9. Pregnancy and Lactation Flashcards
Rule of thumb:
if it isn’t medically necessary do not take it
first trimester
organogenesis - weeks 5-10 when drugs can cause abnormalities
teratogenicity - affect how they are developing
congenital abnormalities
2nd and third trimester
possible growth and function abnormalities from medications
fetal toxicity from medications
teratogen
a substance that can cause fetal abnormalities when given to mother
occur in 120k babies per year - medications cause 3% of these abnormalities, most malfunctions occur because of genetic, environmental or other causes
proven teratogens
alcohol ACEi/ARB cigarette smoke cocaine lamotrigine NSAIDs phenytoin tetracycline warfarin
can drugs cross placenta
yes most drugs do depends on:
MW: greater then 1000 da do not cross the placenta (large)
charge: nonionized cross more easily
protein binding: highly protein-bound drugs do not cross easily
lipophilicity- highly lipophilic drugs cross easily
cross placenta drugs
ondansetron - lipid-soluble, small molecule morning sickness
opiates - min protein-bound
benzos - lipid-soluble, unionized
atropine - lipid-soluble
do not cross placenta
heparin - protein-bound, large molecule
insulin - protein-bound
drugs that cannot cross placenta can still cause harm to mother
uterine contractions
vessel constriction
altered maternal physiology - heparin-induced low platelets
drug classification for pregnancy women
A- controlled studies show no risk to fetus B- no evidence of risk in animal studies C- risk cannot be ruled out D- possible evidence of human fetal risk X- DO not use, contraindicated
PLLR
Pregnancy
Labor and Delivery
Nursing Mothers
thalidomide
tragedy in 1950s-60s in europe
marketed as sleep aid and antiemetic
“safe in pregnancy”
caused seal like appendages
vitmains pregnant women should be taking
prenatal multivitamin
folic acid - prevention of nueral tube defects
calcium- fetal skin development and teeth
Vaccines
Live = NO - cause fetal infection - immune system not as strong as mothers
live attentuated lu vaccine (FluMist)
zoster
varciella (chicken pox)
MMR
Inactivated virus = YES
Flu shot
Tdap (tetanus and pertussis) reccommended between weeks 27 and 36
Parameters affecting drugs in milk and nursing infants
maternal - how high is dose, duration of therapy, renal clearance, rental pH
drug - bioavavilabilty, molecular weight, lipid soluability, prtoein binding, pka
infant - age (just born - absorb more), feeding pattern (give mediction right before she breast feeds will have more in infants system), volume of milk consumed, ADME
