WIWIK RAHAYU

Depart. of Pharmacology & Therapy

Medical Faculty Riau University
 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 Tuberculostatics
Antibiotics Anti thyroid drugs
Anti emetic- Hypnotic-sedatives-
antihistaminic psychotropics
Anti hypertensives Corticosteroidal drugs
Anti malarial drugs Drugs used in asthma.
Antidiabetics
 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
Depart. of Pharmacology & Therapy
Medical Faculty Riau University
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..