Drugs & Supplements in Pregnancy: Key Considerations

• These notes cover key points regarding herbal supplements in pregnancy, OTC drug use, adrenergic and cholinergic drugs, and anticholinergics.

Herbal Supplements and OTC Drugs

• Pregnant women must consult healthcare providers before using herbal supplements due to unverified safety; potential harm to the pregnancy or interactions with medications are possible.
• Over-the-counter (OTC) drug use can delay treatment for serious conditions, address symptoms without the cause, and postpone treatment for chronic diseases.
• Antiplatelet drugs have dangerous interactions with gingko; bleeding risk increases when both are taken together.
• Antidiabetic medications have to be used with caution when taking ginger because ginger can lower blood glucose levels.
• OTC drugs must be safe and effective for use without a prescription, have low misuse potential, treat self-diagnosable conditions, be labeled for safe use without supervision, and have benefits outweighing risks.
• Serotonin syndrome can occur when St. John’s Wort is combined with SSRIs, leading to agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and excessive sweating.

Adrenergic Drugs

• Adrenergic drugs stimulate the sympathetic nervous system.
• Beta2-adrenergic receptors are in the lungs (bronchi), liver, and smooth muscles of blood vessels.
• Albuterol is an example of a beta2-adrenergic drug as a bronchodilator.
• Adrenergic agonists are used therapeutically during shock to increase blood pressure and improve blood flow to vital organs.
• Epinephrine is used in anaphylaxis, severe asthma attacks, and cardiac arrest.
• Salmeterol is a long-acting bronchodilator, not a rescue inhaler, and should not be used for acute asthma symptoms.
• Adrenergic agonists have four major drug effects: increased heart rate, increased force of heart contractions, bronchodilation, and vasoconstriction.

Beta-Blockers and Alpha-Blockers

• Beta1-adrenergic receptors are primarily in the heart.
• Metoprolol is an example of a beta1-adrenergic antagonist drug/beta-blocker.
• Patients prescribed metoprolol should be educated about potential side effects like dizziness, fatigue, and low heart rate, and advised against abruptly stopping the medication.
• Phentolamine is administered to reverse vasoconstriction caused by dobutamine extravasation to prevent tissue necrosis.
• Erectile dysfunction is a male-specific adverse effect of beta-blockers that can cause noncompliance.
• Patients should contact their healthcare provider if their heart rate falls below 60 bpm while taking a beta-blocker.
• Alpha-blockers like tamsulosin, typically prescribed for BPH in males, can treat urinary retention in females related to bladder outlet obstruction.

Cholinergic Drugs

• Cholinergic drugs stimulate the parasympathetic nervous system.
• Donepezil improves cognitive function in Alzheimer’s patients by increasing acetylcholine levels in the brain.
• SLUDGE acronym: Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis (vomiting).
• Muscarinic receptors stimulation results in the desired effects of cholinergic drugs.
• Atropine is the antidote for a cholinergic overdose.
• Patients with post-op urinary retention should urinate within 60 minutes of taking bethanechol.

Anticholinergics

• Oxybutynin is contraindicated in patients with narrow-angle glaucoma.
• Elderly patients should be cautious about anticholinergic side effects like confusion, dry mouth, constipation, and urinary retention.
• Darifenacin has a more selective action on M3 muscarinic receptors, potentially causing fewer side effects like dry mouth compared to tolterodine.
• Anticholinergics in Parkinson’s patients reduce tremors and muscle rigidity by balancing dopamine and acetylcholine in the brain.
• Alcohol increases the sedative effects of scopolamine, leading to excessive drowsiness and potential impairment.
• Dicyclomine is prescribed to treat irritable bowel syndrome (IBS) and reduce abdominal cramping.

Important notes on the use of herbal supplements and OTC drugs during pregnancy, emphasizing the need for consulting healthcare providers. Focus on potential risks, drug interactions (e.g., antiplatelet drugs with gingko), and the safe usage guidelines for OTC medications.