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2017 HCHB_digital

Drugs in Pregnancy Drug

Drugs in Pregnancy Drug use in pregnancy Some medicines taken during pregnancy have been documented to cause birth defects so expectant mums should always discuss safety in pregnancy of any prescription medicine, OTC or herbal remedy with their doctor or pharmacist first. Currently up to 4 per cent of babies are born with birth defects but only about 10 per cent of problems seen at birth can be traced to a specific medication, drug, exposure to an environmental toxin, or nutritional deficiency or supplementation. Agents that can cause malformations are called teratogens and some over-thecounter medicines, vitamins and herbal preparations, fall into this category. Many other medicines may also cause problems but there may be too little research on the expected level of risk. The level of risk is usually dependent on when the foetus is exposed to the substance. Two or three weeks after conception, the embryo is connected to the mother’s blood supply so that anything she ingests can cross over to the growing baby. The first trimester is a critical time for foetal development and, where possible, all drugs should be avoided. The risk of malformation drops after this period but some drugs can still pose risks in the second and third trimesters, which is why pregnant women seeking advice at the pharmacy should always be referred to the pharmacist. General points about drug use in pregnancy •• Avoid drugs whenever possible and attempt non-drug treatments first. •• Avoid all drugs in the first trimester wherever possible. Note, however, that some medicines may be unsafe at another time, eg, NSAIDs such as ibuprofen should be avoided in the third trimester. Paracetamol is the recommended choice for pain relief. •• Drugs should be given at the lowest effective dose for the shortest possible time. •• Select drugs that have an established safety profile and avoid those that have not been used extensively in pregnant women. •• Use topical preparations, if available, to minimise systemic exposure, but be aware that absorption for some may be significant, particularly if used on a large area, eg, methyl salicylate. •• In general, herbal and complementary medicines are not recommended in pregnancy due to lack of safety information. Avoid multivitamin preparations containing vitamin A. •• For guidance on Prescribing in Pregnancy, see the New Zealand Formulary: Prescribing in pregnancy (nzf.org.nz/nzf_151). Hospital Medicines Information Departments also usually have a good database of previously answered questions about specific drug use during pregnancy. •• Refer any pregnant woman who requests a medicine, herbal or complementary medicine to the pharmacist. Useful websites: •• New Zealand Formulary: nzf.org.nz •• Christchurch Drug Information Centre: www.druginformation.co.nz/ pregnancy.htm •• Prescribing medicines in pregnancy, on-line database, TGA Australia: www.tga.gov.au/prescribing-medicines-pregnancy-database REVIEWED BY: Carmen Fookes, Clinical Pharmacist, March 2017 Page 210 HEALTHCARE HANDBOOK 2017-2018 References Charts

Drugs in Driving Drugs in driving – legislation Many medicines can affect driving, and it is an offence to drive a motor vehicle while impaired as a result of taking a prescription medicine or specified controlled drug. Specific medicines mentioned in the Land Transport Act legislation include all illicit controlled drugs (eg, cannabis, methamphetamine), other controlled drugs (eg, morphine, methadone, oxycodone, fentanyl, benzodiazepines) and all prescription medicines. Prescription medicines most likely to impair driving include those that may cause sedation, those that may affect eyesight, and those that may cause hypotension, hypoglycaemia or dizziness. Pharmacists should use the PSNZ Cautionary and Advisory Label number 1, rather than the shortened computer-generated message, on all medicines likely to cause sedation. This written warning that “This medicine may make you sleepy and make it dangerous to drive or operate machinery” should also be supported by clear, verbal advice to ensure patients understand the significance of the information. Pharmacists should advise patients not to drive until they are aware of how the medicine will affect them and for how long after a dose is taken that medicine affects their ability to drive safely. Usually this will become evident during the first seven to 10 days of treatment and for three to four days after any dose increase. If impaired, the person must not drive. Note that it is not an offence to ingest a medicine that may impair driving. An offence is only created if driving is impaired to such an extent that it comes to the attention of the police. The purpose of this legislation is road safety. It empowers police to stop a person from driving if they have good cause to suspect that person is impaired. Police then have the right to conduct a roadside impairment test (walk a straight line, stand on one leg, pupil reaction etc). If the person fails the test, they can be forbidden to drive until no longer impaired, and a blood sample may be taken. If any medicines listed in the legislation are detected, prosecution may result. ORIGINAL AUTHOR: Euan Galloway REVIEWED BY: Carmen Fookes, Clinical Pharmacist, March 2017 Page 211

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