During Pregnancy and Breast-Feeding - University of Buraimi - PDF

SLIDES Ms.Virgina Varghese PREPARED BY PRESENTER Ms.Virgina Varghese COLLEGE / COHS CENTRE PROGRAM NURSING SEMESTER FALL 2022-23 During Pregnancy and Breast-Feeding ‹#› Course Outcomes (From Course Sp...

SLIDES Ms.Virgina Varghese PREPARED BY PRESENTER Ms.Virgina Varghese COLLEGE / COHS CENTRE PROGRAM NURSING SEMESTER FALL 2022-23 During Pregnancy and Breast-Feeding ‹#› Course Outcomes (From Course Specifications) A1 Describe the general principles of pharmacotherapeutic, pharmacokinetics, and pharmacodynamics in wellness promotion and illness prevention and treatment. A2 Explain principles of safe administration of medications B1 Demonstrate proficiency in applying the 10 rights of medication administration during the preparation and administration of medication therapy. B2 Apply the methods of healthcare documentation and professional communication related to medication therapy C1 Analyze the legal and ethical parameters of medication administration √ C2 Utilize the nursing process and teaching-learning principles in health promotion, self-care and management to assess, plan, set goals and administer medications to diverse individuals across the lifespan with basic pharmacological needs. D1 Demonstrate continued ability to calculate drug dosages safely and use of terminology associated with pharmacology D2 Generate a positive and flexible approach to lifelong learning 2 During Pregnancy and Breast-Feeding Loading…  Introduction - Essentially all drugs can cross the - - placenta, although some cross more readily & than others. - Tone and motility of the bowel↓decrease in - - pregnancy, causing intestinal transit time to increase. Because of prolonged transit, there is more time for - - drugs to be absorbed. ⑮ - Any drug taken during pregnancy will reach the fetus. - - - *.‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن ﺑﻌﻀﻬﺎ ﻳﻌﺒﺮ ﺑﺴﻬﻮﻟﺔ أﻛﺒﺮ ﻣﻦ ﻏﻴﺮﻫﺎ‬،‫ﺔ‬C & ‫ ﻳﻤﻜﻦ ﻟﺠﻤﻴﻊ اﻷدوﻳﺔ أن ﺗﻌﺒﺮ اﻟﻤﺸﻴﻤ‬ & ‫ ﻳﻜﻮن‬،‫ وﺑﺴﺒﺐ اﻟﻌﺒﻮر اﻟﻤﻄﻮل‬.‫ ﻣﻤﺎ ﻳﺆدي إﻟﻰ زﻳﺎدة وﻗﺖ اﻟﻌﺒﻮر اﻟﻤﻌﻮي‬،‫ ﺗﻘﻞ ﻗﻮة وﺣﺮﻛﺔ اﻷﻣﻌﺎء أﺛﻨﺎء اﻟﺤﻤﻞ‬ - & -.‫ﻫﻨﺎك وﻗﺖ أﻃﻮل ﻻﻣﺘﺼﺎص اﻷدوﻳﺔ‬.‫ أي دواء ﻳﺘﻢ ﺗﻨﺎوﻟﻪ أﺛﻨﺎء اﻟﺤﻤﻞ ﺳﻴﺼﻞ إﻟﻰ اﻟﺠﻨﻴﻦ‬ - -  ‫اﻵﺛﺎر اﻟﺠﺎﻧﺒﻴﺔ أﺛﻨﺎء اﻟﺤﻤﻞ‬ Adverse Reactions During Pregnancy ‫ اﻟﺘﺄﺛﻴﺮ اﻷﻛﺜﺮ إﺛﺎرة ﻟﻠﻘﻠﻖ ﻫﻮ اﻟﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ )إﻧﺘﺎج ﻋﻴﻮب‬ -.‫ واﺳﺘﺴﻘﺎء اﻟﺮأس‬،‫ واﻟﻘﺪم اﻟﺤﻨﻔﺎء‬،‫ﺧﻠﻘﻴﺔ( ﻣﺜﻞ اﻟﺤﻨﻚ اﻟﻤﺸﻘﻮق‬ - & The effect of greatest concern is teratogenesis (production of birth defects) - inte - - such as cleft palate, clubfoot,‫ﺴﻮر‬and hydrocephalus. :‫اﻵﺛﺎر اﻟﺠﺎﻧﺒﻴﺔ اﻷﺧﺮى‬ -a ‫ واﻟﺘﻲ ﺑﺪورﻫﺎ ﻗﺪ ﺗﺴﺒﺐ ﻛ‬،‫ ﻓﺈﻧﻪ ﻗﺪ ﻳﺴﺒﺐ ﻫﺸﺎﺷﺔ اﻟﻌﻈﺎم‬،(‫ ﻋﻨﺪﻣﺎ ﺗﺘﻨﺎول اﻟﻤﺮأة اﻟﺤﺎﻣﻞ اﻟﻬﻴﺒﺎرﻳﻦ )ﻣﻀﺎد ﻟﻠﺘﺨﺜﺮ‬ - - - water.‫ﺿﻐﻂ ﻓﻲ اﻟﻌﻤﻮد اﻟﻔﻘﺮي‬ brain -.‫ ﻗﺪ ﻳﺴﺒﺐ اﻹﺟﻬﺎض‬،‫ اﻟﺬي ﻳﺤﻔﺰ اﻧﻘﺒﺎض اﻟﺮﺣﻢ‬،(‫ اﺳﺘﺨﺪام اﻟﺒﺮوﺳﺘﺎﺟﻼﻧﺪﻳﻦ )ﻣﺜﻞ اﻟﻤﻴﺰوﺑﺮوﺳﺘﻮل‬ - - Other adverse effects: ‫ ﺑﺎﻹﺿﺎﻓﺔ‬.‫ة‬- ‫ ﻓﺈن اﺳﺘﺨﺪام اﻷﺳﺒﺮﻳﻦ ﻓﻲ وﻗﺖ ﻗﺮﻳﺐ ﻣﻦ اﻟﻮﻻدة ﻗﺪ ﻳﺜﺒﻂ اﻻﻧﻘﺒﺎﺿﺎت أﺛﻨﺎء اﻟﻮﻻد‬،‫ وﻋﻠﻰ اﻟﻌﻜﺲ ﻣﻦ ذﻟﻚ‬ & ‫ ﻳﺰﻳﺪ اﻷﺳﺒﺮﻳﻦ ﻣﻦ ﺧﻄﺮ اﻟﻨﺰﻳﻒ اﻟﺸﺪﻳﺪ‬،‫إﻟﻰ ذﻟﻚ‬ when heparin (an anticoagulant) is taken by pregnant women, it can cause - osteoporosis, - - & - which in turn can cause compression fractures of the spine. Loading… -mar Use of prostaglandins (eg, misoprostol), which stimulate uterine contraction, can cause - - - - abortion. · / M & Conversely, use of minemen aspirin near term can suppress contractions in labor. In addition, aspirin↑increases the risk of serious bleeding - & & barbiturates, alcohol) during pregnancyo - mcan result in the birth em of a drug-dependent infant Certain pain relievers used during delivery canPresen - depress respiration in the Oneonate. The infant should be closely monitored until respiration is normal - ‫ ﻳﻤﻜﻦ أن ﻳﺆدي ﺗﻨﺎول اﻟﺒﺎرﺑﻴﺘﻮرات واﻟﻜﺤﻮل أﺛﻨﺎء اﻟﺤﻤﻞ إﻟﻰ وﻻدة ﻃﻔﻞ ﻣﻌﺘﻤﺪ ﻋﻠﻰ اﻟﻤﺨﺪرات‬ - G - - -.‫ ﻳﻤﻜﻦ أن ﺗﺆدي ﺑﻌﺾ ﻣﺴﻜﻨﺎت اﻷﻟﻢ اﻟﻤﺴﺘﺨﺪﻣﺔ أﺛﻨﺎء اﻟﻮﻻدة إﻟﻰ ﺗﺜﺒﻴﻂ اﻟﺘﻨﻔﺲ ﻋﻨﺪ ﺣﺪﻳﺜﻲ اﻟﻮﻻدة‬ ‫ﻳﺠﺐ ﻣﺮاﻗﺒﺔ اﻟﻄﻔﻞ ﻋﻦ ﻛﺜﺐ ﺣﺘﻰ ﻳﺼﺒﺢ ﺗﻨﻔﺴﻪ ﻃﺒﻴﻌﻴًﺎ‬ - - &  ‫اﻟﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ وﻣﺮﺣﻠﺔ اﻟﻨﻤﻮ‬ Teratogenesis and Stage of Development :‫ ﻳﺤﺪث اﻟﻨﻤﻮ ﻓﻲ ﺛﻼث ﻣﺮاﺣﻞ رﺋﻴﺴﻴﺔ‬ - ‫ﻓﺘﺮة ﻣﺎ ﻗﺒﻞ ﺗﻜﻮﻳﻦ اﻟﺠﺴﻢ‬/‫ ﻓﺘﺮة ﻣﺎ ﻗﺒﻞ اﻟﺰرع‬ Development occurs in three major stages: - (‫)ﻣﻦ اﻟﺤﻤﻞ وﺣﺘﻰ اﻷﺳﺒﻮع اﻟﺜﺎﻧﻲ‬ the preimplantation/presomite period (conception through week 2) ‫اﻟﻔﺘﺮة اﻟﺠﻨﻴﻨﻴﺔ )ﻣﻦ اﻷﺳﺒﻮع اﻟﺜﺎﻟﺚ إﻟﻰ اﻷﺳﺒﻮع‬ - the embryonic period (weeks 3 through 8) (‫اﻟﺜﺎﻣﻦ‬ - ‫ اﻟﻔﺘﺮة اﻟﺠﻨﻴﻨﻴﺔ )ﻣﻦ اﻷﺳﺒﻮع اﻟﺘﺎﺳﻊ وﺣﺘﻰ‬ the fetal period (week 9 through term). - -.(‫اﻛﺘﻤﺎل ﻧﻤﻮ اﻟﺠﻨﻴﻦ‬ - - If the dose is#sufficiently high, the result is death of the conceptus. Conversely, - - j : if the dose is - sublethal, the conceptus is likely & to recover fully. Gross malformations areG 0 - produced by exposure to teratogens during the & embryonic period 3-8 week 6-9 - : 3- 6 Teratogen exposure during the fetal period (ie, the second and third trimesters) - & & usually disrupts function rather O - than - gross anatomy. Disruption of brain development can result in learning deficits and behavioral abnormalities - - - ،‫ إذا ﻛﺎﻧﺖ اﻟﺠﺮﻋﺔ ﻏﻴﺮ ﻣﻤﻴﺘﺔ‬،‫ وﻋﻠﻰ اﻟﻌﻜﺲ ﻣﻦ ذﻟﻚ‬.‫ ﻓﺈن اﻟﻨﺘﻴﺠﺔ ﻫﻲ ﻣﻮت اﻟﺠﻨﻴﻦ‬،‫ إذا ﻛﺎﻧﺖ اﻟﺠﺮﻋﺔ ﻋﺎﻟﻴﺔ ﺑﺪرﺟﺔ ﻛﺎﻓﻴﺔ‬ - - -.‫ﻓﻤﻦ اﻟﻤﺮﺟﺢ أن ﻳﺘﻌﺎﻓﻰ اﻟﺠﻨﻴﻦ ﺑﺸﻜﻞ ﻛﺎﻣﻞ‬ - ‫ﺔ اﻟﺘﻌﺮض ﻟﻤﺴﺒﺒﺎت اﻟﺘﺸﻮﻫﺎت أﺛﻨﺎء اﻟﻔﺘﺮة اﻟﺠﻨﻴﻨﻴﺔ‬O ‫ ﺗﺤﺪث اﻟﺘﺸﻮﻫﺎت اﻟﺠﺴﻴﻤﺔ ﻧﺘﻴﺠ‬ ً - ً & ‫ ﻳﺆدي اﻟﺘﻌﺮض ﻟﻤﺴﺒﺒﺎت اﻟﺘﺸﻮﻫﺎت أﺛﻨﺎء اﻟﻔﺘﺮة اﻟﺠﻨﻴﻨﻴﺔ )أي اﻟﺜﻠﺚ اﻟﺜﺎﻧﻲ واﻟﺜﺎﻟﺚ( ﻋﺎدة إﻟﻰ ﺗﻌﻄﻴﻞ اﻟﻮﻇﻴﻔﺔ ﺑﺪﻻ ﻣﻦ‬ - ‫ ﻳﻤﻜﻦ أن ﻳﺆدي ﺗﻌﻄﻴﻞ ﻧﻤﻮ اﻟﻤﺦ إﻟﻰ ﻋﺠﺰ ﻓﻲ اﻟﺘﻌﻠﻢ وﺗﺸﻮﻫﺎت ﺳﻠﻮﻛﻴﺔ‬.‫ﻴﻢ‬- ‫اﻟﺘﺸﺮﻳﺢ اﻟﺠﺴ‬ ---- P A i(y) i - galligj - - - - - - s - - - ↳ - - Identification of Teratogens To prove that a drug is a teratogen, three criteria must be met: D The drug must cause a characteristic set of malformations. - & · It must act only - during a specific window of vulnerability (eg, weeks 4 & through 7 of gestation). ⑤ - - The incidence of malformations shouldgincrease O & with increasing dosage and - duration of exposure. ‫ﺗﺤﺪﻳﺪ اﻟﻌﻮاﻣﻞ اﻟﻤﺴﺒﺒﺔ ﻟﻠﺘﺸﻮﻫﺎت‬ - :‫ ﻳﺠﺐ اﺳﺘﻴﻔﺎء ﺛﻼﺛﺔ ﻣﻌﺎﻳﻴﺮ‬،‫ﻹﺛﺒﺎت أن اﻟﺪواء ﻫﻮ ﻣﺎدة ﻣﺴﺒﺒﺔ ﻟﻠﺘﺸﻮﻫﺎت‬.‫ ﻳﺠﺐ أن ﻳﺘﺴﺒﺐ اﻟﺪواء ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﻣﻤﻴﺰة ﻣﻦ اﻟﺘﺸﻮﻫﺎت‬ & 4 ‫ اﻷﺳﺎﺑﻴﻊ ﻣﻦ‬،‫ ﻳﺠﺐ أن ﻳﻌﻤﻞ ﻓﻘﻂ ﺧﻼل ﻓﺘﺮة ﻣﺤﺪدة ﻣﻦ اﻟﻀﻌﻒ )ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل‬ &.(‫ ﻣﻦ اﻟﺤﻤﻞ‬7 ‫إﻟﻰ‬.‫ ﻳﺠﺐ أن ﻳﺰداد ﻣﻌﺪل ﺣﺪوث اﻟﺘﺸﻮﻫﺎت ﻣﻊ زﻳﺎدة اﻟﺠﺮﻋﺔ وﻣﺪة اﻟﺘﻌﺮض‬ - ‫‪Drugs That Should Be Avoided During Pregnancy Because of Proven or‬‬ ‫اﻷدوﻳﺔ اﻟﺘﻲ ﻳﺠﺐ ﺗﺠﻨﺒﻬﺎ أﺛﻨﺎء اﻟﺤﻤﻞ ﺑﺴﺒﺐ اﻟﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ اﻟﻤﺆﻛﺪة أو اﻟﻤﺸﺘﺒﻪ ﺑﻬﺎ ﺑﺸﺪة ‪Strongly Suspected Teratogenicity‬‬ ‫‪-‬‬ ‫‪-‬‬ ‫‪Drug and its Teratogenic Effect‬‬ ‫اﻷدوﻳﺔ وﺗﺄﺛﻴﺮﻫﺎ اﻟﻤﺴﺒﺐ ﻟﻠﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ‬ ‫‪Anticancer/Immunosuppressant Drugs‬‬ ‫أدوﻳﺔ ﻣﻀﺎدة ﻟﻠﺴﺮﻃﺎن‪/‬ﻣﺜﺒﻄﺔ ﻟﻠﻤﻨﺎﻋﺔ‬ ‫ ‬ ‫ ﺳﻴﻜﻠﻮﻓﻮﺳﻔﺎﻣﻴﺪ‪ -‬ﺗﺸﻮﻫﺎت اﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‪ ،‬اﻟﺴﺮﻃﺎن اﻟﺜﺎﻧﻮي‪-‬‬ ‫‪Cyclophosphamide- CNS malformation, secondary cancer-‬‬ ‫ ‬ ‫‪Methotrexate-CNS and limb malformations‬‬ ‫ ﻣﻴﺜﻮﺗﺮﻳﻜﺴﺎت‪ -‬ﺗﺸﻮﻫﺎت اﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي واﻷﻃﺮاف‬ ‫‪-‬‬ ‫‪Antiseizure Drugs‬‬ ‫أدوﻳﺔ ﻣﻀﺎدة ﻟﻠﺼﺮع‬ ‫‪-‬‬ ‫ ‬ ‫‪Carbamazepine & Valproic acid - Neural tube defects‬‬ ‫ ﻛﺎرﺑﺎﻣﺎزﻳﺒﻴﻦ وﺣﻤﺾ اﻟﻔﺎﻟﺒﺮوﻳﻚ‪ -‬ﻋﻴﻮب اﻷﻧﺒﻮب اﻟﻌﺼﺒﻲ‬ ‫ ‬ ‫‪Phenytoin - Growth retardation, CNS defects‬‬ ‫ ﻓﻴﻨﻴﺘﻮﻳﻦ‪ -‬ﺗﺄﺧﺮ اﻟﻨﻤﻮ‪ ،‬ﻋﻴﻮب اﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‬ ‫‪Other Drugs‬‬ ‫ ‬ ‫‪Angiotensin-converting enzyme inhibitors- Renal failure, renal tubular dysgenesis, skull hypoplasia‬‬ ‫‪-‬‬ ‫ ‬ ‫‪Oral hypoglycemic drugs - Neonatal hypoglycemia‬‬ ‫أدوﻳﺔ أﺧﺮى‬ ‫ ‬ ‫ ﻣﺜﺒﻄﺎت اﻹﻧﺰﻳﻢ اﻟﻤﺤﻮل ﻟﻸﻧﺠﻴﻮﺗﻨﺴﻴﻦ ‪ -‬اﻟﻔﺸﻞ اﻟﻜﻠﻮي‪ ،‬ﺧﻠﻞ ﺗﻨﺴﺞ اﻷﻧﺎﺑﻴﺐ اﻟﻜﻠﻮﻳﺔ‪ ،‬ﻧﻘﺺ ﺗﻨﺴﺞ ‪Warfarin - Skeletal and CNS defects‬‬ ‫‪-‬‬ ‫ ‬ ‫‪Antithyroid drugs - Goiter and hypothyroidism‬‬ ‫اﻟﺠﻤﺠﻤﺔ‬ ‫&‬ ‫ أدوﻳﺔ ﺧﻔﺾ ﺳﻜﺮ اﻟﺪم ﻋﻦ ﻃﺮﻳﻖ اﻟﻔﻢ ‪ -‬ﻧﻘﺺ ﺳﻜﺮ اﻟﺪم ﻋﻨﺪ اﻷﻃﻔﺎل ﺣﺪﻳﺜﻲ اﻟﻮﻻدة‬ ‫ ‬ ‫‪Tetracycline - Tooth and bone anomalies‬‬ ‫ اﻟﻮارﻓﺎرﻳﻦ ‪ -‬ﻋﻴﻮب اﻟﻬﻴﻜﻞ اﻟﻌﻈﻤﻲ واﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‬ ‫‪NOTE: Lack of teratogenicity in animals is not proof of safety in humans‬‬ ‫ أدوﻳﺔ ﻣﻀﺎدة ﻟﻠﻐﺪة اﻟﺪرﻗﻴﺔ ‪ -‬ﺗﻀﺨﻢ اﻟﻐﺪة اﻟﺪرﻗﻴﺔ وﻗﺼﻮر اﻟﻐﺪة اﻟﺪرﻗﻴﺔ‬ ‫ اﻟﺘﺘﺮاﺳﻴﻜﻠﻴﻦ ‪ -‬ﺗﺸﻮﻫﺎت اﻷﺳﻨﺎن واﻟﻌﻈﺎم‬ ‫ﻼ ﻋﻠﻰ ﺳﻼﻣﺘﻬﺎ ﻋﻨﺪ اﻟﺒﺸﺮ‬ ‫ﻣﻼﺣﻈﺔ‪ :‬إن ﻋﺪم وﺟﻮد ﺗﺸﻮﻫﺎت ﺧﻠﻘﻴﺔ ﻓﻲ اﻟﺤﻴﻮاﻧﺎت ﻻ ﻳﻌﺪ دﻟﻴ ً‬ FDA Pregnancy Risk Categories FDA established a system for classifying drugs into one of five risk categories: A, B, C, D, and X ‫ﻓﺌﺎت ﻣﺨﺎﻃﺮ اﻟﺤﻤﻞ ﻟﺪى إدارة اﻟﻐﺬاء واﻟﺪواء‬ :‫أﻧﺸﺄت إدارة اﻟﻐﺬاء واﻟﺪواء ﻧﻈﺎﻣًﺎ ﻟﺘﺼﻨﻴﻒ اﻷدوﻳﺔ إﻟﻰ واﺣﺪة ﻣﻦ ﺧﻤﺲ ﻓﺌﺎت ﻣﺨﺎﻃﺮ‬ A، B، C، D، ‫و‬X · Y - ↓154 baby & risk s 3tgl more pass(3j) safea - G -. 9 % women &go - - lg - /y :. & - & + (5) digi j ↳ oo j Jigbuil & jj - & ii - # & ·silpita ,S sli J ·s Jayl g  ‫ﺗﻘﻠﻴﻞ ﻣﺨﺎﻃﺮ اﻟﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ اﻟﻨﺎﺟﻤﺔ ﻋﻦ ﺗﻨﺎول اﻷدوﻳﺔ‬ ‫ ﻳﺠﺐ اﻟﻘﻀﺎء ﻋﻠﻰ ﺟﻤﻴﻊ اﺳﺘﺨﺪاﻣﺎت اﻷدوﻳﺔ ﻏﻴﺮ اﻟﻀﺮورﻳﺔ‬ ⑨ Minimizing the Risk of Drug-Induced Teratogenesis‫ﻳﺠﺐ ﻋﻠﻰ اﻟﻤﻤﺮﺿﺎت وﻏﻴﺮﻫﻢ ﻣﻦ اﻟﻤﺘﺨﺼﺼﻴﻦ ﻓﻲ اﻟﺮﻋﺎﻳﺔ‬ T ⑧ - ‫اﻟﺼﺤﻴﺔ ﺗﺤﺬﻳﺮ اﻟﻨﺴﺎء اﻟﺤﻮاﻣﻞ ﻣﻦ اﺳﺘﺨﺪام‬ O All unnecessary drug use should be eliminated j - ⑧ & - ‫ﺟﻤﻴﻊ اﻷدوﻳﺔ ﻏﻴﺮ اﻟﻀﺮورﻳﺔ‬ S.. - Nurses and other health professionals shouldE & - warn pregnant women against use & of all nonessential drugs - Zoll Some disease states (eg, epilepsy, asthma, diabetes) pose a greater risk to fetal => ) n jj0r) : - health than do the drugs used for treatment - Loading… Anticancer drugs, if a woman elects to use such drugs, termination of i pregnancy should be considered. - educated about the teratogenic risk as well as the necessity of using at least one reliable form of birth control during the reproductive age of the women - O ً ‫ ﺑﻌﺾ اﻟﺤﺎﻻت اﻟﻤﺮﺿﻴﺔ )ﻣﺜﻞ اﻟﺼﺮع واﻟﺮﺑﻮ واﻟﺴﻜﺮي( ﺗﺸﻜﻞ ﺧﻄﺮا أﻛﺒﺮ ﻋﻠﻰ ﺻﺤﺔ اﻟﺠﻨﻴﻦ ﻣﻘﺎرﻧﺔ ﺑﺎﻷدوﻳﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ‬ - & ‫ﻓﻲ اﻟﻌﻼج‬.‫ ﻓﻴﺠﺐ اﻟﺘﻔﻜﻴﺮ ﻓﻲ إﻧﻬﺎء اﻟﺤﻤﻞ‬،‫ إذا اﺧﺘﺎرت اﻟﻤﺮأة اﺳﺘﺨﺪام ﻣﺜﻞ ﻫﺬه اﻷدوﻳﺔ‬،‫ اﻷدوﻳﺔ اﻟﻤﻀﺎدة ﻟﻠﺴﺮﻃﺎن‬ - & & ‫ اﻟﺘﺜﻘﻴﻒ ﺑﺸﺄن اﻟﻤﺨﺎﻃﺮ اﻟﻤﺴﺒﺒﺔ ﻟﻠﺘﺸﻮﻫﺎت اﻟﺨﻠﻘﻴﺔ وﻛﺬﻟﻚ ﺿﺮورة اﺳﺘﺨﺪام ﺷﻜﻞ واﺣﺪ ﻋﻠﻰ اﻷﻗﻞ ﻣﻦ وﺳﺎﺋﻞ ﻣﻨﻊ‬ & & ‫اﻟﺤﻤﻞ اﻟﻤﻮﺛﻮﻗﺔ أﺛﻨﺎء ﺳﻦ اﻹﻧﺠﺎب ﻟﺪى اﻟﻤﺮأة‬ & DRUG THERAPY DURING BREAST- FEEDING ‫اﻟﻌﻼج اﻟﺪواﺋﻲ أﺛﻨﺎء اﻟﺮﺿﺎﻋﺔ اﻟﻄﺒﻴﻌﻴﺔ‬ - I Drugs taken by G lactating women can be excreted - in breast milk. If drug concentrations in milk are ⑧ · & high enough, a pharmacologic effect can occur - in the infant, raising the possibility of harm - by i s i s Accordingly, drugs that are lipid soluble enter [ > - -- breast milk readily, whereas drugs that are ionized, highly polar, or protein bound tend to be - excluded ‫ وإذا‬.‫ي‬s - & ‫ ﻳﻤﻜﻦ إﻓﺮاز اﻷدوﻳﺔ اﻟﺘﻲ ﺗﺘﻨﺎوﻟﻬﺎ اﻟﻨﺴﺎء اﻟﻤﺮﺿﻌﺎت ﻓﻲ ﺣﻠﻴﺐ اﻟﺜﺪ‬ - & ‫ ﻓﻘﺪ ﻳﺤﺪث ﺗﺄﺛﻴﺮ‬،‫ﻛﺎﻧﺖ ﺗﺮﻛﻴﺰات اﻟﺪواء ﻓﻲ اﻟﺤﻠﻴﺐ ﻋﺎﻟﻴﺔ ﺑﺪرﺟﺔ ﻛﺎﻓﻴﺔ‬ ‫ ﻣﻤﺎ ﻳﺰﻳﺪ ﻣﻦ اﺣﺘﻤﺎﻟﻴﺔ ﺣﺪوث ﺿﺮر‬،‫دواﺋﻲ ﻋﻠﻰ اﻟﺮﺿﻴﻊ‬ ‫ ﺗﺪﺧﻞ اﻷدوﻳﺔ اﻟﻘﺎﺑﻠﺔ ﻟﻠﺬوﺑﺎن ﻓﻲ اﻟﺪﻫﻮن ﺣﻠﻴﺐ اﻟﺜﺪي‬،‫ وﺑﻨﺎًء ﻋﻠﻰ ذﻟﻚ‬ - 6 - & ‫ ﻓﻲ ﺣﻴﻦ ﺗﻤﻴﻞ اﻷدوﻳﺔ اﻟﻤﺆﻳﻨﺔ أو ﺷﺪﻳﺪة اﻻﺳﺘﻘﻄﺎب أو اﻟﻤﺮﺗﺒﻄﺔ‬،‫ﺑﺴﻬﻮﻟﺔ‬ & ‫ﺑﺎﻟﺒﺮوﺗﻴﻦ إﻟﻰ اﻻﺳﺘﺒﻌﺎد‬ & Steps to minimize risk includes the following: -h 2- -insijj Dosing immediately after breast-feeding (to minimize drug concentrations in - :‫ﺗﺘﻀﻤﻦ ﺧﻄﻮات ﺗﻘﻠﻴﻞ اﻟﻤﺨﺎﻃﺮ ﻣﺎ ﻳﻠﻲ‬ O milk at the next feeding) & ‫ ﺗﺤﺪﻳﺪ اﻟﺠﺮﻋﺔ ﻓﻮًرا ﺑﻌﺪ اﻟﺮﺿﺎﻋﺔ اﻟﻄﺒﻴﻌﻴﺔ )ﻟﺘﻘﻠﻴﻞ ﺗﺮﻛﻴﺰات اﻟﺪواء ﻓﻲ‬ (‫ﺐ ﻓﻲ اﻟﺮﺿﺎﻋﺔ اﻟﺘﺎﻟﻴﺔ‬ - G ‫اﻟﺤﻠﻴ‬ ‫ ﺗﺠﻨﺐ اﻷدوﻳﺔ اﻟﺘﻲ ﻟﻬﺎ ﻋﻤﺮ ﻧﺼﻒ ﻃﻮﻳﻞ‬ Avoiding drugs that have a long half-life - - ‫ ﺗﺠﻨﺐ اﻟﺘﺮﻛﻴﺒﺎت ذات اﻹﻃﻼق اﻟﻤﺴﺘﻤﺮ‬ ‫إﻟﻰ اﻻﺳﺘﺒﻌﺎد ﻣﻦ اﻟﺤﻠﻴﺐ‬O ‫ اﺧﺘﻴﺎر اﻷدوﻳﺔ اﻟﺘﻲ ﺗﻤﻴﻞ‬ ً Avoiding C # sustained-release formulations & ‫ﻊ‬ ‫ﻴ‬ ‫ﺿ‬ ‫ﺮ‬ ‫ﻟ‬ ‫ا‬ ‫ﻰ‬ ‫ﻠ‬ ‫ﻋ‬ ‫ﺮ‬ ‫ﻴ‬ ‫ﺛ‬ ‫ﺄ‬ ‫ﺘ‬ ‫ﻠ‬‫ﻟ‬ ‫ اﺧﺘﻴﺎر اﻷدوﻳﺔ اﻷﻗﻞ اﺣﺘﻤﺎﻻ‬ ‫ ﺗﺠﻨﺐ اﻷدوﻳﺔ اﻟﻤﻌﺮوﻓﺔ ﺑﺄﻧﻬﺎ ﺧﻄﻴﺮة‬ Choosing drugs that· tend to be excluded from milk- Choosing drugs that are ↳least likely to affect the infant · Using the lowest effective dosage - for the shortest possible time. Avoiding drugs that are known to be hazardous  Adapted from Shinya I: Drug therapy for breast- Drug of choice for Breast-feeding women feeding women. N Engl J Med 343:118–126, 2000. it · slo - > - 2 &Isc -- - - So - silic - - - More G ~arful - xkci & - -& j G - Egi - - ojy - &: - O - = - I I References Broyles, B., Reiss, B., & Evans, M. (2012). Pharmacological aspects of nursing care. Nelson Education. Berman, A., Snyder, S. J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., & Park, T. (2010). Kozier and Erb's fundamentals of nursing (Vol. 1). Pearson Australia. Lehne, R. A. (2013). Pharmacology for nursing care. Elsevier Health Sciences. Thank You ‹#› 16