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Narcotici:attraversano la placenta e nel feto raggiungono livelli sierici simili a quelli materni. Morfina, metadone, pentazocina, buprenorfina, fentanil e petidina non sono controindicati in gravidanza e nessuno di questi farmaci determina malformazioni fetali; tutti, se usati in modo continuativo, possono indurre dipendenza e quindi fenomeni di astinenza nel neonato: tremori, ipertono muscolare, iperattività, vomito, diarrea. Se usati in prossimità del parto possono provocare depressione respiratoria neonatale.
Barbiturici: Nella pratica clinica i barbiturici risultano avere una pericolosità superiore alle benzodiazepine, e ciò è riconducibile ai rispettivi meccanismi d’azione. Le benzodiazepine aumentano la frequenza di apertura dei recettori canali GABAA in modo GABA dipendente, i barbiturici invece aumentano la permeabilità agli ioni Cl– interagendo direttamente sul canale anche in assenza di GABA. Per questa classe di farmaci quindi l’effetto controllo operato dalla naturale attività neuronale viene meno, ed è per questo che i barbiturici possono indurre effetti gravi come il coma a dosi relativamente vicine a quelle terapeutiche, mentre le dosi di benzodiazepine necessarie per avere effetti neurodepressivi seri sono molto lontani dalle dosi terapeutiche. Nella classifica di pericolosità delle varie droghe stilata dalla rivista medica Lancet, i barbiturici occupano il terzo posto, mentre le benzodiazepine il settimo.
Benzodiazepine: presentano antagonisti recettoriali specifici, come il Flumazenil (Annexate) i quali possono essere somministrati in casi di overdose. Non esistono invece antagonisti recettoriali per i barbiturici ed è per questo che la pericolosità di tali farmaci è maggiore. Tale caratteristica ha reso i barbiturici i principali farmaci d’abuso in casi di suicidio.
Curarizzanti (Succinilcolina, Pancuronio, etc.): farmaci utilizzati per intubazione rapida, episodi acuti di asma, e tetano, sono farmaci capaci di bloccare le contrazioni muscolari per competizione recettoriale con l’acetilcolina a livello delle placche muscolari. Hanno brevissimi tempi di latenza ed emivita. Gli effetti collaterali parasimpaticomimetici come la bradicardia e scialorrea possono essere evitati dalla somministrazione di atropina. I farmaci curarizzanti, pur avendo un basso peso molecolare (397 dalton) in donne sane non passano la barriera placentare tranne che nelle pazienti con deficit di pseudocolinesterasi; in tal caso si assiste al passaggio transplacentare del farmaco che può produrre apnea nel neonato. Inoltre i curarizzanti determinando un profondo rilasciamento muscolare a livello pelvico possono provocare un effetto Poseiro in donne posizionate in decubito dorsale ed è quindi opportuno sistemare le donne da sottoporre a taglio cesareo o parto in anestesia in pozione laterale. Inoltre c’è un aumentato rischio di polmonite ab ingestis a causa del rallentato transito del cibo nello stomaco delle donne gravide e a causa del rilasciamento del cardias indotto dai farmaci curarizzanti.
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Tab. 30 – Narcotici |
management |
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OPPIACEI |
Morfina (Oramorph, Twice, |
ctg C della FDA; se usati in modo continuativo, possono Se usati in prossimità del parto possono provocare |
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metadone (Narcan) |
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Pentazocina (Talwin) |
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Buprenorfina |
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Fentani (Fentanest) |
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Durogesic |
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Petidina |
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Antagonisti degli |
Naltrexone antagonista dei recettori oppiacei utilizzato in |
Antaxone |
Ctg B3 Mancano studi adeguati Sconsigliati in |
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Nalorex |
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Narcoral |
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Enflurane |
Ethrane |
A |
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Halotano |
Fluotane |
A |
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Ketamina |
Ketalar |
A |
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Tiopentone |
Pentotal |
A |
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Desflurane |
Suprane |
B3 |
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Isoflurane |
Forane |
B3 |
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Metossifluorane |
Pentrane |
C |
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Protossido di azoto |
A |
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Propofol |
Diprivan |
C |
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barbiturici |
Fenobarbital (Luminal) |
depressione respiratoria neonatale |
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Curarizzanti |
Succinilcolina (Midarine), Alcoronium, Mivacurium, Pancuronio (Pavulon), Atracurium |
B2 Effetto Poseiro Apnea in neonati da donne con deficit di PCHE |
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