- •Cardiotocography
- •Ultrasound examination
- •Self control questions.
- •3.5.2. Self control tests.
- •Gestosis
- •Oligoamnios
- •Anemia
- •Hydramnion
- •1. Recognize factors which determine drug passage across the placenta and into breast milk.
- •2. Identify aspects of medications that determine safety during lactation.
- •• A substance, organism, physical agents or deficiency state capable of inducing abnormal structure or function such as:
- •• Timing of exposure
- •• Developmental stage during exposure
- •• Maternal dose and duration
- •• Maternal pharmacokinetics
- •IV. FDA Pregnancy Categories
- •V. FDA Pregnancy Categories
- •VI. FDA Labeling Changes
- •VII. Drug Transfer to the Fetus
- •VIII. Drug Passage into Breast Milk
- •IX. Drug Transfer
- •XI. Fetal Drug Disposition
- •• 60 – 80% passes through liver, the rest travels through ductus venosus to heart and brain
- •XII. Drug Concentration in Breast Milk
- •XIII. Calculating Drug Exposure
- •Infant dose/maternal dose using mg/kg/d
- •XIV. Neonatal Factors
- •XV. Infant Adverse Effects
- •XVI. Anti-infectives
- •XVII. Penicillins
- •XVIII. Cephalosporins
- •• Category B/C/B in pregnancy
- •XXIII. Sulfonamides
- •XXV. Miscellaneous Antibiotics
- •XXVI. Miscellaneous Antibiotics
- •XXVII. Miscellaneous Antibiotics
- •XXVIII. Miscellaneous Antibiotics
- •Antiretrovirals/NNRTI (delavirdine, efavirenz, nevirapine)
- •Antiretrovirals/PI
- •Antiretrovirals/Fusion Inhibitor (enfuvirtide)
- •Antiretroviral Combinations
- •Antifungals/Echinocandins (anidulofungin, caspofungin, micafungin)
- •Antifungals/Polyenes
- •XXXII. Migraine Headache Therapy
- •Triptans (5-HT1 agonists)
- •Triptans (5-HT1 agonists)
- •Butalbital and Caffeine
- •Dichloralphenazone and Isometheptene (Midrin)
- •Questions to Ask:
- •Questions to Ask:
- •Considerations in Breastfeeding:
- •• Withhold or delay therapy if possible
Antifungals/Polyenes
•Amphotericin B
–Pregnancy Category B, compatible, lipid complexes also compatible
–Lactation – no data available
XXXII. Migraine Headache Therapy
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Triptans
Ergots
Butalbital
Caffeine
Dichloralphenazone
Isometheptene
Triptans (5-HT1 agonists)
•Pregnancy Category C
–Limited human data exists, sumatriptan has been associated with VSDs in several cases
–No data available in humans for almotriptan, eletriptan, frovatriptan, or zolmitriptan
–Limited human data exists with naratriptan and rizatriptan, although animal data indicates moderate risks
–Pregnancy registry available for exposures
Triptans (5-HT1 agonists)
•Lactation
–Cross into breastmilk and may concentrate
–No reports of human lactation with almotriptan, frovotriptan, naratriptan, rizatriptan, or zolmitriptan
–Sumatriptan is compatible per AAP
–Eletriptan is likely compatible with low concentrations
Ergots
(Dihydroergotamine, ergotamine)
•Pregnancy Category X
–Oxytocic properties could cause IUGR by vascular disruption or increased uterine tone
–Early exposure appears safe, not teratogens
–Chronic exposure is contraindicated
•Lactation
–Contraindicated