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Reproductive module > ✓ 29- Drugs During Pregnancy, Labor and Lactation > Flashcards

✓ 29- Drugs During Pregnancy, Labor and Lactation Flashcards

1
Q

What drugs are capable of crossing the placental barrier?

A

Drugs that are:

  • Low M.W [< 500 Da]
  • Non-polar
  • Non-protein binding
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2
Q

What effect does heparin administration have on the growing fetus?

A

No effect as it doesn’t cross the placental barrier

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3
Q

What effect does insulin administration have on the growing fetus?

A

No effect as it doesn’t cross the placental barrier

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4
Q

T/F: concentrations of drugs is much lower in fetal circulation as compared to maternal.

A

False, majority of drugs reach concentration in the fetus like those in maternal blood

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5
Q

T/F: Paracetamol is contraindicated throughout the pregnancy and is not used in pregnancy under any circumstances.

A

False, it’s a category B drug that can be used for fever to prevent any harm it may cause the fetus

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6
Q

What drugs is used for gestational DM?

A

Insulin

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7
Q

Are drugs a common cause of fetal congenital abnormalities?

A

No, only causes 2-3% of cases

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8
Q

How can drugs affect the growing fetus?

A
  • Directly interacts with fetal tissue
  • Contracting uterine muscle
  • Reduced fetal BF ( placental ischemia)
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9
Q

How can drugs reduce fetal blood glow?

A

→ Placental vasoconstriction→ Lowers Systemic BP in mother → decreasing fetal BF [indirectly]

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10
Q

What is the “ All or None” period?

A

1st week of fertilization/pre-implantation period

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11
Q

What is the “teratogenesis” period?

A

Organogenesis period [2-8 week]

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12
Q

What is the “Organ Dysfunction” period?

A

Fetal development period [3-9 months]

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13
Q

What drugs may effect the fetus during the pre-implantation period?

A
  • Alchohol
  • Methotrexate
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14
Q

What drugs may effect the fetus during the organogenesis period?

A
  • Thalidomide
  • Warfarin
  • Valproate
  • Vitamin A derivatives
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15
Q

What structural deformity is caused by Valproate?

A
  • Tall forehead
  • Cleft lip
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16
Q

What structural deformity is caused by Thalidomide?

A
  • Amelia
  • Phocomelia
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17
Q

What structural deformity is caused by Warfarin?

A
  • Nasal hypoplasia
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18
Q

What structural deformity is caused by Vitamin A derivates?

A
  • Skeletal deformities
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19
Q

What drugs may effect the fetus during the fetal development period?

A
  • Antithyroid drugs
  • ACEI
  • Aminoglycosides
  • Tetracyclines
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20
Q

What structural deformity is caused by Antithyroid drugs?

A

Neonatal hypothyroidism [Goiter]

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21
Q

What structural deformity is caused by ACEI?

A

Fetal renal failure

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22
Q

What structural deformity is caused by Aminoglycosides?

A

Kidney damage and hearing problem

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23
Q

What structural deformity is caused by tetracycline

A

Bone and teeth formation

24
Q

What drugs given around labor effects the fetus?

A
  • Aspirin
  • NSAIDs
  • Opiates
  • Sulfonamides
  • Benzodiazepines
25
Q

What effects are seen when Sulfonamides is administered around labor?

A
  • Neonatal Jaundice
  • Hemolytic anemia
26
Q

What effects are seen when large doses of Aspirin and NSAIDs are administered around labor?

A
  • Delayed labor
  • Bleeding
  • Premature closure of Ductus Arteriosus
27
Q

What effects are seen when Opiates and Benzodiazepines are administered around labor?

A
  • Respiratory depression
  • Feeding difficulties
  • Hypotension
28
Q

Define Category A drugs

A
  • Remote possibility of fetal harm
  • Studies show no fetal risk during pregnancy
29
Q

List examples of Category A drugs

A
  • Vitamin B6
  • Thyroid Hormone
30
Q

Define Category B drugs

A

No studies on human, but animal studies show no risk

31
Q

List examples of Category B drugs

A
  • Paracetamol
  • Penicillins
32
Q

Define Category C drugs

A

No studies in humans, and animal studies show some risks. But drugs benefits outweigh potential risk

33
Q

List some examples of Category C drugs

A
  • Quinolone antibiotics [Ciprofloxacin]
  • Corticosteroids
  • Fluconazole
34
Q

Define Category D drugs

A

Evidence of human fetal risks, so it shouldn’t be used during pregnancy except if needed for serious disease and no effective alternative

35
Q

List some examples of Category D drugs

A
  • Phenytoin
  • Valproic acid
  • Tetracycline
  • Aminoglycosides
36
Q

Define Category X drugs

A

Studies or experience show fetal abnormalities in both humans and animals, and risks clearly exceed benefits

37
Q

List some examples of Category X drugs

A
  • Thalidomide
  • Warfarin
  • Retinoids
38
Q

Who cannot use Category X drugs?

A

Pregnant women or those trying to get pregnant

39
Q

How does pregnancy affect drug absorption?

A

Reduced gastric acid secretion and intestinal motility due to increased female hormones

Frequent vomiting in early pregnancy

40
Q

What is the fetal development period?

A

From 3rd-9th months, at this point drugs modify the function of fetal organs, not their gross appearance

41
Q

What is the organogenesis period?

A

A period of teratogenesis, where drugs cause structural deformities. This is from Week 2-8

42
Q

What is the pre-implantation period?

A

Fetus may recover or die from the effects of the drug. This period is up until a week of fertilization

43
Q

How does pregnancy affect drug’s volume of distribution?

A
  • Increase of intravascular and extravascular water content → increased VD for hypophilic drugs
  • Increase in fat deposition and body weight → increase of VD for fat soluble drugs
  • But there’s a decreased serum albumin
44
Q

How does pregnancy affect the metabolism of metoprolol?

A

CYP2D6 is induced during pregnancy → increased metabolism → decreased efficacy

45
Q

How does pregnancy affect the metabolism of imipramine?

A

Estrogen decreases oxidation → increases efficacy

46
Q

How does pregnancy affect the renal clearance of drugs?

A

Increases clearances due to increased maternal CO [30%], RBF, and GFR

47
Q

How does pregnancy affect the clearance of penicillins?

A

Penicillins, such as amoxicillin, are cleared through renal elimination, and it’s clearance is increased during pregnancy

48
Q

How does pregnancy affect the hepatic metabolism of drugs?

A

Hepatic clearance increases due to induction of hepatic enzymes and increased hepatic blood flow

49
Q

How does pregnancy affect the bile dependent elimination of drugs?

A

Elevated estrogen causes cholestasis, reducing thus route of elimination and increased efficacy of drugs eliminated through this route

50
Q

What drugs are used in higher doses in the second and third trimesters and why?

A

Phenytoin and Valproic acid, as their clearance is increased during pregnancy

51
Q

What drugs should be avoided in breast feeding?

A
  • Benzodiazepines
  • Narcotic analgesics
  • Anti thyroid drugs
  • Sulfonylureas
  • Anti cancer drugs [methotrexate]
52
Q

What drugs suppress lactation?

A
  • Thiazide diuretics
  • Estrogen [in high doses]
53
Q

What drugs are safe in breast feeding mothers?

A
  • Penicillins, cephalosporins
  • Theophylline, salbutamol
  • Anticonvulsants
  • Antihypertensives (beta blockers, methyldopa)
  • Warfarin, heparin
  • Tricyclic antidepressants
54
Q

Describe whic drugs achieve higher concentrations in milk?

A

Unionized, highly lipid soluble, and with low protein binding

55
Q

How would drugs pass to the baby during breast feeding?

A

Most drugs are secreted into milk through passive diffusion and reach to suckling babies

56
Q

What are the guidelines to minimize drug effects during breastfeeding?

A
  • If possible avoid drugs
  • Use the safest effective medicine
  • Decrease babies’ exposure via:
    • Using the lowest possible dose
    • Taking medications immediately after breast feeding
    • Alternating breast feeding with bottle feeding

Reproductive module (41 decks)

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