孕妇用药分级与禁忌药品介绍.ppt

孕婦用藥分級與禁忌藥品介紹及鼓勵藥物不良反應通報案
前言
懷孕前期吃了藥,就要考慮拿掉孩子?
懷孕期間不管怎麼樣都不能服用藥物?
Rate of Medication use during pregnancy: data from the Avon Longitudinal Study of Parents and Children.
11,545 women
Only % used no medicinal product throughout their entire pregnancy.
% used at least one product at some stage.
Analgesics:1/3 women
Antacids were reported by 23%.
Antibiotic use decreased slightly during pregnancy from 8% early on to % at 32 weeks.
Amoxicillin was the most frequently reported antibiotic. (B級)
Eur J Clin Pharmacol.  2004; 60(5):355-61
Class outline for today
ics of pregnant women
Drug selection during pregnancy
Teratogenic drugs
ics of pregnant women
Pregnancy physiology . PK (ics)
GI activity changed →(absorption)
Cardiovascular system →(distribution)
-- plasma volume expansion
-- increase in cardiac output
-- regional blood flow changed
Decrease in albumin concentration →(distribution)
Enzyme activity changed →(metabolism)
Increase in GFR →(elimination)
GI activity changed
Decrease gastric acidity
Delay in gastric emptying
 Alter drug absorption
Cardiovascular system
Plasma volume expansion
-- begins at 6-8 wks of gestation
-- volume of 4700 – 5200 ml
-- peaks at 32 wks of gestation
-- 40%: partment
60% amniotic fluid,placenta,fetus
Cardiac output
-- increase 30-50 %
-- 50% by 8 wks of gestation
Cardiovascular system
Regional blood flow changed
-- increase blood flow to uterus ( 20% of cardiac output)
-- increase renal blood flow
-- increase skin blood flow
-- increase mammary blood flow
-- decrease skeletal muscle blood flow
Albumin level
Decrease in albumin concentration
 free form of drugs increased