Learning disabilities were unusually frequent in two small series of children exposed to amiodarone during gestation Bartalena et al. Fetal digitalis toxicity has occurred, but this was secondary to maternal overdose Sherman and Locke, 1960. It provides therapeutic guidance for the clinician. However, according to the manufacturer, quinolones may cause lameness or irreversible arthropathy in immature dogs Box 2. The two most common disorders of pregnancy for which propranolol has been used are hypertension and hyperthyroidism. Of 29 cases of perinatal renal failure, 18 occurred following maternal therapy with enalapril during pregnancy Rosa and Bosco, 1991.
All counseling regarding a drug or medication exposure should be performed by a clinician knowledgeable in both teratology and in counseling. Chlamydia trachomatis may be isolated in up to 30 percent of women of lower socioeconomic status unpublished observations, 1990. Pregnant women have the full enzyme complement for metabolizing drugs, but most such systems have lower activity during pregnancy, as does cholinesterase Pritchard, 1955 , which metabolizes cocaine. Moreover, the clinician must be aware that drugs and medications represent a bountiful field for litigation, since there is a reasonable likelihood that, once the family and the attorney have concluded that there is merit to their allegation, they can locate experts who will support the nonmeritorious allegation. Many of these agents are given for life-threatening illnesses. Again, it should be noted that it may be very difficult to maintain therapeutic levels of aminoglycosides in the mother or fetus with usual or standard doses.
Nicardipine Treatment of hypertension in pregnancy with nicardipine was more effective than metoprolol in decreasing blood pressure, and neonatal outcomes were not different Jannet et al. Drugs associated with adverse neonatal are not usually associated with teratogenic effects. Urinary tract infections Urinary tract infections are among the most common infections encountered in pregnant women Duff, 1994. It has been shown readily to cross the human placenta Gilstrap et al. Conversely, those at high risk of damage to their own health or that of their unborn require the help of appropriate medicinal technology, including drugs. Other calcium antagonists, such as diltiazem, nicardipine, and nifedipine, may also be useful as antianginal agents and have not been reported to be associated with an increase in malformation rates in animal studies Ariyuki, 1975. Chronic use of sodium nitroprusside is logically associated with a much higher risk than acute usage.
Anesthetic and Obstetric Management of High-Risk Pregnancy, 2nd edn. Of all the human teratogens, thalidomide is the most notorious and heuristic example of how such agents might not be identified. Nonetheless, it is prudent to avoid use of nitroprusside during pregnancy because of the theoretical accumulation of cyanide in the fetal liver. The current state of health of all people in the pedigree should also be elicited. Category B1 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. This dose can be increased and repeated every 15—20 min, as necessary.
Several other beta-adrenergic blocking agents are available but are used primarily for the treatment of hypertension. It was published by Elsevier Science and has a total of 380 pages in the book. Therefore, the responses of adults, fetuses, embryos, and pregnant women to drugs pharmacodynamics, pharmacokinetics differ markedly Little, 1999. Also, no increase in the frequency of malformations was found among the offspring of rats, rabbits, and hamsters that had received nadolol in doses several times higher than the usual human dose Sibley et al. Follow-up of children exposed to carbimazole in utero found no physical growth or development deficits McCarroll et al.
They are very similar in structure to the penicillins, both containing a four-member beta-lactam ring. It has been documented that congenital abnormalities caused by human teratogenic drugs account for less than 1% of total congenital abnormalities. As with other sulfonylurea drugs, neonatal hypoglycemia is likely to occur with chronic use near the time of delivery. Enders 1985 has published the most compelling data to support this recommendation. Aztreonam Aztreonam belongs to a relatively new class of antibiotics: the monobactams. Elder care medication tips 7. Thromb Haemost 1999; 81: 668—72.
Nursing process: Patient safety during drug therapy 10. Of 168 liveborn neonates, 159 had no congenital anomalies and of the nine neonates who did, no distinctive pattern of anomalies could be identified Andrews et al. Michigan State, then ranked No. A comprehensive review of pharmacokinetics during pregnancy is published Little, 1999 , and Table 2. Antidotes: Indications and dosages 14.
Amiodarone This drug is used primarily to treat life-threatening ventricular arrhythmias e. Organic nitrites are the most commonly used agents in this group, and nitroglycerin is the prototype organic nitrite agent. Although pregnancy is considered contraindicated in women within 3 months of receiving the rubella vaccine, the actual risk of congenital rubella syndrome from maternal vaccination would appear to be extremely small, if it exists at all Preblud and Williams, 1985. An extensive review of the use of propranolol in pregnancy can be found in Chapter 3. Erythromycin Erythromycin is a bacteriostatic agent which interferes with bacterial protein synthesis.
Is lower birth weight associated with the blood pressure medication, or the disease of hypertension, or some combination? As many as 25 percent of women with acute pyelonephritis during pregnancy will experience another such episode during either the antepartum or postpartum periods. Potential adverse maternal effects of metronidazole are summarized in Box 2. Although there are no large studies regarding its use during pregnancy, increased malformations have been reported when large doses were used to attempt abortion Nishimura and Tanimura, 1976. In addition, a searchable index of proprietary and generic names is provided on the website. The Merck Manual was first published in 1899 as a service to the community. Definitions of the Australian categories for prescribing medicines in pregnancy Category A Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.
In each chapter information is presented separately for two different aspects of the problem seeking a drug appropriate for prescription during pregnancy, and assessing the risk of a drug when exposure has already taken place. It may also be of use in treatment of whipworm infestations. The treatment goal of medical therapy is to achieve a diastolic blood pressure less than 110 mmHg, and in the range of 90—100 mmHg. Neonatal thrombocytopenia was observed with hydrochlorothiazide, as with other thiazide diuretics Rodriguez et al. Although there are no such reports, vancomycin could theoretically result in the same toxicity in the fetus, since this drug readily crosses the placenta.