Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Passive diffusion
Facilitated diffusion
Active transport
Placental surface area
Placental metabolism
Drug Transfer
Across Placenta
Molecular weight
Lipid solubility
Lipid solubility
Ionization
Ionization
Protein binding
Protein binding
Chemical Structure
Drug concentration
Drug equilibrium
STADIUM EMBRIOGENESIS
Week II- late week VIII
Most sensitive stadium
Organ development
STADIUM FETOGENESIS
Late week VIII
Growth and development stadium
Histogenesis CNS
Cloramphenical
- Gray baby syndrome
- Cardiovascular collapse
5. Tetracycline
- Tooth discoloration
- Enamel hypoplasia
- Bone dysplasia
6. Aminoglycosides
- Fetal ototoxicity
4.
7. Sulfonamide
- Neonatal jaundice
- Hemolytic anemia
8. Ciprofloxacin
- Fetal cartilage damage
9. -Blockers
- Intrauterine growth retardation,
hypoglycemia, hypotension,
bradycardia, death
PHARMACOKINETICS
1. Molecular Size
2. Lipid solubility
- Lipophilic drugs readily cross placenta
(thiopental)
3. Ionization
- Highly ionized cross the placenta
slowly (succinylcholine,tubocurarrine)
- anionized is highly lipid soluble
4. Protein binding
Only unbound drug is capable of
crossing the placenta
Drugs with low protein binding reach
higher concentrations in the fetus than
mom
Ex: Ampicillin, digoxin
PHARMACODYNAMIC
1.
3. Sodium valproate
- CNS
4. Carbamazepine
- Craniofacial
- Fingernail
5. Sex hormone
- Cardiac defects
- Multiple anomalies
6. Lithium
- Cardiac defects
7. Warfarin
- Condrodysplasia punctata
- Microcephaly, spontaneous abortions
- Facial anomalies
- Several anomalies of CNS
8. Retinoic acids
- Craniofacial, cardiac, CNS
Category B
Presumed safety based on animal studies, with no
Category C
Studies in women and animals are not available or
Category D
There is positive evidence of human fetal risk (unsafe),
however in some cases such as a life-threatening illness
the potential risk may be justified if there are no other
alternatives
EX: Warfarin, Fenitoin, Sodium Valproat, Diazepam,
obat kanker
Category X
Highly unsafe, risk of use outweighs any potential
benefits. Drugs in this category are contraindicated in
women who are or may become pregnant
Alkohol, Isotretionin, Estrogen, Androgen, and life
vaccine
Penicillins
Category B in pregnancy
Lactation
Crosses in low concentrations
Compatible with breastfeeding
Antivirals
(acyclovir, famciclovir, valacyclovir)
Pregnancy Category B
Acyclovir and valacyclovir readily cross the
placenta
Can be used for HSV treatment and suppression
Lactation
Acyclovir and valacyclovir are compatible
Famciclovir should be avoided
Aminoglycosides
(amikacin, gentamicin, tobramycin)
Pregnancy Category C
Rapidly cross placenta
Enter amniotic fluid through fetal circulation
Lactation
Compatible with breastfeeding
Not absorbed through GI tract
Sulfonamides
Pregnancy Category C
Readily cross the placenta
Concerns of use at term
Lactation
Excreted into breastmilk in low levels
Use should be avoided in premature infants
Antifungals/Echinocandins
(anidulofungin, caspofungin, micafungin)
Pregnancy Category C
No data with anidulofungin
No human data with caspofungin, single case at
Tetracyclines
(doxycycline, minocycline, tetracycline)
Pregnancy Category D
Can cause problems with teeth and bone and
other defects/effects
Have been linked to maternal liver toxicity
Lactation
Compatible with breastfeeding
Serum levels in infants undetectable