17) Pharmacotherapy in pregnancy and breastfeeding:

Question 1

why must pregnant women be given careful consideration in drug therapy

Answer 1

exhibit altered pharmacokinetics or pharmacodynamics responses

potential to cross the placenta abd cause adverse fetal effects

Question 2

which drugs easily cross the placental barrier

Answer 2

• small mw
• unchanged at physiological pH
• highly lipid soluble

Question 3

which drugs slowly cross the placental barrier

Answer 3

-weak acids
-ionized at physiological pH
high mw
stongly bind to PP

Question 4

other factotr influencing transplacental drug movement

Answer 4

maternal-to-fetal concentration gradients,

Question 5

phK and phD in preg

Answer 5

⦁ cardiac output increases up to 40%;
⦁ renal blood flow, glomerular filtration and plasma volume increase;
⦁ plasma albumin concentration decreases

Question 6

what is the risk-benefit analysis of drug use in pregnant women

Answer 6

5 point scale from category A to X used for drug administration in pregnancy

Question 7

⦁ Category A

safest

Answer 7

considerable data available concerning the use of the drug in pregnant women and the risk of fetal harm appear negligible

Question 8

⦁ Category B

Answer 8

Animal studies showed no risk and there is little human data,

or the animal studies showed some risk that wasn’t confirmed in humans

Question 9

⦁ Category C

Answer 9

no animal or human studies

or

animals risk but no human studies

Question 10

⦁ Category D

Answer 10

evidence of human fetal risk, but the benefits of the drug may still overweigh risks in certain situations.

Question 11

⦁ Category X

Answer 11

animal or human studies show a fetal risk outweighing any potential benefit to the mother.

Drugs in this category pose definite and high risk if used during pregnancy.

Question 12

pregnancy and DB drug recc

Answer 12

I: strict insulin contral

CI: sulfonylurea

Question 13

pregnancy and HTN drug recc

Answer 13

methyldopa, prazosin

CI

• beta blockers
• diurretics
• ccb

Question 14

pregnancy and UTI

Answer 14

cefalopsorines

CI
-sulfonamide

Question 15

drugs during breastfeeding

Answer 15

drugs can be excreted into breast milk which can be exposed to baby

Question 16

factors determining drug conc in breast milk

Answer 16

mw (most important)

ionisation at physio ph

Concentration of the drug in maternal plasma.

Question 17

why are nursing babies at risk of ADR

Answer 17

renal and hepatic pathways of drug excretion and biotransformation are immature

Question 18

CI drugs in breast feeding

Answer 18

endocrine: iodine
radioph: iodine
cytotoxic: methotrexate
hormones: androgens;/ estrogens

psychoactive: barbituates
ethanol
lithium

opiods: strong
morphine
heroine
cocaine

Question 19

strategies to minimose drug toxicity if pt and doctor agree

Answer 19

discard milk produced after drug administration

use drug w/ fewest adr to infant

seperate drug admin times from breast feeding times