Pregnancy nurses

Pregnant women after the third month of pregnancy, nursing women, and children under the age of 8 years should not be treated with tetracyclines, because of the risk of discoloration of the teeth. Besides its merely cosmetic aspect, tooth discoloration in children is associated with enamel defects and hypoplasia in severe cases (169). 

The nurse should use cephalosporins cautiously in patients with renal or hepatic impairment and in patients with bleeding disorders. Safety of cephalosporin administration has not been established in pregnancy or lactation these drugs are assigned to Pregnancy Category B. 

Judy Cowan, age 28 years, has been prescribed clomiphene to induce ovulation and pregnancy. Judy is very anxious and wants desperately to become pregnant. Her husband, Jim, has come to the clinic with her. Discuss assessments the nurse would consider important before initiating treatment with clomiphene. Discuss information the nurse would include in a teaching plan for Jim and Judy. 

There is no experimental evidence available to assess whether the toxicokinetics of -hexane differ between children and adults. Experiments in the rat model comparing kinetic parameters in weanling and mature animals after exposure to -hexane would be useful. These experiments should be designed to determine the concentration-time dependence (area under the curve) for blood levels of the neurotoxic /7-hcxane metabolite 2,5-hexanedione. w-Hcxanc and its metabolites cross the placenta in the rat (Bus et al. 1979) however, no preferential distribution to the fetus was observed. -Hexane has been detected, but not quantified, in human breast milk (Pellizzari et al. 1982), and a milk/blood partition coefficient of 2.10 has been determined experimentally in humans (Fisher et al. 1997). However, no pharmacokinetic experiments are available to confirm that -hexane or its metabolites are actually transferred to breast milk. Based on studies in humans, it appears unlikely that significant amounts of -hexane would be stored in human tissues at likely levels of exposure, so it is unlikely that maternal stores would be released upon pregnancy or lactation. A PBPK model is available for the transfer of M-hcxanc from milk to a nursing infant (Fisher et al. 1997) the model predicted that -hcxane intake by a nursing infant whose mother was exposed to 50 ppm at work would be well below the EPA advisory level for a 10-kg infant. However, this model cannot be validated without data on -hexane content in milk under known exposure conditions. 

Postpartum administration Postpartum administration in non-nursing mothers may begin at the first postpartum examination (4 to 6 weeks), regardless of whether spontaneous menstruation has occurred. Also, start no earlier than 4 to 6 weeks after a midtrimester pregnancy termination. 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

All HMG-CoA reductase inhibitors are contraindicated in pregnant and nursing women. When ezetimibe is administered with an HMG-CoA reductase inhibitor in a woman of childbearing potential, refer to the pregnancy category and product labeling for the HMG-CoA reductase inhibitor. 

First-generation antihistamines Flypersensitivity to specific or structurally related antihistamines newborns or premature infants nursing mothers monoamine oxidase (MAO) therapy pregnancy (hydroxyzine) angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, elderly, debilitated patients (cyproheptadine). 

In patients with impaired renal function, the serum half-life is prolonged. Pregnancy Category B. Aztreonam crosses the placenta and enters fetal circulation. Lactation Aztreonam is excreted in breast milk in concentrations that are less than 1% of maternal serum. Consider temporary discontinuation of nursing. 

Early worries about risk of cancer or leukaemia have proven unfounded in prolonged follow-up studies. However radioactive treatment is contraindicated in pregnant woman or nursing mothers. Other risks for the fetus are abortion, intrauterine death, congenital malformation and congenital hypothyroidism (if administered after 12 weeks gestation). It is customary to avoid pregnancy for the first... 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Cortisone should be used with caution in pregnancy, especially during the first 14 weeks, as it may give rise to fetal damage. The drug should also be administered with caution to nursing mothers [64],... 

Case Example A 28-year-old woman had been stable on lithium treatment for several years. When she became pregnant, her lithium was discontinued, and within a few weeks she was hospitalized for a severe exacerbation of mania unresponsive to CPZ in doses up to 1,200 mg/day. After a course of ECT she became euthymic and was adequately maintained on lower doses of CPZ (i.e., 50 to 100 mg/day) for the remainder of her pregnancy. The delivery and the immediate postpartum period went well, but lithium was not resumed because she opted to nurse her infant. Several weeks later, she was rehospitalized for an episode of depression, which also responded to a course of ECT. She then agreed to discontinue nursing her child and resume lithium. The patient was doing well at follow-up 1 year later. 

All sedative-hypnotics cross the placental barrier during pregnancy. If sedative-hypnotics are given during the predelivery period, they may contribute to the depression of neonatal vital functions. Sedative-hypnotics are also detectable in breast milk and may exert depressant effects in the nursing infant. 

Radiation destruction of thyroid parenchyma Hyperthyroidism patients should be euthyroid or on blockers before RAI avoid in pregnancy or in nursing mothers Oral half-life 5 days onset of 6-12 weeks maximum effect in 3-6 months Toxicity Sore throat, sialitis, hypothyroidism... 

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