Farmakoterapi Pada Kehamilan

7/16/2019 Farmakoterapi Pada Kehamilan

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FARMAKOTERAPI

PADA KEHAMILANDAN LAKTASI

Welly Ratwita, dr., MKes.

Lab Farmakologi FK Unjani


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TeratologiMempelajari malformasi kongenital yang dapat

diamati saat kelahiran dan diinduksi oleh agen

eksogen selama periode organogenesis

Dismorfisme

Abnormalitas fungsional dan struktural padafetus


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Thalidomide Tragedy

Akhir 1950-Awal 1960 thalidomide dianggap

aman pada kehamilan

Penelitian pada hewan belum sempurna

Amelia, phocomelia, abnormalitas jantung,

defek pada mata


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Mekanisme Dismorfogenitas1. Efek Langsung Obat pada Fetus

Dipengaruhi oleh:

Distribusi obat ke plasenta

aliran darah maternal & uterus

Struktur & biokimia plasenta

Komponen obat (BM


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2. Efek Obat pada Fungsi Plasenta

Biotransformasi obat pada plasenta dapatmempengaruhi fungsi plasenta melalui

kompetisi enzimatik, produksi hormon &

inhibisi transpor energi

Rokok: Mengganggu nutrisi dan oksigenasi

fetal, resistensi vaskular,

benzopiren hidroksilase plasenta


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3. Efek Obat terhadap Metabolisme Maternal

Misal: Efek hipotensi yang diinduksi anestesispinal

4. Tahapan Perkembangan Fetus All or none pada awal kehamilan

Diferensiasi & Organosintesis

Hambatan pertumbuhan, gangguan fungsi, padaperiode fetogenik


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5. Genetik

6. Metabolisme Obat

Cyt P450 mempengaruhi metabolisme

obat, keseimbangan hormonal yangdapat mempengaruhi viabilitas fetus


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Guidelines for Prescribing1. Penggunaan obat esensial yang memiliki

efek dismorfogenik harus dibatasi pada

WUS, atau berikan dengan disertaikontrasepsi adekuat & tes kehamilan

secara teratur


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2. Penggunaan obat esensial dengan

komplikasi (-) pada fetus diberikandengan dosis rendah dan waktu singkat


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3. Jika memungkinkan ganti dengan obat

lain. Misal: OHO Insulin

4. Apabila tidak ada obat pengganti,

pertimbangkan risiko & keuntungan.

Biarkan pasien mengambil keputusan.


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Klasifikasi keamanan Obat padaKehamilan (FDA): Category A:

Controlled studies in women fail to

demonstrate a risk to the fetus in the firsttrimester (and there is no evidence of a

risk in later trimesters), and the possibility

of fetal harm appears remote.


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Category B:

Eitheranimal-reproduction studies havenot demonstrated a fetal risk but there are

no controlled studies in pregnant women or

animal-reproduction studies have shownan adverse effect (other than a decrease in

fertility) that was not confirmed in

controlled studies in women in the first

trimester (and there is no evidence of a risk

in later trimesters.)


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Category C:

Eitherstudies in animals have revealed

adverse effects on the fetus (teratogenic

or embryocidal, or other) and there are no

controlled studies in women or studies in

women and animals are not available.

Drugsshould be given only if the potential

benefit justifies the potential risk to thefetus.


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Category D:There is positive evidence of human fetal

risk, but the benefits from use in pregnant

women may be acceptable despite the risk( e.g., if the drug is needed in a life-

threatening situation or for a serious

disease for which safer drugs cannot beused or are ineffective).


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Category X:Studies in animals or human beings have

demonstrated fetal abnormalities, or there

is evidence of fetal risk based on humanexperience, or both, and the risk ofthe

use of the drug in pregnant women clearly

outweighs any possible benefit. The drugis contraindicated in women who are or

may become pregnant.


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Key:

++++ : Contraindicated

+++ : Avoid in preference for safer

categories

++ : Use cautiously, weighing risk and

benefits

+ : Seems safe but information limited - : Proven safe in pregnancy


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Antiulcer DrugsWeek 0 12 24

termAntasid ++ 1 st suggest malform

Mg++ ++ ++ ++ Large, frequent dose:

neuromusc, CVS, renal

damageBicarbonat ++ ++ ++ Large dose: metabolic

acidosisSimetidin ++ ++ ++ 1 case report: no ADR

17-24w


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Analgetik

Week 0 12 24 term

Codein ++ Withdrawal effects

Aspirin ++ ++ ++++ 3rd: impaired plateletfunc, haemorrhage,

kernicterus

NSAIDs + ++ ++++ No evidence effecton organogenesis.

Premature closure of

ductus arteriosus,pulmonary HT

PCT + + +


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Anti TBC

Week 0 12 24 term

Rifampicin +++ +++ +++ Neonatal bleeding,suggested embryotoxicity,IUFD, malformation

Ethambuthol ++ ++ ++ Theoretical malformation, noevidence of damage

Isoniazid ++ ++ ++ Pyridoxine 10 mg shouldaccompany each Isoniazid

dose to prevent fetal neural

damage


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Anti-InfectivesWeek 0 12 24

termAminoglikosid ++++ ++++ ++++ Ototoxicity, renal

damage

Sulfonamid ++ ++ +++ Haemolysis in G6PDdef., kernicterus

Penisilin No reported fetal rx

Cefalosporin No reported fetal rx

Kloramfenikol ++++ Grey syndrome, CVS

collaps, +Tetrasiklin ++++ ++++ ++++ Dental discolourisation,

bone growth disturb.

Cotrimoksazol ++ ++ +++ Risk of kernicterus


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DRUGS IN LACTATION Endocrine SystemContraindicated Caution May be

pescribedComments

Corticosteroid

Betamethasone

Prednisone

Prednisolon

Insignificant amounts in milk

CS inhalated, low

dose

Cortisone

Dexa

Hydrocortison

(systemic)

Methylprednisolon

Triamcinolone


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Hypoglycaemic agentsContraindicated Caution May be precribed Comments

OHO-theoritical

risk of infanthypoglicaemia.

Monitor

Chlorpropramide Exreted in milk.

Effects on infant

unknown

Glibenclamide

Metformin

Tolazamide

Tobutamide Infant dose 18 %

maternal dose.

Avoid in

neonatal period


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GITContraindicated Caution May be prescribed Comments

Antacids

Al+3, Mg +2 Not absorbed

Cimetidine Infant dose 5 % maternaldose. Avoid in prematurity

Nizatidine Secreted & cocentrated in

milk (rats)

Ranitidine Exreted in milk. ADRR (-)

but long term effect?

Sucralfat

Bisacodyl

Loperamide

Infection


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InfectionContraindicated Caution May be

prescribed

Comments

Amoxycillin Insignificant amount in milk.

Cephalosporin Insignificant amount in milk. No ADRR

Chloramphenicol Gray syndrome. Theoritical risk of blood

dyscrasia

Cotrimoxazole Minimal risk from sulpha component.

No ADRR

Sulphonamide May cause diarrhoea, rash, kernicterus

Tetracycline Probable negligible abs. in infant due to

chelation w/ Ca in mik. Remote

possibility of toth staining/bone growth

abn.

Ethambuthol

Isoniazid Infant dose 50 % maternal. Theoritical

risk of convulsion and neuopathy. Avoid

in newborn

Pennicillin No ADRR, possibility of

hypersensitivity in infant


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Farmakoterapi Pada Kehamilan

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