MEDICATION EXPOSURES DURING PREGNANCY AND LACTATION

MEDICATION EXPOSURES DURING PREGNANCY  AND LACTATION

 

            Every woman in the general population has a 3–5% risk of having a child with a birth defect or mental retardation. Birth defects are the leading cause of infant mortality in the United States. Two important factors to consider when assessing the teratogenic potential of a medication are the stage of pregnancy at which the exposure occurred and the amount of medication taken. It is critical to evaluate each exposure on a case-by-case basis in order to give an accurate risk assessment. Some of the known, possible, and unlikely human teratogens are listed below.

            If you have a pregnant or breast feeding patient who is currently taking, or considering taking, a medication, the patient needs to be counselled about potential adverse effects the medication could have on her fetus or infant.

 

Some Known Teratogens

 

• Radiation

Atomic weapons

Radioiodine

Therapeutic radiation

 

• Infections

Cytomegalovirus

Herpes simplex virus I and II

Parvovirus B-19 (Erythema

infectiosum)

Rubella virus

Syphilis

Toxoplasmosis

Varicella virus

Venezuelan equine encephalitis virus

 

• Maternal & Metabolic Imbalance

Alcoholism

Amniocentesis, early

(before day 70 post conception)

Chorionic villus sampling

(before day 60 post conception)

Cretinism, endemic

Diabetes

Folic acid deficiency

Hyperthermia

Myasthenia gravis

Phenylketonuria

Rheumatic disease

Sjögren’s syndrome

Virilizing tumors

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Drugs and Environmental Chemicals

ACE inhibitors (benazepril,

captopril, enalapril, fosinopril,

lisinopril, moexipril, quinapril,

ramipril, trandolapril)

Aminopterin

Androgenic hormones

Busulfan

Chlorobiphenyls

Cigarette Smoking

Cocaine

Coumarin anticoagulants

Cyclophosphamide

Diethylstilbestrol

Etretinate

Fluconazole (high doses)

Iodides

Isotretinoin (Accutane®)

Lithium

Mercury, organic

Methimazole

Methotrexate (methylaminopterin)

Methylene blue (via intraamniotic

injection)

Misoprostol

Penicillamine

Phenytoin

Tetracyclines

Thalidomide

Toluene (abuse)

Trimethadione

Valproic acid

 

Possible Teratogens

Binge drinking

Carbamazepine

Colchicine

Disulfiram

Ergotamine

Glucocorticoids

Lead

Primidone

Quinine (suicidal doses)

Streptomycin

Vitamin A (high doses)

Zidovudine (AZT)

Zinc deficiency

 

Unlikely Teratogens

Agent Orange

Anesthetics

Aspartame

Aspirin (but aspirin in the 2nd half of

pregnancy may increase cerebral

hemorrhage during delivery)

Bendectin® (antinauseant)

Electromagnetic waves

Hydroxyprogesterone

LSD

Marijuana

Medroxyprogesterone

Metronidazole

Oral contraceptives

Progesterone

Rubella vaccine

Spermicides

Video display terminals

Ultr

New drugs For Hiv _ Aids

44 new HIV/AIDS products now in US R&D

US biopharmaceutical companies are currently developing 44 new medicines and vaccines for HIV/AIDS treatment and prevention, according to new industry figures.

 

Products in the pipeline include 25 antivirals, 16 vaccines and three cell/gene therapies, all of which are either in clinical trials or awaiting review by the Food and Drug Administration (FDA), reports the Pharmaceutical Research and Manufacturers of America (PhRMA). They include:

• a first-in-class medicine (attachment inhibitor) intended to prevent HIV from breaking through the cell membrane;

• a cell therapy that modifies a patient’s own cells with the aim of making them resistant to HIV; and

• a therapeutic vaccine designed to induce responses from T cells that play a role in immune protection against viral infections.

 

There are currently 94 active clinical trials for HIV medicines and vaccines in the US. Of these 43 have either not yet started recruiting patients or have recently begun seeking participants, while the remaining 51 are ongoing but not recruiting new patients., adds PhRMA. 

 

The therapies being investigated include:

• attachment inhibitor: a new class of medicines, one of which now in development attaches to gp120, a part of the virus, and inhibits entry of the virus into cells by blocking the interaction between gp120 and the cell receptors; 

• gene modification: one cell therapy in development is designed to modify the DNA sequence of CCR5 – a co-receptor on the surface of cells that allows HIV to enter and infect T cells – with the aim of making the patient’s own cells resistant to infection by HIV. The patient’s cells are extracted, modified and then reinserted into the patient, to provide a population of cells that can fight HIV and opportunistic infections; and

• inducing T cell responses: deficits of CD4+ T cells, which play a key role in immune protection against viral infections, are associated with virus reactivation, vulnerability to opportunistic infections and poor vaccine efficacy. 

 

Since AIDS was first reported in 1981, nearly 40 medicines have been approved to treat HIV infection in the US, says PhRMA. They have made HIV infection a manageable chronic disease, but opportunities for greater progress remain, and the current research projects are focused on improved treatment regimens, more effective therapies and preventative vaccines.

 

Globally, approximately 35 million people are infected with HIV, but new infections have dropped by 38% since 2001, according to UNAIDS, the Joint United Nations Programme on HIV/AIDS