السلام عليكم ورحمة الله وبركاته
الموضوع منقول من

Cephalosporin

ودكتور محمد الشريف
جزاهم الله خير الجزاء

كثير منا درس Teratogenicity في مادة السموم
وسبحان الله وجدت أن ال malformations بسبب الأدوية
كثيرة جدا وسهلة الحدوث جدا لو الأم تهاونت في أخذ أدوية أثناء الحمل سواء
في ال 1st أو 2nd ,3rd trimesters على السواء (على حسب الدواء اللى خدته)
ويمكن اللى شجعنى اجمع الموضوع ده ان واحدة صاحبتى بتحكى لى عن واحدة صاحبتها حامل وامتد حملها اكتر من 9 شهور وداخلة في العاشر !!
فافتكرت ساعتها انها ممكن تكون خدت Aspirin أو
Indomethacin خلال آخر شهور الحمل لصداع او غيره فقلل ال Prostaglandins
اللازم للطلق فعمل stillbirth

المشكلة اللى بواجهها
أنى درست اه المواد الفعالة اللى بتسبب malformations
لكن للأسف معرفش الأسماء التجارية وكل الأدوية في السوق بتاعة المواد
الفعالة دى !!!!!!!
الى جانب انه لو جيت احذر حامل من انها تاخد ادوية
معينة اثناء الحمل مش هقول لها اسم المادة الفعالة لكن هقولها الدوا اللى
اسمه كذا ماتاخديهوش !

وأنا هاحصر دلوقتى أسماء المواد
الفعالة او ال family بتاعتها وال malformation اللى بتعمله وباطلب من كل
اللى بيشتغلوا في صيدليات انهم يحصروا لى الأدوية في السوق اللى بتحتوى على
المادة دى بحيث يبقي في زى database لكل الادوية اللى teratogenic للحامل
او برضه الادوية اللى pass though milk to the baby (بالنسبة لل lactating)
وفي نفس الوقت تكون

Drugs contraindicated in:

1-Early pregnancy
(highly teratogenic drugs )

Thalidomide===>cause phocomelia or amelia
Warfarin
Isotretinoin(used in ttt of Acne)=====>xss Vit. A is teratogenic
Corticosteroids
Anticancer drugs
Radioactive Iodine
Diazepam
Phenobarbitone


2-Throughout pregnancy

Aspirin
Ibuprofen
Male hormones=====>cause masculinization of female fetus


3-Late pregnancy
they are hazardous if given during ! 2nd 7 3rd trimesters , some
(are hazardous also if given during 1st trimester

Androgens & Progestrones=======>musculinization of female fetus
Estrogens=======>feminization of fetus , abnormal spermatogensis
Dietylstilbesterol(DES)======>Adenocarcinoma of Vagina in gils(15-20 years) whose mothers took DES durind 1st trimester
Oral contraceptives=====>VACTERL syndrome ie. defects in Vertebrae , Anus , CVC ,Trachea ,Esophagus ,Renal tract , Limbs
Tetracycline=====>Tooth discolouration & interference with bone development
Sulfonamides =====>Jaundice
Chloroquine &Chloropromazine=====>congenital cataract
Sulfonyl Ureas=====>prolonged hypoglycemia &malformations
Phenytoin=====>cleft lip & cleft palate
Aspirin / NSAIDS as Indo----cin=====>Aspirin in 1st trimester cause cleft lip & left palate (in a few %) , but
Aspirin & other NSAIDS in 2nd & 3rd
trimesters decrease PG so fetal bleeding , prolonged gestation , low
birth weight & stillbirth


4-Drugs not given prior to labour

Chloramphenicol=====>Grey Baby syndrome
Vasoconstrictors=====>Placental casoconstriction so decreases nutriens to fetus so malformations


5- Drugs not given during labour

(drugs causing respiratory depression)-
Opioids , Barbiturates , General anaesthetics (xpt N2O
Tranquilizers(diazepam)=====>muscle relaxation of baby and decrease ability of suckling
B-adrenergic agonists=====>complication of labour
Anticoagulants=====>decrease clotting of blood (should be stopped some time before delivery)

متنوعة
Ergotamine=====>Aborfacient
Diflunisal=====>drug induced hypoxia which make interference with energy production and osmolarity within ! developing embryo


<<<يتبع مع ال lactating woman>>>

Drugs contraindicated in:


1-Early pregnancy
(highly teratogenic drugs )


Thalidomide===>cause phocomelia or amelia
Warfarin e.g.hemofarin , marivanil , marevan
Isotretinoin(used in ttt of Acne)=====>xss Vit. A is teratogenic
e.g. isotrex, netlook, roaccutane
Corticosteroids e.g. solu-cortif , urbason, fortecortin .. etc.
Anticancer drugs
Radioactive Iodine
Diazepam e.g.valpam , valium
Phenobarbitone e.g. sominal , sominaletta, asmolin , epicophylline



2-Throughout pregnancy

Aspirin e.g. rivo, aspocid , aggrex, alexoprine
Ibuprofen e.g. brufen, marcofen, ultrafen, profusol
Male hormones=====>cause masculinization of female fetus
e.g. proviron, sustanon, provimest, andriol


3-Late pregnancy
they are hazardous if given during ! 2nd 7 3rd trimesters , some
(are hazardous also if given during 1st trimester

Androgens & Progestrones=======>musculinization of female fetus
progesterone e.g. primolut depot, prontogest, gestone, utrogestan

Estrogens =======>feminization of fetus , abnormal spermatogensis
e.g.premarin,primogyn, ovestin
AND estrogen / progesterone combination e.g. lutofolone (بيستخدموها عشان الاجهاض) , cycloprogynova

Dietylstilbesterol(DES) ======>Adenocarcinoma of Vagina in girls(15-20 years) whose mothers took DES durind 1st trimester

Oral contraceptives=====>VACTERL syndrome ie. defects in Vertebrae , Anus , CVC ,Trachea ,Esophagus ,Renal tract , Limbs

Tetracycline e.g. hostacycline, tetracid=====>Tooth discolouration & interference with bone development

Sulfonamides e.g. sutrim, septazole, septrin =====>Jaundice

Chloroquine e.g. hydroquine, alexoquine i&Chloropromazine e.g. largactil, neurazine, promacid =====>congenital cataract

Sulfonyl Ureas (antidiabetics) e.g. daonil, amaryl, diamicron,..etc.=====>prolonged hypoglycemia &malformations

Phenytoin e.g.epanutin, ipanten, phenytin=====>cleft lip & cleft palate

Aspirin / NSAIDS as Indomethacin e.g. indocid=====>Aspirin in 1st trimester cause cleft lip & left palate (in a few %) , but
Aspirin & other NSAIDS in 2nd
& 3rd trimesters decrease PG so fetal bleeding , prolonged gestation
, low birth weight & stillbirth

4-Drugs not given prior to labour

Chloramphenicol e.g. cidocetine, levocol, miphenicol =====>Grey Baby syndrome

Vasoconstrictors e.g. nasal decongestant (oral cold prep. & drops) , effortil , corasore, vascon, heptaminol, gutron =====>Placental casoconstriction so decreases
nutriens to fetus so malformations

5- Drugs not given during labour

(drugs causing respiratory depression)-
Opioids , Barbiturates , General anaesthetics (xpt N2O
Tranquilizers(diazepam)=====>muscle relaxation of baby and decrease ability of suckling
B-adrenergic agonists (bronchodilator containing salbutamol, salmetrol, terbutaline, ..etc) =====>complication of labour
Anticoagulants (warfarin, heparin)=====>decrease clotting of blood (should be stopped some time before delivery)
(عند وجود ضرورة لاعطاء anticoagulant يقوم الطبيب
باعطاء warfarin حتى بداية الشهر التاسع ثم يكمل بـ heparin لتجنب حدوث
نزيف حيث أن ال heparin ليه short half life و بالتالي يمكن عن طريق وقف
العلاج تفادي حدوث نزيف بسهولة )


:Antimicrobials as
Quinolones(Nalidixic acid-Norfloxacin-Ciprofloxacin-Ofloxacin) =====>cause "joint effects" as:arthropathy ,arthalgia ,swelling
e.g. tarivid, kiroll, tariflox,
ciprobay, ciprocin, ciprofar, cipromax, serviflox, rancif, tavanic,
lee-flox, unibiotic, levoxin, tequine, gatilox, avalox, spara, lomeflox

Sulfonamides =====>cause Kernicterus in infants(replace
bilirubin in plasma protein --->free bilirubin--->pptn in brain so
(convulsions (fatal

others
Ergotamine e.g. migrainil, spasmomigrain, no-migrain, metograin=====>Aborfacient
Diflunisal e.g. doloban, dolozal =====>drug induced hypoxia which make interference with energy production and osmolarity within ! developing embryo