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analgezia si anestezia in obstetrica. analgezia in travaliu - anestezie ...

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Obstetrică<br />

264<br />

Antiepileptice<br />

Medicament Sapt.<br />

1-12<br />

Acid valproic (valporat<br />

de sodiu)<br />

Barbiturice (fenobarbital)<br />

Sapt.<br />

13-39<br />

Per<strong>in</strong>atal<br />

Lactatie Observatii<br />

(-) (-) (-) + Scade eficacitatea contraceptivelor<br />

estroprogestative<br />

-- (+) (+) +<br />

Fenito<strong>in</strong>a (+) (+) (+) +<br />

Carbamazep<strong>in</strong>a -- -- -- (+)<br />

Benzodiazep<strong>in</strong>a<br />

(diazepam, clonazepam)<br />

(-) (-) -- diazepam<br />

IV de<br />

electie<br />

<strong>in</strong> status<br />

epilecticus<br />

Medicamente utilizate <strong>in</strong> gastroenterologie<br />

Medicament Sapt.<br />

1-12<br />

Antagonistii<br />

receptorilor H2<br />

(ranitid<strong>in</strong>a)<br />

Inhibitor de pompa<br />

Na/K<br />

Omeprazol, Lansoprazol,Pantoprazol,<br />

Esomeprazol<br />

Antiacide (Sucralfat)<br />

Sapt.<br />

13-39<br />

Per<strong>in</strong>atal<br />

(cu exceptia valporatului de<br />

sodiu)<br />

Sfat preconceptional<br />

util datorita riscului de<br />

malformatii fetale (buza<br />

de iepure, cardiopatii – <strong>in</strong><br />

cazul fenobarbitalului <strong>si</strong><br />

fenito<strong>in</strong>ei; sp<strong>in</strong>a bifida – <strong>in</strong><br />

cazul valporatului de sodiu;<br />

malformatii cranio faciale<br />

hipoplazie unighiara <strong>si</strong> faciala,<br />

retard mental)<br />

Se va efectua ecografie<br />

fetala optim <strong>in</strong>tre a 18 <strong>si</strong><br />

20 saptamana de sarc<strong>in</strong>a<br />

pentru depistarea acestor<br />

malformatii<br />

Absenta manifestarilor<br />

convul<strong>si</strong>ve cativa ani <strong>in</strong>a<strong>in</strong>tea<br />

sarc<strong>in</strong>ii poate constitui o<br />

<strong>in</strong>dicatie de sevraj<br />

adm<strong>in</strong>istrarea valporatului<br />

justifica amniocenteza la 16<br />

18 saptamani <strong>si</strong> dozarea α<br />

fetoprote<strong>in</strong>ei <strong>si</strong> a acetilcol<strong>in</strong>esterazei<br />

<strong>in</strong> lichidul<br />

amniotic. Pentru prevenirea<br />

complicatiilor hemoragice<br />

la nou nascut se vor asocia<br />

vitam<strong>in</strong>a k1 vitam<strong>in</strong>a D <strong>si</strong><br />

acid folic<br />

Clasa FDA D<br />

Lactatie Observatii<br />

-- -- -- -- Risc de fem<strong>in</strong>izare a fatului<br />

de sex mascul<strong>in</strong><br />

Clasa FDA B<br />

+ + + + Fara risc teratogen<br />

Clasa FDA B<br />

-- (+) (+) + Clasa FDA B<br />

Laxative (+) (+) (+) (+)<br />

Antidiareice (+) (+) (+) (+)

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