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ADMINISTRAREA MEDICAMENTELOR IN SARCINA

medicina











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MASAJ - AUTOMASAJ DEFINITIE


A

B

C

D

X

Acid folic

Fier

Vit B6

Aciclovir

Adenozina

Adrenalina

evitat in primul trimestru)

Amoxicilina

Ampicilina

Ateplaza

Atropina

Augmentin Azitromicina

Bromhexin

Cefaclor

Cefalexin

Ceftriaxon Clindamicina

Clorfeniramin Clotrimazol-

(uz vaginal)

Codeina

Dexametazona

Digoxin

Dobutamina

Eritromicina

Famotidina

Hidroclorotiazida

Hidrocortizon

Insulina

ISDN

Ketamina

Lactuloza

Loratadina

Metoclopramid

Metronidazol(de

Mexiletina

Paracetamol

Prednison( nu in primul trimestru) Preparate de Al si Mg (Maalox)

Ranitidina(nici un antiH2 nu e recomandat in primul trimestru)

Salbutamol

Suxametoniu

Teofilina

Urokinaza

Amiodarona Amlodipina

Barbiturice

Benzodiazepine Biseptol

Bismut Ciprofloxacin

Claritromicina
Clotrimazol

Diclofenac

Diltiazem Dopamina

Ergotamine

Felodipina

Fluconazol Fortral

Furosemid

Glibenclamid

Glipizid

Heparina

Hidralazina

Ibuprofen

Indometacin Indapamid

Izoniazida Metformin

Mialgin

Miconazol 
Mebendazol

Morfina

Nifedipina

Nimodipine Nizatidina

Omeprazol

Piroxicam Propofol

Rifampicina

Simeticon

Spironolactona

Streptokinaza

Tramal

Trimetoprim

Verapami

Alcoolul

Aminoglicozide

Aspirina

Atenolol

Carbamazepina

Colchicina

Doxiciclina

Fenitoina

IEC

Sartani

Tetraciclina

Unii agenti chimioterapici Vitamina A

Misoprostol

Unii agenti chimioterapici

Statine

Warfarina

ADMINISTRAREA MEDICAMENTELOR IN SARCINA

A

Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities.

B

Animal studies have revealed no evidence of harm to the fetus, however there are no adequate and well-controlled studies in pregnant women.orAnimal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.

C

Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women.

D

Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.

X

Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

The FDA system ranks drugs as:

·         Category A - drugs that have been tested for safety during pregnancy and have been found to be safe. This includes drugs such as folic acid, vitamin B6, and thyroid medicine in moderation, or in prescribed doses.

·         Category B - drugs that have been used a lot during pregnancy and do not appear to cause major birth defects or other problems. This includes drugs such as some antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener), famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes), and ibuprofin (Advil, Motrin) before the third trimester. Pregnant women should not take ibuprofen during the last three months of pregnancy.

·         Category C - drugs that are more likely to cause problems for the mother or foetus. Also includes drugs for which safety studies have not been finished. The majority of these drugs do not have safety studies in progress. These drugs often come with a warning that they should be used only if the benefits of taking them outweigh the risks. This is something a woman would need to carefully discuss with her doctor. These drugs include prochlorperzaine (Compazine), Sudafed, fluconazole (Diflucan), and ciprofloxacin (Cipro). Some antidepressants are also included in this group.

·         Category D - drugs that have clear health risks for the foetus and include alcohol, lithium (used to treat manic depression), phenytoin (Dilantin), and most chemotherapy drugs to treat cancer. In some cases, chemotherapy drugs are given during pregnancy.

·         Category X - drugs that have been shown to cause birth defects and should never be taken during pregnancy. This includes drugs to treat skin conditions like cystic acne (Accutane) and psoriasis (Tegison or Soriatane); a sedative (thalidomide); and a drug to prevent miscarriage used up until 1971 in the U.S. and 1983 in Europe (diethylstilbestrol or DES).

Condition

Safe Medications to Take During Pregnancy*

Allergy

Benadryl

Cold and Flu

Tylenol (acetaminophen) or Tylenol Cold
Warm salt/water gargle
Saline nasal drops or spray

Sudafed, Actifed, Dristan, Neosynephrine*

Robitussin DM, Trind-DM, Vicks Cough Syrup, Romilar, Halls*

*Do not take "SA" (sustained action) forms of these drugs or the "Multi-Symptom" forms of these drugs.

Constipation

Metamucil
Citrucil
Fiberall/Fibercon
Colace
Milk of Magnesia
Senekot

Diarrhea

For 24 hours, only after 12 weeks of pregnancy:
Kaopectate
Immodium

Parepectolin

First Aid Ointment

J & J

Bacitracin

Neosporin

Headache

Tylenol (acetaminophen)

Heartburn

Maalox
Mylanta
Tums
Riopan
Titralac
Gaviscon

Hemorrhoids

Preparation H

Anusol

Tucks

Witch hazel

Nausea and Vomiting

Vitamin B6 100 mg tablet
Emetrol (if not diabetic)

Emetrex
Sea
bands

Rashes

Hydrocortisone cream or ointment
Caladryl lotion or cream
Benadryl cream

Oatmeal bath (Aveeno)

Yeast Infection

Monistat or Terazol

Do not insert applicator too far

  • Paracetamol at normal dose is safe and useful for headaches, backache, and other aches and pains that may occur during pregnancy.
  • Anti-inflammatory painkillers such as ibuprofen. You should not normally take these during pregnancy. Regular use during pregnancy may affect the large blood vessels of the developing baby.
  • Laxatives. Constipation is common in pregnancy and you may need a laxative. At first it is best to try increasing the fibre in your diet and increasing the amount that you drink. If this fails then fibre supplements such as bran, ispagula and sterculia are safe. If you need something stronger, then it is best to discuss this with a doctor. Some laxatives such as docusate and lactulose may be prescribed safely for a short time.
  • Antihistamines. The safest one to use in pregnancy is chlorphenamine. This is because it is the oldest, and so has a long established safety record. However, it tends to make some people drowsy. If you require an alternative then it is best to see a doctor for advice.
  • Decongestants such as pseudoephedrine, phenylephrine and xylometazoline are best avoided in the early stages of pregnancy. However, they are unlikely to be harmful if used just 'now and then'.

Most medications, though, have not been studied or shown to be safe to this extent. For these, we are left with this guideline: Medications that are considered safe in pregnancy are those that have been used extensively in humans and don't appear to cause any major birth defects or other problems (they also have been shown not to cause birth defects in animals). The FDA classifies these drugs as Category B. Treatment with Category B medications is considered "probably safe." This group includes ampicillin, acetaminophen (Tylenol is a common brand), ibuprofen (such as Motrin) before third trimester, aspartame, caffeine in moderation, hydrochlorothiazide (HCTZ), metoclopramide (Reglan), famotidine (Pepcid), loperamide (Imodium), and insulin.

Category C medications are somewhat more likely to have some complications for mother or fetus, or there isn't enough research to draw conclusions about their safety. These medications come with the warning that they should be used only if the potential benefits outweigh the possible risks. These include prochlorperazine (Compazine), Sudafed, fluconazole (Diflucan), and ciprofloxacin (Cipro). Most prescription medications are classified in Category C.

Category D medications are those that clearly have some health risks for the fetus, including ethanol (alcohol), lithium, phenytoin (Dilantin), and most chemotherapy agents, which still may be used under certain circumstances.

Category X drugs have been shown to cause birth defects and are not to be used in pregnancy under any circumstances. This category includes isotretinoin (Accutane), thalidomide, ribavirin (a treatment for hepatitis C) and diethylstilbestrol (DES).

For a list of treatments that are considered safe in pregnancy, go to our article about the specific condition or symptom in which you're interested, or see the article on antibiotics in pregnancy.
Category A
Only a few medications fall into category A, which means that human studies have shown no evidence of fetal harm in the first trimester or later in the pregnancy.

Nystatin vaginal (Mycostatin)

Category B
Most antibiotics are Category B, which means that there is no known association with birth defects or other pregnancy-related complication and the drug is probably safe. These include:

Amoxicillin
Ampicillin
Augmentin (amoxicillin-clavulanate)
Dicloxicillin
Macrobid (nitrofurantoin)
Flagyl (metronidazole) (although there is some controversy about taking it by mouth in the first trimester)
Cephalosporins including: Keflex (cephalexin), Ceclor (cefaclor), Duricef (cefadroxil)
Cleocin (clindamycin)
Erythromycin (all forms)
Zithromax (azithromycin)
Sulfa drugs (until near term)
Famvir (famciclovir)
Zovirax (acyclovir)
Valtrex (valacyclovir)
Clotrimazole-vaginal (Mycelex, Lotrimin)


Category C
Others are Category C, meaning that either there isn't enough information or there are some concerns arising from animal studies, but no confirmation of problems like birth defects in humans. These include:

Bactrim
Trimethoprim
Biaxin (clarithromycin)
Cipro (ciprofloxacin)
Diflucan (fluconazole)
Monistat (miconazole)
Terazol (terconazole)
Isoniazid
Rifampin
Vermox (mebendazole)
Tetanus booster (tetanus toxoid)
Vaccines: hepatitis A, hepatitis B, influenza, meningococcus, pneumonia (pneumococcus), polio
Vaccines: Measles, Mumps, Rubella (in this category because there is no proof that the MMR vaccine causes birth defects, but it is never purposefully used during pregnancy because there is some fear that the rubella component could adversely affect an unborn child)

Category D
Category D medications have clear-cut problems in pregnancy and should not be used unless there are no better alternatives. Category D includes:

Tetracycline derivatives, which can cause discoloration of teeth: tetracycline, doxycycline (Vibramycin), Minocin (minocycline)
Sulfa drugs - if near delivery (because they can increase the chance of serious newborn jaundice)

Anti-histamines. Older anti-histamines, such as chlorpheniramine and tripelennamine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer anti-histamines such as over-the-counter loratadine (Claritin®/Alavert® and generic forms) and prescription cetirizine (Zyrtec®) are also pregnancy category B medications.

Decongestants. Pseudoephedrine (Sudafed®, many generic forms) is the preferred oral decongestant to treat allergic and non-allergic rhinitis during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.

Medicated nasal sprays. Cromolyn nasal spray (NasalCrom®, generics) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over-the-counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua®), recently received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.

Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50% during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, there is no data showing that the allergy shots themselves are actually harmful to the fetus.

Sources:

Category A: Controlled studies in pregnant women demonstrate no fetal risk (eg, folic acid, levothyroxine);

Category B: Controlled animal studies have not shown a fetal risk but there are no studies done on women OR controlled studies in animals have shown a fetal risk that was not reproduced in controlled human studies (eg, amoxicillin, ceftriaxone);

Category C: Controlled animal studies have demonstrated adverse fetal effects and there are no human studies or there are no controlled studies in humans or animals (eg, nifedipine, omeprazole);

Category D: Controlled studies in humans demonstrate adverse fetal effects but the benefits of using the drug are greater than the risks (eg, propylthiouracil); and

Category X: Controlled studies in animals and humans have demonstrated adverse fetal effects or there is evidence of fetal risk based on human experience. The risk of using these drugs outweighs any possible benefit. The drug is absolutely contraindicated in pregnancy (eg, misoprostol, warfarin, isotretinoin).


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