell
mass is termed a blastocyst. HCG is now produced in amounts that
could be detected. The blastocyst then moves and rests on the
endometrium, and begins to grow into the endometrial wall. After 6
days, the blastocyst begins to receive nutrients from maternal blood,
and is called embryo.
Maternal Pharmacokinetic Changes in Pregnancy
Reduced GI motility and increased gastric pH
Increased maternal plasma volume by 50% (of the 8 L
increase of the total body water during pregnancy, 40% is
distributed to maternal compartments, 60% to the amniotic
fluid, placenta, and fetus)
Decreased of serum albumin binding capacity
increased unbound drug
Decreased ingested drug/kg of body weight
Increased hepatic and renal elimination of drugs
Increased renal blood flow of 25% to 50% and glomerular
filtration rate of 50%
 PREGNANCY-INFLUENCED ISSUES
1. Constipation

Nondrug therapy: education, physical exercise,

increased intake of dietary fiber and fluid.

Drug therapy: supplemental fiber/stool softener such as

docusate. Lactulose/sorbitol/bisacodyl/senna is accepted
for occasional (not for routine) use.

These drugs should be AVOIDED: castor oil

PREGNANCY-INFLUENCED ISSUES
2. Gastroesophageal reflux
Occurs in 50-80% pregnant women due to estrogen and
progesteron expression that cause smooth muscle relaxation.

Nondrug therapy: small-frequent meals, caffeine avoidance, food

avoidance 3 h before bedtime, elevation of the head-bed.

Drug therapy: aluminium/calcium/magnesium antacid, sucralfate,

ranitidine/cimetidine, combination of antacid and nonprescription
ranitidine. If a patient does not respond to H2R blockers,
lansoprazole and metoclopramide are also viable.

These drugs should be AVOIDED: NaHCO3 and Mg-trisilicate,

famotidine, nizatidine.
 PREGNANCY-INFLUENCED ISSUES
3. Hemorrhoids

Nondrug therapy: high intake of dietary fiber, adequate

oral fluid intake, and sitz bath
Drug therapy: topical anaesthetics, skin protectants, and
astringents.
 PREGNANCY-INFLUENCED ISSUES
5. Gestational diabetes
 PREGNANCY-INFLUENCED ISSUES
6. Hypertension
In pregnancy the spectrum of hypertension are:
chronic hypertension, gestational hypertension (>140 mmHg/>90
mmHg), preeclampsia-eclampsia (gestational BP elevation with
proteinuria > 300 mg in 24h urine collection).

Nondrug therapy: activity restriction and psychosocial therapy.

Drug therapy: methyldopa, labetolol, -blockers (except atenolol),

prazosin, nifedipine, isradipine, hydralazine, clonidine, and diuretics.

For acute severe hypertension in preeclampsia parenteral

hydralazine+labetolol and oral nifedipine for hypertension control +
magnesium sulfate for seizure prevention are standard therapy.
 PREGNANCY-INFLUENCED ISSUES
7. Thyroid abnormalities
HCG may stimulate the thyroid gland due to similarity
between HCG and thyrotropin. Pregnant patients with
excessive thyroid gland stimulation may show gestational
thyrotoxicosis, which usually present with severe vomiting, an
increased thyroxine and a decreased thyrotropin in serum.

Nondrug therapy: --

Drug therapy: If there is asymptomatic, treatment is not

needed. If hyperthyroidism is observed, the patient should
undergo further testing.
 PREGNANCY-INFLUENCED ISSUES
8. Thromboembolism

Nondrug therapy: compression stockings are reccommended

for prevention and treatment.

Drug therapy: low MW heparin, aspirin,

These drugs should be AVOIDED: warfarin, dextran, and hirudin.

 PREGNANCY-INFLUENCED ISSUES
9. Headaches
Headache in pregnancy is classified into tension,
migraine, or secondary to an underlying disorder.

Nondrug therapy: relax

Drug therapy: acetaminophen, NSAIDs (generally

contraindicated after 37 weeks gestation), narcotics
(maybe used), metoclopramide (for patients with nausea
associated with migraine headaches).
These drugs should be AVOIDED: ergotamine, dihydroergotamine
 UTI
STD (syphilis, Neisseria gonorrhoeae, Chlamydia
trachomatis, genital herpes, bacterial vaginosis)

ACUTE CARE ISSUES IN PREGNANCY

 CHRONIC ILLNESSES IN PREGNANCY
Allergic rhinitis, asthma
Epilepsy
Diabetes
HIV infection
1. Allergic rhinitis, asthma

Drug therapy: inhaled cromolyn, inhaled budesonide or

beclomethasone, inhaled -agonists (terbutaline, metaproterenol,
and albuterol). Oral theophylline (considered as add-on to inhaled
corticosteroid for severe-persistent asthma, as an alternative, long
acting -agonists salmeterol can be used).

Leucotriene antagonists are not considered as drugs of choice.

CHRONIC ILLNESSES IN PREGNANCY

2. Epilepsy

Drug therapy: carbamazepine, divalproate sodium or valproic acid.

All women with epilepsy should take folic acid supplementation
0.4 to 5 mg daily. To correct vitamin K deficiency in newborns,
10 mg oral vitamin K1 should be supplemented daily by the mother
during the last month of gestation.

The women on therapy should be checked their alpha-fetoprotein

at 14-16 weeks gestation and a level II USG at 16-20 weeks
gestation.

CHRONIC ILLNESSES IN PREGNANCY

3. Diabetes

CHRONIC ILLNESSES IN PREGNANCY

4. HIV

CHRONIC ILLNESSES IN PREGNANCY