20 Pharmacy Issues in Pregnancy Flashcards
what is the start of preganacy calculated from
the 1st day of the last menstrual period
what is the conception date
might be the day sex occurred or some days later as sperm can live up to 5 days
when is a blastocyst formed
0-16 days after conception
what does organogenesis take place
day 17-60 of pregnancy
what is organogenesis
- cell division
- migration
- differentiation
- cell death
when does histogenesis and functional maturation happen
days 61 to full term
how long is the average pregnancy
280 days/40 weeks but can get survival at 22 weeks
does maternal weight increase
yes (11-14kg)
does blood volume, uterine and breast size increase in 1st T
yes
does deposition of fat stores increase in 2nd T
yes
is there foetal and placental growth in the 3rd T
yes
does HR increase during pregnancy
yes
does BP increase or decrease during pregnancy
decrease
does gastric acid secretion increase or decrease
decrease
does gastric emptying increase or decrease
decrease
does bladder capacity increase or decrease
decrease
does urinary control increase or decrease
decrease
functions of placenta
- respiratory function (gas exchange)
- excretory function (maintain water and pH balance)
- resorptive function (like GI)
does the placenta act as a barrier
yes
what drugs can pass through placenta
lipid soluble with low Mwt
what is transfer across placenta determined by
concentration gradient between foetal and maternal circulation
what does the quantity of drug reaching the foetus depend on
- physiochemical characteristics
- maternal pharmacokinetic parameters
what is high placental transfer
the drug crosses rapidly, at equilibrium foetal conc close to maternal pharmacological concentration
what is limited placental transfer
foetal conc is lower than maternal conc
what is excess placental transfer
foetal concentration is higher than maternal (limited retro-passage to maternal circulation)
do some compounds not cross the placenta at all
yes eg pituitary hormones etc
what percentage of people experience nausea and vomiting
70-80%
when does nausea and vomiting usually occur
4-8 weeks gestation – rarely after 16 weeks
what is the severe form of nausea and vomiting
hyperemesis gravidarum
what causes nausea and vomiting
- hormonal
- neurological
- physical factors
increase in hCG, decreased gastric emptying
how to treat nausea and vomiting
anti emetics — usually POMs so should refer to GP
what causes constipation
- decrease in motility of smooth muscle
- increase in progesterone
food passes through GIT slower - decreased activity
treatment of constipation
laxatives (osmotic or bulk forming not stimulant)
what causes haemorrhoids
- enlarging uterus exerts pressure
- increase blood volume leads to venous dilation and engorgement
treatment of haemorrhoids
- laxatives
- haemorrhoid cream/oinment
what can cause indigestion
slowing of peristalsis caused by progesterone
when does indigestion usually occur
3rd trimester
non drug treatment of indigestion
- eating smaller more frequent meals
- elevation on top of bed
- avoid certain foods
drug treatment of indigestion
antacids
what is thrush
a fungal infection caused by Candida albicans
what causes thrush
hormonal changes during pregnancy as the vaginal environment is altered
treatment of thrush
- topical agents eg clotrimazole
- natural yoghurt
REFER to GP as they can give oral treatment
what causes UTIs in pregnancy
foetus puts pressure on bladder and urinary tact — traps bacteria or causes urine to leak
how to treat UTI
REFER — doctor will usually give antibiotic
what can anaemia cause on baby
- anaemia during infancy
- spontaneous abortion
- premature delivery
- LBW
treatment for anaemia
iron supplements — usually 200mg FeSO4
what is a teratogen
a substance, organism or process that causes malformation in a foetus
do the effects of teratogens correspond to stages of foetal development
yes – most influence on oranogenesis stage
when does organ formation occur
in the first three months of pregnancy
when do teratogens cause structural defects
first three months
what effects do teratogens cause from 3 months onwards
growth defects
what is class A of drug in pregnancy
drug is well studies and poses no threat to a developing baby
what is class B of drug in pregnancy
drug is less studies but still prob low risk
what is class C of drug in pregnancy
drug hasn’t been studied so risk is unknown
what is class D of drug in pregnancy
studies based on animal or human data, may pose risk
what is class X of drug in pregnancy
drug causes birth defects or theres no benefit for use during pregnancy. NOT recommended
should you breast feed before or after taking medication
before
what type of drugs diffuse into breast milk
lipid soluble due to high fat content of milk
