PAL COLLEGE OF NURSING & MEDICAL SCIENCE,HALDWANI

LESSON PLAN
ON
EFFECT OF DRUG USE IN PREGNANCY

SUBMITTED TO SUBMITTED BY
Mrs Varsha Rawat Priyanka Joshi
Associate professor M.Sc Nusing 1st Yr
PCNMS

SUBMITTED 0N
/04/2021

STUDENT PROFILE

Name Priyanka Joshi

Title of the course M.Sc Nursing

Class 1st yr

Number of student in the group 2

Subject Obstetrics &Gynecological Nursing

Topic Effects of drug in pregnancy

Date and time /5 /2021 &

Duration 45 min

Venue Specialty class room

Method of teaching Lecture cum discussion

List of teaching Aids Projector , flash card , white board

Name of the evaluator Mrs Varsha Rawat

OBJECTIVES
GENERAL OBJECTIVES:
➢ Student’s point of view:

At the end of the presentation, class will be able to know about Effects of Drugs use in Pregnancy view:

SPECIFIC OBJECTIVE:
-The class will be able to;

• Define the Drugs.

• Describe the Teratogen and Teratogenicity.
• Explain FDA category of drugs.
• Explain Different type of drugs and their effect during pregnancy
• Explain pharmacokinetics of drugs during Pregnancy
• Explain Maternal pharmacokinetic changes in pregnancy.
• Describe the guidelines for administering the drugs.
• Explain the role of midwife in drug administration.
S. Time Specific Content Teaching A.V Evaluation
n. objective learning aids
aids
1 5min To Introduction L Ppt What do you
introduced Pregnancy is a unique period in a woman’s life. Many changes are happening to her body that E understand
about the may affect the pharmacology of medications. C by
pregnancy. • During pregnancy, a woman’s gastric pH is increased and gastric motility is reduced which T introduction
may interfere with the rate and extent of medication absorption. U ?
• Maternal plasma volume is increased leading to changes in the volume of distribution. In R
addition, increases in progesterone and estradiol levels may affect the hepatic metabolism of E
some medications.
• Glomerular filtration rate is increased due to increase renal blood flow which may affect C
renally cleared medications. Despite the changes, the pharmacology of most medications is not U
altered enough to require dosing changes. M
• The placenta is an organ of exchange allowing the mother to pass nutrients and medications to
the fetus; therefore, medications administered to pregnant women have the potential to affect D
the growing fetus. I
• The fetus is generally at the greatest risk of developing teratogenic effects from medications S
during the first trimester, but it is drug specific. The use of medications in pregnancy should be C
evaluated for the benefits and risks to both the mother and fetus U
2 5min To define the S What do you
definition of Definition of Drugs – According to Merriam Webster S Ppt understand
drugs, “A substance intended for use in the diagnosis, cure, treatment, or prevention of disease.” I by definition
teratogen and O of drug,
teratogenicit Teratogen N teratogen,tera
y. A teratogen is defined as any agent that results in structural or functional abnormalities in the togenicity ?
fetus, or in the child after birth, as a consequence of maternal exposure during pregnancy.
• The teratogenic mechanism for most drugs remains unclear, but may be due to the direct
effects of the drug on the fetus and/or as a consequence of indirect physiological changes in the
mother or fetus.

Teratogenicity:
 It refers to capacity of a drug to cause fetal abnormalities when administered to pregnant L
mother. Drug can affect fetus at three stages, E
• Stage of fertilization and implantation C
• Stage of organogenesis T
3. 5min To explain • Stage of growth and development U
the R What do you
classification understand
Classification of drugs according to FDA (food and Drug Administration) E
by the
of drug.
C classification
The FDA has categorized the potential teratogenic risk of medications by an A, B, C, D, X
U of drug?
system. Flash
Category A: No evidence of Risk in Human M cards
Controlled studies in women have failed to demonstrate a risk to the fetus in the first trimester
and there is no evidence of risk in later trimesters. The possibility of fetal harm appears remote. D
Medications in this class are considered safe to use in pregnancy. Examples of medications in I
this class are vitamins and levothyroxine. S
C
Category B: No evidence of Risk in Human U
Either animal‐reproduction studies have not demonstrated a fetal risk but there are no controlled S
studies in pregnant women, or animal studies have demonstrated risk to the fetus that was not S
confirmed in controlled studies in pregnant women in the first trimester and there is no evidence I
of a risk in later trimesters. Medications in this class are generally considered safe. Examples of O
medications in this class are Penicillin V, Amoxycillin, Erythromycin, Paracetamol, Lignocaine. N

Category C: Risk cannot be ruled out

Studies in animals have revealed adverse effects on the fetus and there are no controlled studies
in women, or studies in women and animals are not available. Drugs from this class can be
given to pregnant women if the benefit to the mother outweighs the risk to the fetus. Examples
of medications in this class are Morphine, Codeine, Atropine, Corticosteroids, Adrenaline,
thiopentone, bupivacaine

Category D: Positive evidence of risk

Evidence of human fetal risk has been documented, but the benefits to the mother may be
acceptable despite the risk to the fetus. Drugs in this class may be used in pregnancy if the
 benefits to the mother outweigh the risk to the fetus (i.e. a life-threatening situation or a serious
disease for which safer medication cannot be used or are not efficacious). Examples of
medications in this class are Aspirin, phenytoin, Carbamazepine, valproate, lorazepam, Inj.
Magnesium sulphate, Methimazole.

Category X: Contraindicated in pregnancy

Studies in animals or humans have demonstrated teratogenic effects. The risk to the fetus
clearly outweighs any potential benefit to the mother. Drugs in this category are contraindicated
in pregnancy.

Examples of medications in this class are thalidomide, Isotretinoin, Ergometrin, Quinine

(1st trimester.
DURGS CATEGORIES
Analgesics and Antipyretics B&C
Acetaminophen B
Aspirin B
Antiemetics B&C
Antibiotics B,C,D
Penicillin, ampicillin , amoxicillin B
Cephalosporin B
Gentamycin C
Streptomycin D
Metronidazole B
Antimalarial C
Antifungal C
Antituercular B&C
4. 8min To explain Vitamin B,C,D,E and folic acid A
the different What do you
types of understand
drugs and L by effects of
their effect E drugs during
during C pregnancy?
Different type of drugs and their effect during pregnancy. T Ppt
pregnancy.
U
DRUG ADVERSE EFFECT R
ANTIBIOTICS E
Chloramhenicol Gray baby syndrome (peripheral
vascular collapses) Bone marrow C
depression irreversible aplastic U
anemia , agranulocytosis M

Sulphonamides Kernicterus , methamoglobinemia D

I
Tetracyclines Dental discoloration (yellow) and S
deformity, inhibition of bony growth, C
cataract U
Aminoglycosides Fetal ototoxicity due to 8th cranial S
nerve damage S
Anti – malarials I
Intrauterine death Quinine O
Chloroquine: Retinopathy , N
congenital deafness, corneal opacities
.Anticonvulsants Drug
Phenytoin Fetal Hydantoin Syndrome
(microcephaly, cleft palate,
hypoplasytic changes, IUGR)
Carbamazepine
Spina bifida
Phenobarbitone
Relatively safe
Sodium valproate
Neural Tube Defect ( NTD),
hypospadias, microstomia,
developmental dealy
. Hormonal Agents
Cortiosteroids
 Growth retardation, cleft palate, and
Diethy stilbestrol lip, Inhibit brain growth
( of used as “morning – after ”pil)-
vaginal adenosis in female offspring
Anti-thyroid drugs of teenagers.
Neonatal hypothyroidism and goiter
Clomiphene
NTD, multiple gestation, Down,s
Synthetic progestins Syndrome
Masculinization in female Fetus
.Psychiatric Drugs
Lithium
Epstein’s Anomaly
Alcohol Foetal alcohol syndrome : Prenatal
onset growth deficiency ,
developmental delay, facial
dysmorphisms ,multiple joint
anomalies and cardic defects
Heroin
(ASD,VSD) mental sub normality
Cocaine
Irritability , hyperactivity, tremors
Beta blockers
Abruption placentae, preterm labor ,
cerebral infarction
Anticoagulants Fetal bradycardia
Vitamin K

Warfarin Hyperbilirubinemia and Kernicterus

Birth defects, abortion, hypoplasia of

nasal bones, stippled epiphyseal
calcification resembling What do you
5. 8min To explain chondrodysplsia punctata, L Ppt understand
the IUGR,CNS abnormality if drug is E by
 pharmacokin Aspirin used in 2nd / 3rd trimester C pharmacokin
etics of drugs T etics of
during Hemorrhagic disease of newborn oral U drugs?
pregnancy. clefts and other defects, intrauterine R
death , growth retardation E

Pharmacokinetics of drugs during Pregnancy C

Drug absorption: U
• The gastric emptying as well as gut motility resulting in slower drug absorption. M
• Parenteral drug administration is preferred in order to obtain a quick response.
• Drug compliance may be poor because of nausea and fear of adverse effect. D
I
Drug metabolism: S
• Hepatic drug metabolizing enzymes are induced during pregnancy probably by high C
concentration of circulating progesterone. U
S
This can lead to more rapid metabolic degradation especially of highly lipid soluble drugs. S
Drug excretion: I
• During pregnancy the renal plasma flow increases by 100% and glomerular filtration rate by O
70%. N
• Hence, drugs which depend for their elimination mainly on kidney are eliminated more
rapidly than in non-pregnant stage, e.g. ampicillin, gentamicin and cephalosporin.

Increase total blood volume: L

• There is increased total blood volume, because of increased fluid retention. E
• This leads to change in cardiac output, blood pressure and glomerular filtration rate. C
6. 3min To discuss This results in change in volume of distribution of drug, change in metabolism, change in T Ppt What do you
the absorption, change in excretion of drug, change in protein binding of drugs and passage of U understand
guidelines drug through placenta. R by guidelines
for drugs E of drugs?
Maternal pharmacokinetic changes in pregnancy
prescription dication effects, resulting in the need to monitor and, sometimes, adjust therapy.
in pregnancy. • Maternal plasma volume, cardiac output, and glomerular filtration increase by 30% to 50%. C
U
• As body fat increases during pregnancy.
M
 • Plasma albumin concentration decreases.
D
Guidelines for Drugs Prescription in Pregnancy I
S
Don’t use drug unless it is absolute necessary— use drug in pregnant patient only when it is C
7. 10 To discuss absolutely necessary. U
min the role and What do you
• Ruling out possibility of pregnancy— rule out possibility of pregnancy in every female of S
responsibility reproductive age group and restrict drug usage. understand
S
of midwife . by roes
I
Risk and benefit ratio— O
• Prioritize drug usage in the situation and avoid drug usage if the non-usage can do i.e. risk Vs Les and
N responsibility
benefit ratio should be calculated.
of midwife ?
Lower doses— use lower than usual doses of drug if necessary, for short term

Roles and Responsibility of Midwife in administration of Drugs.

Medicine administration is a core responsibility of registered nurses in healthcare settings;
increasingly, the task is also being carried out by nursing associates.
To ensure patient safety, it is essential the correct procedure is implemented so the correct
medicine is given in the prescribed amount using the most appropriate route.
Before administering any medicine, the person carrying out the procedure must be familiar
L
with the advantages and limitations of the prescribed route, and know the indications,
E
contraindications and side-effects of the medicine they intend to give.
Medication are most frequently used to manage the diseases, because medication C
administration and evaluation are essential to nursing practice, nurses need to have knowledge T
about the action and effect of the medications their client take. U
The greatest challenge facing health care providers when administering pharmacologic R
agents during labor and delivery. E

Health care providers need to consider the effect of the medication on both the mother and the C
fetus. U
Follow ten rights of medication Administration M
▪ Right medication
▪ Right dose D
▪ Right time I
▪ Right route S
▪ Right client C
▪ Right documentation U
▪ Right client education S
▪ Right refuse S
▪ Right assessment I
▪ Right evaluation O
• Midwife must check the prescription, dosages, and route, expiry date. N
• Midwife must be identify the patient to whom the medicine to be administered.
• Midwife must be check that the patient is not allergic to the medicine before administering it.
• Midwife must know the therapeutic uses of medicine to be administered, its normal dosage,
side effects, precautions and contra indications.
• Monitor the vitals of the patient.
• Midwife must be record and report.

Article
Berard A., and Sheehy O. (2019) were conducted a prospective cohort study on Antidepressant
use during pregnancy and the risk of major congenital malformations in depressed pregnant
women in Montreal, Quebec, Canada. The objectives of the study were to determine the
association between first-trimester exposure to antidepressants and the risk of major congenital
malformations in a cohort of depressed/anxious women. Data were collected through 18 487
pregnant women. Result revealed that Only citalopram was increasing the risk of major
congenital malformations 95% paroxetine increased the risk of cardiac defects 95%, TCA was
associated with eye, ear, face and neck defects 95% This study was concluded that
Antidepressants with effects on serotonin reuptake during embryogenesis increased the risk of
some organ-specific malformations in a cohort of pregnant women with depression.

Conclusion
Medication are most frequently used to manage the diseases, because medication administration
and evaluation are essential to nursing practice , nurses need to have knowledge about the
action and effect of the medications their client take. Administration of medications safely
requires an understanding of legal aspects of health care and pharmacology.
Summary
In this we discuss about the introduction, definition, classification of drug, different type of
drugs and their effects, pharmokinitics of drugs, and role and responsibility of midwife.

Reference
Dutta D.C. Text book of Obstetrics:7 th Ed. Delhi: Published by Jaypee Brothers;2011. Pp-(411-
416).
Bhasker Neema. MIDWIFERY and OBSTETRICAL NURSING:2nd Ed. Bangalore: Published
by EMMESS medical publisher; Pp. (568-570).

Dr. Magon Shally. Textbook of Midwifery and Obstetrics; 3 RD Ed. Published by lotus
publishers:2016. Pp. (792-798).

Myles. Midwives: 5th Ed.UK; Published by Elesvier. Page no. (212- 216).
Berard A., and Sheehy O. Antidepressant use during pregnancy and the risk of major
congenital malformations in depressed pregnant women; 2019. BMJ journal [cited on 30 /1/21]
available from https://bmjopen.bmj.com