Transcript PRESCRIBING IN PAEDIATRIC CYSTIC FIBROSIS

DRUGS IN PREGNANCY
AND LACTATION
Scottish Neonatal and Paediatric Pharmacists Group
AIMS
• To update pharmacists on
current opinion relating to the
prescribing of drugs in
pregnancy and breastfeeding.
Scottish Neonatal and Paediatric Pharmacists Group
OBJECTIVES
• To be aware of the background and
relevance of this specialised area of
prescribing
• To be able to find information regarding
current drug use in pregnancy - and
breast feeding
• To be able to interpret this in day to day
cases encountered in working - practice.
Scottish Neonatal and Paediatric Pharmacists Group
INTRODUCTION
• Thalidomide
• Foetal malformations occur in 2% of
population
• 65% - 70% of malformations are of
unknown cause
Scottish Neonatal and Paediatric Pharmacists Group
PRINCIPLES OF TERATO GENESIS
• Placental barrier does not exist
• Teratogenicity is usually dose dependent
• Teratogenic agents may be synergistic.
• A teratogen may be harmless to the mother but
devastating to the embryo.
• Timing and exposure is critical
• Susceptibility to teratogenesis is genetically
determined.
Scottish Neonatal and Paediatric Pharmacists Group
PRINCIPLES OF PRESCRIBING
• Evaluate every drug prescribed
• Use drugs which have been
widely used in pregnancy
• Medico-legal
Scottish Neonatal and Paediatric Pharmacists Group
PROBLEMS ENCOUNTERED
1. Anxious and emotional patients
2. Medico legal implications
3. Defensive Pharmaceutical Companies
4. Poor quality data
5. Media Scares
Scottish Neonatal and Paediatric Pharmacists Group
FACTORS TO TAKE INTO CONSIDERATION
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Pregnant, planning pregnancy
Script needed
Consider period of gestation
Medicate only if benefits outweigh the
risks
Avoid new drugs
Use a single drug if possible
Use lowest effective dose
Involve and counsel patient
Scottish Neonatal and Paediatric Pharmacists Group
INADVERTENT DRUG EXPOSURE
• Identify medicines taken
• Go to the SPC
• Either contact the local medicines
information unit or
• Contact the National Teratology
Information Service at Newcastle
Scottish Neonatal and Paediatric Pharmacists Group