WIWIKRAHAYU

RAHAYU
WIWIK
Depart.of
of Pharmacology
Pharmacology&&Therapy
Therapy
Depart.
MedicalFaculty
FacultyRiau
RiauUniversity
University
Medical

Stadia of growth and

development
I. Preimplantation
Begin from conception - 2 weeks
II. Organogenesis
> 2 - 12 weeks
III. Fetal growth and development
> 12 weeks - termination
IV. Perinatal periode
Before and during parturition

Pregnancy is a physiological process

Alters the function of organs
Changing in pharmacokinetics
and pharmacodynamics
Plasma concentration
Pass into placental barrier
Fetus

Types of teratogenesis

Death => abortion

Malformation / anomalies
Changing in behavior
Retardation

Examples

Anticonvulsants: fetal hydantoin syndrome

Anticoagulants: warfarin syndrome
Alcohol: fetal alcohol syndrome
Antithyroid drugs: ablatio thyroid
Mefenamic acid: embryotoxic
Aminoglycosides: N. VIII, ototoxic, nephrotoxic
DES: late abnormality

The factors contribute to

congenital anomalies
Teratogenic potency of drugs and other
disadvantages
Drug dosage and the ability to cross the
placenta
The stadium of pregnancy
General condition of the mother.

Classification of drugs used in pregnancy

(Australian Drug Evaluation Commeetee)
Pregnant women and reproductive women use drugs no increase malformation - directly or indirectly.
Used by pregnant women - no increase - directly or
indirectly.
Pharmacologically the drugs may cause problems in
fetus, without malformation - reversible.
Drugs result in malformation - irreversible.
Drugs exactly have high risk and cause irreversible
malformation.

Drugs often used during pregnancy

Analgesic-antipyretics
Antibiotics
Anti emeticantihistaminic
Anti hypertensives
Anti malarial drugs
Antidiabetics

Tuberculostatics
Anti thyroid drugs
Hypnotic-sedativespsychotropics
Corticosteroidal drugs
Drugs used in asthma.

General principles of drug used in pregnancy

Absolute reasons
Correct benefits
Appropiate drugs
Contribute the changes in pharmacodynamics and
pharmacokinetics in pregnant women to dosage, route of
administration and duration.
Avoid the combination of drugs
Do not take self medication
Effect on the fetus are not always as same as on the mother
Some drugs cause late abnormal effect.

Giving drugs during pregnancy must

be considered to these factors:

Stadium of pregnancy
General condition and complicated disease
The potency of teratogenecity
Monitoring during longterm therapy

DRUG USE DURING

LACTATION

WIWIK RAHAYU
RAHAYU
WIWIK
Depart. of
of Pharmacology
Pharmacology && Therapy
Therapy
Depart.
Medical Faculty
Faculty Riau
Riau University
University
Medical

Most drugs administered to lactating women

are detectable in breast milk
The concentration of drugs achieved in
breast milk is usually low. The total amount
the infant would receive in a day is
substantially less than what would be
considered a therapeutic dose .

If the nursing mother must take medications

and the drug is relatively safe one, she should
optimally take it 30- 60 minutes after nursing
and 3-4 hours before the next feeding.
This allow time for many drugs to be cleared
from the mothers blood, and the
concentrations in breast milk will be relatively
low.

Most antibiotic taken by nursing mothers

can be detected in breast milk.
Tetracyclin concentrations in breast milk are
approximately 70 % of maternal serum
consentrations and present a risk of
permanent tooth staining in the infant.
Chloramphenicol cause gray baby syndrome
and possibility of bone marrow suppression.

 Barbiturates taken in hypnotic doses by the

mother can produce lethargy, sedation, and
poor suck reflexes in the infant.
Diazepam can have a sedative effect on the
nursing infant, but most importantly its long
half life can result in significant drug
accumulation.

Tq..