النتائج 1 إلى 3 من 3



الموضوع: dental drugs for pregnant and nursing patient

  1. #1

    افتراضي dental drugs for pregnant and nursing patient

    Dental Drugs for Pregnant and
    Nursing Patients

    Considerations

    Dental treatment for pregnant patients
    Prescribing for two
    Cross placenta
    Excretion into breast milk
    Metabolism by fetus and neonate
    Liability

    Considerations

    Crossing placenta
    Excretion in breast milk
    Approx 1% plasma conc
    Passive diffusion
    Factors:
    Low molecular weight
    Highly un-ionized
    Low protein binding
    Highly lipophilic

    Pharmacology

    Metabolism by fetus and neonate
    Immature liver low hepatic
    glucuronidation
    Immature kidney low elimination
    Accumulation of metabolites
    Longer half-lives



    Pregnancy

    First trimester
    2nd to 8th week organogenesis
    Teratogenesis
    Spontaneous abortion – 1 in 5 pregnancies
    Second trimester
    Third trimester

    FDA

    Classification System
    A: Controlled studies show NO risk to fetus
    B: No evidence of risk in humans
    either NO risk seen from animal studies, or human 1st
    trimester studies OK after adverse animal studies
    C: Risk cannot be ruled out
    either animal studies show risk with no subsequent
    human studies, or no animal or human studies avail
    D: Positive evidence of risk
    evidence human risk, but benefit > risk
    X: Contraindicated in pregnancy
    evidence human risk, risk >> benefit

    Dental Drugs

    Local anesthetics
    Antibiotics
    Analgesics
    Sedatives
    Local Anesthetics
    Pregnancy
    Safe
    Class B – lidocaine,
    etidocaine, prilocaine
    Class C –
    mepivacaine,
    bupivicaine
    Epinephrine
    Preeclampsia?,
    uterine blood flow?
    Safe, benefit >> risk
    Nursing
    Safe
    Lidocaine shown to
    be compatible
    Antibiotics
    Pregnancy
    Safe: penicillins,
    cephalosporins,
    macrolides
    Watch: E-mycin
    estolate, sulfa,
    metronidazole
    Do not use:
    tetracycline,
    doxycycline
    Nursing
    Safe: almost all
    Watch:
    metronidazole
    Do not use: ??
    doxycycline,
    ketoconazole,
    fluconozole
    Analgesics
    Pregnancy
    Safe: Acetaminophen
    NSAIDs
    Avoid in 3rd trimester
    ASA
    PDA closure,
    prolonged pregnancy,
    inhibit labor,
    labor hemorrhage
    Narcotics
    Avoid codeine?
    Oxycodone
    Nursing
    ASA?
    ?Risk of Reye’s syndrome
    Narcotics
    excretion:
    Oxycodone, meperidine
    «excretion (better):
    Codeine, morphine
    Timing
    Sedatives
    Pregnancy
    Benzodiazepines
    Short vs long-term
    Try to avoid, esp near
    term
    Fetal CNS depression,
    “floppy baby syndrome”
    Nursing
    Short vs. long-term
    Timing
    Breast pump
    Nurse immediately prior
    Wait 1-2 half-lives after
    Choose agents with
    shorter half-lives
    Benzodiazepines
    Opiates

    منقول من الانتر نت

  2. #2

    افتراضي

    موضوع رائع
    شكرا على الجهود دكتور عبد الجواد .

  3. #3

    افتراضي

    مشكور للنقل
    جزاك الله خيرا


ضوابط المشاركة

  • لا تستطيع إضافة مواضيع جديدة
  • لا تستطيع الرد على المواضيع
  • لا تستطيع إرفاق ملفات
  • لا تستطيع تعديل مشاركاتك
  •