Farmaci in Gravidanza e Allattamento

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FARMACI STIMOLANTI IL SNC:

  • Anfetamine: amine simpaticomimetiche, interagiscono direttamente con il recettore adrenergico e lo attivano e/o aumentano la biodisponibilità delle catecolamine a livello a livello sinaptico, tra la fibra post-gangliare e l’organo effettore, inducendo il rilascio delle catecolamine da parte delle vescicole trasportatrici ed inibendone la ricaptazione. Sono sostanze stimolanti del sistema nervoso central, vasocostrizione periferica, aumento della pressione arteriosa, tachicardia, riduzione del senso di fatica e diminuzione dell’appetito. L’amfetamina fu scoperta nel 1887.
  • LSD (Dietilamide dell’acido lisergico): sintetizzata per la prima volta da Albert Hofmann nel 1938. Gli effetti sono molto variabili e la durata è da 5 a 12 ore circa. L’ effetto dell’ LSD può essere interrotto rapidamente somministrando 50 mg di chlorpromazine. L’ LSD viene commercializzato (illegalmente) su cartoncini dalle dimensioni di 1×0,8 cm circa e sono contenuti circa 100-200 mg. Raramente è commercializzato anche dissolto in liquido (100 mg), oppure in un gel colorato conosciuto con il nome di “windowpane”. LSD non causa dipendenza fisica. L’ unico rischio è quello di una dipendenza psichica: se una persona ha una debole forza di volontà e non riesce più farne a meno. LSD non è tossico per il corpo, al contrario delle anfetamine, MDMA e altro e non causa alcun danno ai cromosomi. Però comportano gravi danni della personalità e frequenti episodi di flashback, isonnia, confusione mentale, spossatezza. Tutte le persone, che abbiano assunto sostanze o no, hanno flashback (si manifestano per via di forti sensazioni vissute, shock, spaventi, dispiaceri immensi,…). Con flashback si intende un momento di distorsione visuale, di tempo, sintomi psichici (convinzione di qualcosa di irreale, confusione mentale, perdita di controllo della mente), rivivere per qualche secondo o minuto un’ intensissima emozione.
  • Caffeina: 3-4 tazzine al dì non producono alcun danno alla donna gravida, al feto ed al bambino in allattamento. Vari studi però indicano che bere più di 7-8 caffé al giorno si associa a un’aumentata incidenza di morte intrauterina, di parti pre-termine, di neonati con basso peso alla nascita e di aborti spontanei. Esiste anche un rischio teratogeno della caffeina ma per dosaggi enormi (>60 tazzine di caffè al giorno), al di fuori di ogni comportamento di persone normali.
  • Nicotina: La nicotina crea dipendenza: i fumatori che provano a rinunciare spesso presentano sintomi sgradevoli come irritabilità, cefalea, irrequietezza, insonnia, difficoltà di concentrazione e forte desiderio per le sigarette, perché sono dipendente dalla nicotina presente nel tabacco. La terapia sostitutive della nicotina con cerotti o chewin gum che contengono una piccola quantità di nicotina, limita gli effetti da privazione ed abitua a snettere di fumare e non provoca gli effetti pericolosi del fumo di tabacco su polmoni, cuore e arterie.
  • Alcool:l’alcolismo fra le donne è in aumento: il rapporto maschi/femmine è attualmente 3:1. Il fenomeno è particolarmente diffuso fra le donne di 30-40 anni ma si va sempre più diffondendo fra i giovani e le teen-agers. L’etanolo passa facilmente la barriera placentare e raggiunge nel sangue fetale una concentrazione pari a quella materna. Gli effetti negativi dell’alcool sulla gravidanza prevedono aborto e malformazioni fetali, soprattutto nel 1° trimestre, fino alla grave “sindrome feto-alcolica”. Il potere dannoso dell’alcool sul feto è dovuto alla carenza di enzimi epatici deputati alla metabolizzazione dell’etanolo. Nel II-III° trimestre l’abuso di alcool può provocare: sindrome feto-alcolica (FAS) con IUGR per modulazione negativa dell’etanolo sull’assorbimento degli aminoacidi, anomalie cranio-facciali, morte fetale intrauterina. I neonati da madre alcolista presentano basso peso alla nascita in rapporto all’epoca gestazionale e difficoltà a recuperarlo successivamente, fessura palpebrale ridotta, il labbro superiore assottigliato, microftalmia, strabismo e miopia; solitamente la faccia ha un aspetto tirato con un profilo piatto. L’allattamento al seno da mamma alcolista presenta rischi per il lattante in quanto l’alcool è secreto nel latte materno e può provocare intossicazione etilica con turbe neurologiche di varia gravità.

Tab. 33 – Stimolanti il SNC

Management

amfetamina

Ctg B3;
difetti cardiaci congeniti

LSD

Commercio illegale

Ctg D;

Confusione mentale della gravida

LSD-canapa/hash

Commercio illegale

LSD-Cocaina

Commercio illegale

LSD-Alcol

Commercio illegale

LSD-MDMA (Extasy)

Commercio illegale

caffeina

Ctg A; ma se assunta in dosi eccessive (>8 tazzine/die), può provocare aborti spontanei, morte intrauterina, parti pre-termine, neonati con basso peso alla nascita

Nicotina

Tabacco da fumo

Ctg D Ipossia fetale, IUGR, LBW (Low Birth Weight), VLBW (Very Low Birth Weight), VVLBW (Very Very Low Birth Weight), ELBW (Extremely Low Birth Weight)

 

 

Nicotine cerotti, nicotine gum, nicorette
chewing gum

Ctg D, Ipossia fetale, IUGR, LBW (Low Birth Weight), VLBW (Very Low Birth Weight), Peso alla nascita
VVLBW (Very Very Low Birth Weight), ELBW (Extremely Low Birth Weight)

Alcool

Ctg C

Sindrome “feto-alcolica”

Intossicazione etilica del lattante

Antagonisti degli
oppiacei

Naltrexone

antagonista dei recettori oppiacei utilizzato in
farmacologia per il trattamento della dipendenza da oppioidi

Antaxone

Ctg B3

Mancano studi adeguati per l’uso in gravidanza

Sconsigliati in allattamento

Disulfiram

Antabuse (terapia dell’alcoolismo)

B2

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