2021年2月17日星期三

preparation h hemorrhoids,Note on medication during pregnancy

    In clinical practice, expectant mothers often come to the hospital for treatment. At this time, the safety of medication is the first consideration.

    During pregnancy, the increased pressure in the abdominal cavity affects the blood circulation in the rectum and anal canal, and the return of blood is blocked. Such as dry stools, frequent stools, excessive stool time, sedentary sitting, abdominal tumors, increased portal pressure in liver cirrhosis, chronic illness, physical weakness, drinking, eating spicy and hot foods, pregnancy, childbirth, etc. During pregnancy and childbirth, after pregnancy, uterine enlargement affects hemorrhoids and venous reflux, which is easy to induce hemorrhoids. Generally, there is less activity during pregnancy, which causes dry stools and induces hemorrhoids. Inducing hemorrhoids.

    •Pregnancy is the number of weeks of pregnancy. Medical pregnancy refers to the period from the first day of the last menstrual period to the end of delivery.

    • The World Health Organization's survey of drug use during pregnancy in different countries and regions shows that about 80% of pregnant women have received drug treatment during pregnancy, receiving an average of 2.9 prescription drugs, which does not include the use of over-the-counter drugs. Studies have shown that human birth defects are caused by drugs accounting for 2% to 3%, and the teratogenic effects of drugs depend on the teratogenic properties of the drugs themselves, the period of pregnancy and the interaction with other factors. The same drug has different teratogenic sites in different periods of pregnancy. In order to prevent the teratogenic effects of drugs, the use of drugs should be avoided during the first 3 months of pregnancy, especially new drugs. Pregnant women need to receive treatment in time when they are sick, but they should understand whether the drugs used have any effect on the growth and development of the fetus and the pregnant woman.

    Principles and measures of safe medication

    1. Pregnant women should have a physical examination before pregnancy, and strive to get pregnant in a healthy state.

    2. Any drug application must be taken under the guidance of a doctor or pharmacist.

    3. If a certain chronic disease is discovered before pregnancy, the continuity and safety of medication during pregnancy should be taken into consideration when medication, and medications that may endanger the fetus should be avoided.

    4. In the early pregnancy (within 12 weeks), try not to use drugs. For drugs that can not be used or drugs that can be stopped temporarily, consider not using or temporarily stopping them.

    5. Do not use more drugs that can be used less frequently, and use less or less drugs that can be used as much as possible.

    6. Try to avoid combination medications. Drugs that can be used alone are not combined. Drugs that can be used with a certain conclusion do not need newer drugs.

    7. Don't take medicine at will or listen to folk prescriptions or secret prescriptions to prevent accidents.

    8. Avoid using advertised drugs or drugs that you do not know.

    •9. Pay attention to the words "pregnant women use with caution, avoid use, and prohibit use" on the packaging bag when taking medicine.

    •10. When drugs are required, try to choose drugs that do not harm the fetus or have little impact; if you must use a teratogenic drug for a long time due to treatment needs, the pregnancy should be terminated

    •11. After pregnant women take teratogenic or potentially teratogenic drugs by mistake, under the guidance of a doctor, they should consider whether to terminate the pregnancy based on the pregnancy time, dosage, and time of medication.

    •12. Most of the instructions of proprietary Chinese medicines are relatively simple, and many instructions do not include the item "Medication for pregnant women". Because it is difficult to weigh the pros and cons of medication for pregnant women, they should be used with caution to ensure drug safety

    • The United States Food and Drug Administration (FDA) classifies the teratogenic risk of drugs:

    • Category A: The safest, after a large number of strict controlled studies, animal and clinical data

    • Drugs that have not been shown to be harmful to the fetus, such as potassium chloride and gluconic acid

    • Potassium, etc.;

    • Category B: Drugs that show no risk in animal experiments but have no evidence of risk to humans,

    • Such as penicillins and cephalosporins;

    • Category C: It is a drug that has been shown to be risky in animal experiments but has not been carried out in clinical research, and the risk cannot be excluded

    • Drugs, such drugs should only be used after carefully weighing the pros and cons of the pregnant woman and the fetus;

    • Category D: The pre- and post-marketing data of the drug have proved to be harmful to the fetus, and the pros and cons need to be weighed.

    • Drugs of medicine, such as anti-tuberculosis drugs, antipsychotics, anticoagulants, antithyroid drugs, etc.;

    • Category X: It is proved to be serious in animal and human trials or research data before and after drug marketing

    • Harm to the health of the fetus, and are banned drugs for pregnant women, such as methotrexate, cyclophosphamide,

    • Marilan, trimethyldione, etc.

    • Anti-cancer drugs :

    • Methotrexate can cause skull and facial deformities, cleft palate, etc. Cyclophosphamide, marlilan, busulfan, cytarabine, daunorubicin, 6-mercaptopurine, etc., can cause finger (toe) malformations, hydrocephalus, cleft palate, external ear defects, renal hypoplasia or Multiple deformities.

    • Hormonal drugs:

    • The use of estrogen, progesterone, testosterone and their derivatives in the first trimester often causes abnormal fetal development and increases the rate of birth defects, which may make female fetuses virilize. Glucocorticoids used in large quantities in early pregnancy can cause stillbirth, miscarriage, cleft palate, anencephaly, one eye, bone deformities, etc.

    •Sedative hypnotics:

    • Phenobarbital, pentobarbital, diazepam, chlordiazepoxide, and Mianertong can all cause deformities, among which diazepam and chlordiazepoxide can cause a variety of deformities

    •Antipsychotics:

    •(1) Haloperidol: can cause fetal limb deformities, curled fingers, delayed intrauterine growth and gastrointestinal insufficiency.

    (2) Chlorpropanol: can cause brain hypoplasia, anencephaly, hydrocephalus, cleft palate, microcephaly, curled fingers, etc. Long-term use can cause fetal extrapyramidal hypoplasia and infant retinopathy. In the middle and late stages of pregnancy, it can cause central depression of the fetus and newborn, dyspnea, muscle weakness, difficulty in sucking, etc.

    • Anti-epileptics

    • Phenytoin: The incidence of birth defects in pregnancy is as high as 30%.

    • Sodium valproate: application in early pregnancy can cause fetal neural tube defects, malformed ears, hydrocephalus, large eyes, etc. The incidence is about 1%

    • Anti-malaria drugs

    • Pyrimethamine and chloroquine: can cause deformities such as deafness, hydrocephalus and limb defects.

    • Quinine: application in early pregnancy can cause stillbirth, premature delivery, miscarriage, auditory nerve defects, heart malformations, genitourinary tract malformations, etc.

    • Antipyretic, analgesic and anti-inflammatory drugs:

    • (1) Aspirin and other salicylic acid drugs: In the early pregnancy, it can cause fetal heart and blood vessel malformations, kidney defects, hypospadias, cleft lip, palate, and nervous system damage. Long-term use of aspirin in pregnant women can cause severe bleeding and even stillbirth.

    • (2) Indomethacin: It can cause various deformities such as cleft lip and palate in early pregnancy.

    •Cardiovascular system drugs:

    • Quinidine, clonidine, methyldopa, prazosin, etc. can cause stillbirth or teratogenesis in early pregnancy, and affect fetal heart function in the middle and late pregnancy.

    • Drugs acting on the blood system: Dicoumarin, warfarin can cause fetal bleeding, stillbirth or nasal bone hypoplasia, achondroplasia, optic nerve atrophy, cerebellar children, etc.

    • Hypoglycemic drugs: Insulin in early pregnancy can cause fetal bone abnormalities. Tolbutamide and chlorpropamide can cause stillbirth, multiple malformations, miscarriage, and premature delivery.

    •Antimicrobial drugs:

    • (1) Rifampicin: The teratogenicity rate is 4% to 5%, which can cause stillbirth, anencephaly, hydrocephalus, limbs, ear canal, and urinary tract malformations.

    • (2) Tetracycline drugs: In the early pregnancy, it can cause fetal cataracts, dysplasia of the limbs, short fingers and limbs, and in the middle stage, it can cause death of the fetus, renal hypoplasia, and yellow staining of the teeth, enamel hypoplasia, and bone after birth. Growth disorders, etc., medication in the late pregnancy can cause hemolytic anemia and fulminant liver failure in the fetus and newborns, and in severe cases can cause maternal and infant death.

    • (3) Chloramphenicol: medication in the first trimester can cause fetal cleft palate and cleft lip, and in late pregnancy can cause neonatal bone marrow suppression or fetal death. Use chloramphenicol before delivery

    •Can cause neonatal circulatory disorders and gray baby syndrome.

    • (4) Aminoglycoside antibiotics: in early pregnancy or in large quantities, they can cause damage to the fetus’s auditory nerve and kidneys. The infants born with mild hearing loss can cause complete deafness in severe cases. Streptomycin and gentamicin can occur The rate is higher.

    • (5) Sulfadiazine: It can cause a variety of deformities in early pregnancy.

    • (6) Trimethoprim can also cause fetal malformations and affect the safety of newborns.

    • (7) Norfloxacin also has teratogenic effects, which can inhibit the growth and development of cartilage joints and limbs of fetuses and newborns.

    • (8) Fenfluramine can also cause a variety of fetal malformations in the early pregnancy.

    • Anti-obesity drugs: dexamphetamine can cause fetal heart defects, ectopic large blood vessels, cleft lip, and limb deformities.

    •General anesthetics: The application of halothane in the early and middle pregnancy can affect the hearing function of the fetus. Methoxyflurane can cause fetal bone deformities. During labor, pregnant women who use anesthetics such as ether or chloroform, morphine, melanidine, and diazepam can cause central nervous system depression and nervous system damage to the fetus. Newborns born are not eating, crying, hypothermia, respiratory depression, or circulatory failure. .

    • Central stimulants: Continuous use of caffeine in the early pregnancy can cause fetal limb deformity and osteogenesis hypoplasia.

    • Antitussives: Codeine can cause cleft lip, palate, and stillbirth. Antithyroid drugs: thiouracil, tapazole, and iodine can affect fetal thyroid function, leading to stillbirth, congenital hypothyroidism or goiter, and even asphyxia.

    Based on the above factors, it is hoped that the majority of pregnant women will undergo surgery before pregnancy to avoid serious symptoms of hemorrhoids during pregnancy, but they cannot use medicine.

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