Drugs used in pregnancy

Fe
Calcium
B complex
folic acid
Lactulose

1. Drugs used in pregnancy Sharon Treesa Antony First Year M.Sc Nursing

2. Folic ACID Needed for erythropoiesis Prevents neural tube defects 2-5mg/day (therapeutic dose) 0.5mg/day (prophylactic dose) Carbamazepine increases need for folic acid Methotrexate reduces folate levels Urine bright yellow

3. National anaemia control program T. Folifer * 100 days during pregnancy, to be continued till 100 days postpartum WHO recommendations 60 mg Fe + 400 mcg folic acid * 6months during pregnancy, to be continued till 3 months postpartum National iron plus initiative T. Folifer * 100 days during pregnancy from 2 nd trimester and for 100 days in postpartum

4. FERROUS SULPHATE Replaces iron stores needed for RBC development as well asO2 transport and use Used in iron deficiency anaemia, prophylaxis of iron deficiency anaemia in pregnancy, and as nutritional supplementation 100 mg elemental iron daily Nausea, vomiting, constipation, epigastric pain, black tarry stools, diarrhea , temporarily discoloured teeth and eyes

5. Vitamin C increases action of iron preparation Caffeine, egg and dairy products reduces absorption

6. Swallow tables whole With Juice between meals Liquid preparations through straw I hour before bedtime Avoid reclining position for 15-30 minutes Iron toxicity: nausea, vomiting, dirrhea ( green & then tarry)

7. Vitamin C General growth and development Involved in pathway of Hb synthesis 500mg OD

8. B complex Niacinamide Pyridoxine Riboflavin Thiamine

9. Niacin: conversion of fats, proteins and carbohydrates ( vasodialation ) Pyridoxine: fat, protein and carbohydrate metabolism Thiamine : Pyruvate metabolism, Riboflavin: respiratory reactions

10. Calcium carbonate Fetus absorb 28g calcium from mother RDA : 1000- 1500 mg Dosage: 500mg daily

11. Tetanus toxoid Formaldehyde treated exotoxin 1 st dose : 1 st visit in 1 st trimester 2 nd dose : 1 month apart & at least 2 weeks prior to delivery

12. Govt of India 2 doses in 2 nd trimester 4 weeks apart If again pregnant within 3 years, single dose is enough WHO 1 st dose: 1 st visit in 1 st trimester 2 nd dose: 4 weeks later 3 rd dose : after 6 months

13. lactulose Synthetic disaccharide of galactose and fructose Hydrolized in the large intestine Draws water into the intestine Effect seen only after 24-48 hours 15- 30ml at night Antacids 1 hour before/after lactulose

14. Doxylamine succinate First generation H1 receptor antagonist Peak action at 2-4 hours 20mg PO at bed time/ 5-10mg more may be given in the morning and afternoon

15. H2 receptor antogonist Reduces acid production Used in heart burn, GERD, for prevention of stress ulcer 150-300mg TDS or HS PO 50mg IM/ slow IV Constipation, Diarrhoea, Headache, Fatigue

16. Proton pump inhibitors Suppress gastric acid secretion by irreversible blockade of hydrogen- pottassium ATPase GERD, Erosive esophagitis , gastric and duodenal ulcers Contraindicated in severe hepatic disease OMEZ:20-40mg OD PANTOP: 40mg OD

17. Ursodeoxycholic acid Hydrophilic dehydroxylated bile acid Alters the relative concentrations of bile acids& reduces the cholesterol content of bile Protective of hepatocytes Used in Intrahepaytic Cholestasis of pregnancy 13-15mg/kg in 2 divided doses