1. IN THE NAME OF GOD

2. PAIN MANAGEMENT DURING PREGNANCY AND LACTATION

3. Pharmacokinetic changes during pregnancy
GI changes
Renal function
Hepatic function
Drug distribution
Pr binding
clearance

4. TRANSFER OF DRUG ACROSS THE PLACENTA

5. TERATOGENICITY
Possible adverse effect
Critical period

7. COMMON DRUGS A
None B
Acetaminophen,fentanil,oxycodone,oxymorphone nalbuphine,metadone,meperidine,morphine,iboprofen,
naproxen,indometacin, prednisone ,cafffeine C
Amitriptyline,Asprin,Ketorolac,Betamethasone,cortisone,codeine
gabapentine,lilidocaine,propranolol,sertaline,fluxitine,bupropion D
Imipramine,carbamazepine,diazepam,paroxetine,phenobarbital,phenytoin,valporic acid X
ergotamine, metotrexate

8. SPECIFIC DRUGS ASPRIN OPIOIDS LOCAL ANESTHETIC STERIODS TCA SSRIs
ANTICONVULSANT DRUGS
ERGOTAMINE

9. DRUGS DURING LACTATION
MATERNAL FACTORS
INFANT FACTORS

10. WHEN PRESCRIBING DRUGS TO LACTATING WOMAN…
Is drug therapy really necessary?
The safest drug must be chosen,such as acetaminophenrather than Asprin for mild analgesia
If there is a possibility of risk to the infant,then one should consider monitoring infant serum levels of the drug.
Having the mother take the medication just after she has breast fed the infant or before the infant is due to sleep can minimize drug exposeure.

11. RISK CATEGORY OF DRUGS FOR NURSING INFANTS
Effect on nursing infants is unknown but may be of concern
Benzodiazepines,TCA,Bupropion,
Fluxetine
Drugs that have been associated with significant effect and should be given to nursing infant with caution
Asprin,Ergotamine
Compatible with breast-feeding
Acetaminophen,Anticonvulsant,B blochers,LA,NSAIDS,Opioids,steroids,sertaline,paroxetine

12. Specific drugs Acetaminophen Opioids Prednisone Anticonvulsant
Antidepssant
Bblochers
Ergotamine

13. IMAGING DURING PREGNANCY