Dental Drug Therapy In Pregnancy And Lactation Flashcards
Two main concerns when administering a drug to pregnant women
- drug teratogenicity
- will the drug affect the near term fetus
Possible adverse effects include
Spontaneous abortion, congenital defects, LBW, direct drug toxicity/ adverse rxn in the newborn, neonatal drug withdrawal, long term effects on neurobehavioural development
What occurs in 1st trimester
Organs of fetus are forming, most critical time of teratogenicity
2nd trimester events
OH, prophy, most comfortable
3rd trimester events
Consider drug effects on newborn
Amount of drugs that pass through the milk through the baby depend on
Plasma concentration, lipid solubility, degree of ionization, protein binding, molecular weight
The majority of adverse reactions occurs in? The highest risk occurs?
< 6 months, < 2 month
Local anesthetics considerations
- safe
- can cause fetal bradycardia and neonatal respiratory depression in v high doses
Best LA for pregnancy? Worst?
Lidocaine, Bupivicaine
Which LA are associated with methemglobinemia
Prilocaine, benzocaine, tertacaine.
Teratogenic LA in animal studies
Mepivicaine, bupivicaine
Large doses of epi effects in the fetus
Anoxia, from umbilical cord vasoconstriction
Epi contraindication
Nope, since not deposited into vascular
What is analgesic of choice
Acetaminophen, safe in breast feeding and pregnancy
Aspirin and NSAIDs
Slight risk of congenital anomalies - cardiac defects with some NSAIDs in early pregnancy
In 3rd trimester - delayed delivery, premature closure of the ductus arteriosus, decrease placental function and increased risk of maternal or fetal hemorrhage
