Rational use of drugs in patients with skin diseases in pregnancy

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Pregnancy medication principleTo avoid the use of any drugs in the first 3 months of pregnancy, pregnant women throughout the pregnancy medi

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Pregnancy medication principle

To avoid the use of any drugs in the first 3 months of pregnancy, pregnant women throughout the pregnancy medication should be particularly cautious, should be put an end to non essential drugs;

The dosage of all drugs should be the minimum effective dose;

Try to use a more complete drug during pregnancy;

The patients with chronic diseases during pregnancy, medication to seek doctor's permission;

It can have as far as possible without external medicine medicine.

Effects of drugs on the fetus during pregnancy

Pregnancy medication in accordance with the pregnancy of the first three months of pregnancy, 3 - 6 months, 6 - 9 months of the three stages. Early pregnancy is considered to be a sensitive period of drug teratogenicity. From fourth weeks to 8 weeks, the embryo organ began to develop, and rapidly developed to a period of third months. This period is the most active period of organ development, but also the most vulnerable to interfere with the normal differentiation of embryonic tissue cells, may lead to fetal abortion, deformity or organ dysfunction, this period as far as possible without medicine. In March, second and a half weeks after the pregnancy, the cells had not yet differentiated, and this was mainly due to spontaneous abortion rather than congenital abnormality. Second weeks to eighth weeks, fetal organs in the development stage, this period mainly consider the impact of drugs on cell differentiation, leading to congenital abnormalities. Third to sixth months, each organ system is mature, at this time the main effect of drug use organ function, such as maternal iodine, can lead to fetal thyroid function. Pregnancy sixth months to September (prenatal), the main consideration of the use of maternal amniotic fluid, fetal brain, respiratory function.

The use of drugs in pregnancy risk level America promulgated by the FDA classification of pregnancy using drugs to the level of risk, some drugs due to the harm of drugs because of their different duration, and different levels of harm, the classification criteria are as follows:

In a controlled study, women who had 3 months of gestation did not see signs of fetal harm (and there was no evidence of harm to the next 6 months).

B level in animal reproductive studies (no controlled study of pregnant women), no impact on the fetus. Adverse reactions in animal reproductive studies were not confirmed in women who had been pregnant for 3 months (and there was no evidence of harm to the next 6 months).

C class animal experiments have shown adverse effects on the fetus (teratogenic or killing embryos), but not in pregnant women in the control study. This kind of medicine can only be used after weighing the advantages of pregnant women more than the harm to the fetus.

D has clear evidence of harm to the fetus, despite the harm, but pregnant women after medication with absolute benefits (such as pregnant women by the threat of death or serious illness, although the application of other drugs safe but invalid), still want to use.

X levels in animal or human studies have shown that it can cause fetal abnormalities, and the use of such drugs in pregnant women is clearly unhelpful. This drug is contraindicated in patients who are pregnant or are about to become pregnant.

FDA drugs used during pregnancy in A can be used during pregnancy, but it is a pity that this kind of medicine is very small in the Department of dermatology. Nystatin only for external use. FDA pregnancy category B drugs can be used during pregnancy.

1 antibiotics

FDA class B: penicillins, cephalosporins, erythromycin, azithromycin, clindamycin and lincomycin

FDA class C: aminoglycosides, sulfonamides, clarithromycin (FDA grade C, close to the end of pregnancy in application for D) and trimethoprim (TMP), quinolones (most FDA grade C)

FDA class D: tetracycline, kanamycin, streptomycin, tobramycin, amikacin, gentamicin, neomycin, spectinomycin.

2 antifungal drugs

Antifungal agents for the treatment of fungal infections during pregnancy.

FDA class B: amphotericin B (local), terbinafine (local), miconazole and clotrimazole (local)

FDA class C: griseofulvin, ketoconazole, fluconazole, itraconazole

3 antiviral drugs (FDA grade C)

A Silowe (FDA C), not for pregnancy; famciclovir (famciclovir) (FDA grade B), animal non teratogenic, indeed necessary when using; valacyclovir (valaciclovir) (B, FDA classification) no animal teratogenicity, but only the interests in fetal risk in pregnant women use only. Herpes simplex virus infection can cause severe damage to the fetus or newborn in the process of intrauterine and delivery. Many reports mention no side effects on pregnant women. However, due to the small number of monitoring, can not completely determine the safety of the drug during pregnancy.

4 antitumor and immunosuppressive agents D

FDA class D: methotrexate, chlorambucil, busulfan, chlorambucil, cyclophosphamide, chlorambucil, busulfan and fluorouracil, both couples who are suitable for the application of this product, after the end of treatment six months pregnant again.

5 glucocorticoids

All glucocorticoids pass through the placenta. The prednisone and hydrocortisone in the placenta is easily affected by the role of 11- beta dehydrogenase inactivated, the fetus is less affected, it is suitable for the treatment of pregnant women with SLE. At present, there is no evidence to determine the role of glucocorticoids in early pregnancy. Zuanadchanyson, prednisone, cortisone acetate, betamethasone / dexamethasone FDA classification C.

6 sex hormones (estrogen and progesterone)

Oral contraceptives (Oral contraceptives, OC) and diethylstilbestrol FDA classification X. Oral medication is usually avoid preparations containing a synthetic estrogen (ethinyl estradiol or progesterone and quinestrol) a (such as norethisterone, norethisterone acetate, ethynodiol diacetate, norgestrel, levonorgestrel) mixture. There is also a progestin containing contraceptives.

7 antihistamine drugs

There is no clear guideline on how to evaluate the safe use of antihistamines in pregnant women. It is generally believed that there is no obvious teratogenic effect of this kind of drugs on the fetus, but in the 2 weeks after the birth of the fetus, the lens can be formed in the newborn.

FDA B drug: tripelennamine, diphenhydramine, cyproheptadine, loratadine, cetirizine, cimetidine, chlorpheniramine, Rene Titi (Pu Ermin), famotidine

FDA C: two drug methoxy benzyl amine, mepyramine, hydroxyzine, brompheniramine, terfenadine

8 vitamins

(1) vitamin A vitamin A deficiency or excess may be teratogenic: birth heart malformation, lack of infant cerebellar malformation and no eye disease, retinal fissure, ectopic ureter and diaphragmatic hernia, high doses of vitamin A in infant genitourinary malformations, with small ears, microphthalmia.

(2) vitamin B6 (FDA grade A) for a long time to take a large number of similar "stop reaction" deformity, short limbs.

(3) vitamin D overdose can cause neonatal aortic stenosis and spinal bifida, excessive use of vitamin D can cause neonatal hypercalcemic, mental retardation, supravalvular aortic stenosis, deficiency can cause rickets, skeletal deformity.

9 retinoids

FDA X: if different dimension A acid A ester, avi,

10 other (thalidomide, dapsone, lamprene, chloroquine and hydroxychloroquine)

FDA classification X: Thalidomide

FDA classification: C DDS dapsone, lamprene, chloroquine and hydroxychloroquine, of which 1 cases of chloroquine for teratogenic reported in 1968 was assigned to the D class, then there is no new information, so Sweden will chloroquine into class B3. There are reports of 169 infants whose mothers took effect of chloroquine on the fetus during the whole pregnancy, the conclusion is that the drug has a strong teratogenic. But can not rule out the possibility of a slight increase in congenital defects.

11 topical drugs

FDA class B: azelaic acid, topical nystatin, clotrimazole, miconazole and other imidazoles.

Crotamiton the drug use during pregnancy, there is no systemic side effects were reported.

Topical salicylic acid has no teratogenic effect.

FDA class C: topical corticosteroids, minoxidil, benzoyl peroxide, retinoic acid, three alcohol, A Da Palin capobenic, tar, dithranol, podophyllotoxin.

12, Chinese herbal medicine

The provisions of the Ministry of health of arsenolite (red arsenic and Bai Pi), arsenic, mercury, nux vomica, Sichuan aconite root, kusnezoff Monkshood, white, aconite, aconite roots, pinellia tuber, Arisaema, Croton, cantharidin, green snake, red lady, Euphorbia kansui, Euphorbia, Garcinia, thousands of students, students of gold day fairy, rhododendronmolle, xueshangyizhihao, red, white, light Jiang Dan toad, powder, realgar, and other 27 kinds of Yangjinhua may cause serious harm to the fetus, must be disabled.

FDA pregnancy category B drugs can be used during pregnancy, as well as other:

Doxepin (topical), topical antihistamine anti allergic

(Garrido Kain) local anesthesia with epinephrine injection

Metronidazole (local), antibacterial

Peptide (local), antibacterial

Mupirocin (local), antibacterial

(local), antifungal

Lidocaine local anesthesia

Lin Dan (pregnancy of not more than 2 times), the treatment of scabies

Note: some of the drugs used in the FDA period of pregnancy are C, and there are no reports of any problems that have been widely used in the Department of Dermatology, such as

Aciclovir oral and topical antiviral.

The local use of benzoyl peroxide acne treatment.

There is one we are most concerned about A acid, adapalene also belongs to the class C - differin.

Miconazole, antifungal drugs

Astemizole, anti allergic drugs

Tacrolimus, antiallergic

Table 1 Classification of dangerous drugs used during pregnancy

Antihistamine drug

Booker Li (C), chlorpheniramine (B), Simiti Martin (B), Sai Gengding (B), diphenhydramine (B), dimenhydrinate (C), hydroxyzine (C), Meclozine (B) and promethazine (C), mepyramine (C)

Anti infective agents

An anti drug

Kaba (D), bis (C)

Anthelmintic drug

Long Danzi (C), piperazine (B), antiminth (C), pyrvinium embonate (C)

Antimalarial drug

Chloroquine and primaquine (D) (C) (C), pyrimethamine, quinine (C)

Drug resistance

Metronidazole (C)

Antibiotic

Amikacin (Cm), gentamicin (C), kanamycin (D), neomycin (D) and streptomycin (D), tobramycin (C), cephalosporins (B), penicillin (B), tetracycline (D), demeclocycline (D), methacycline (D), minocycline (D), oxytetracycline (D), chlortetracycline (D) and Bacillus peptide (C), chloramphenicol (C), clindamycin (B), erythromycin (B), lincomycins (B), novobiocin (C), oleandomycin (C), polymyxin B (B) and vancomycin (C)

Other antibiotics

Sulfonamides (B/D) and trimethoprim (C), furazolidone, nitrofurantoin (C) (B), Meng Deli (C), acid (B), nalidixic acid (B)

Antituberculosis drugs

Para aminosalicylic acid (C), ethambutol (B), isoniazid (C), Li Fuping (C)

Antifungal agents

Amphotericin B (B) and clotrimazole (B) and griseofulvin (C), miconazole (B)

Nystatin (B)

Antiviral drug

Amantadine (C), glucoside (C), adenosine monophosphate (C)

Antineoplastic agents

Methotrexate (X), azathioprine (D), bleomycin (D), Bai Xiaoan (D), chlorambucil (D), cisplatin (D) and cyclophosphamide (D) and cytarabine (D), actinomycin (D) and daunorubicin (D), adriamycin (D) and 5-fluorouracil (D), nitrogen mustard (D) and melphalan (D), mercapto purine (D), methotrexate (D), mithramycin (D), procarbazine (D), thiotepa (D), Changchun alkali (D), vincristine (D)

Autonomic nervous system drugs

Cholinergic drugs

Acetylcholine (C), neostigmine (C), pentazocine (B/D) and pethidine (B/D) and methadone (B/D), Ventani (B/D), pyridostigmine (C), edrophonium chloride (C) and pilocarpine (C) and physostigmine (C), nalorphine (D) and naloxone (C)

Anticholinergic drugs

Atropine, belladonna (C) (C), benzene (C), atropine and homatropine (C) and anisodamine (C) and scopolamine (C), propantheline bromide (C) and trihexyphenidyl (C)

Adrenergic drug

Epinephrine (C), norepinephrine (D), isoprenaline (C), ephedrine (C), mephentermine (C) and metaraminol (D), methoxamine (D) and phenylephrine (D) and terbutaline (D), Doba (C), dobutamine (C)

Adrenergic drug

Propranolol (C)

Muscle relaxant

Isocarboxazid (C) and nortriptyline (D), phenelzine (C), tranylcypromine (C), ten hydrocarbon bromide (C)

Central nervous system drugs

Central stimulant

Caffeine (B), dexamfetamine (D), methylphenidate (C)

Antipyretic analgesic shake

Acetaminophen (B), aspirin (C/D), non - cefoxitin (B), Dallefon (C/D), sodium salicylate (C/D), sodium salicylate (C/D)

Non steroidal anti-inflammatory drugs

Fenoprofen (B/D), Bloven (B/D) and indomethacin (B/D), Meclofenamic (B/D), Nai Pusheng (Bm/D), hydroxyl phenylbutazone (D) and phenylbutazone (D), sulindac (B/D) and Tolmetin (B/D)

Analgesics

A method of Luoding (B/D), epinephrine (B/D) codeine and morphine (B/D), opioid (B/D), trimetaphan camsilate (C)

Sedative and hypnotic

Amobarbital (C), Babito (C), Bernd Bobby Toy (B), Scobabito (C), chloral hydrate (C), ethanol (C/X), diazepam (D), cloz Lan (D), meprobamate (D), methaqualone (D), Asha Si (C), clonazepam (C)

Tranquilizer

The class of chlorpromazine (C) and droperidol (C), lithium salt (D), thioxanthene class (C)

Antidepressant

Amitriptyline (D), Dosepin (C), imipramine (D) and dexamethasone (C) and prednisone (B), P Nixonn Ron (B)

Vasodilator

Isoamyl nitrite (C), dipyridamole (C) and isosorbide dinitrate (C), e four nitrate (C) and nitroglycerin (C), tolazoline (C)

Cardiacglycosides

Acetyl digitoxin, digoxin (B) (B) (B), digoxin, digitoxin (B), Mao Huagan (B), deacetyl cedilanide (B), BRETYLIUM (C), propiram (C), quinidine (C), Vera Pammy (C)

Hypotensor

Kato Pury (C), clonidine (C), two (D), diazoxide hexamethonium bromide (C), hydralazine (B), Ca Guido Ba (C), Mino Di M (C), Mino Di M (C), sodium nitroprusside (D), Pagelin (C), prazosin (C), reserpine (D), estradiol (D), oral contraceptives (D)

Diuretics

Acetazolamide (C) and amiloride (Bm), hydrochlorothiazide class (D) and ethacrynic acid (D), furosemide (C), glycerol (D), Gan Luchun (C), spironolactone (D), triamterene (D), urea (D)

Digestive system drugs

Diphenoxylate and loperamide (C) (C), Compound Camphor Tincture (B/D), two methyl silicone oil (C)

Hormones

Adrenal cortical hormone

Cortisone (D), Batamison (C), insulin (B) chlorpropamide (D)

Progesterone

Progesterone (D)

thyroid hormone

Calcitonin (B)

estrogen

Diethylstilbestrol (X)

This article is only for users reference, friends can not the random self medication medication. Please use specific friends consultation consulting a doctor working in the Department of Dermatology

Reproduced from, No.304 Hospital,,, in this thanks.

 

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