Ch 9: Drug Therapy During Pregnancy and Breast-Feeding Flashcards
What is the dilemma when prescribing drugs for a pregnant patient?
The prescriber is obliged to balance risks versus benefits, without knowing what the risks really are.
(p. 81)
The incidence of stillbirth in pregnant asthmatic patients is doubled among those patients who do not…
…take medications for asthma control.
p. 81
What is the MEPREP program?
MEPREP stands for Medication Exposure in Pregnancy Risk Evaluation Program.
It is a collaborative effort among the FDA, Kaiser Permanente, Vanderbilt University, and a group of HMO’s. The purpose of it is to collect data on drug use during pregnancy.
(p. 81)
How much does renal blood blow increase by the 3rd trimester?
What is the implication of this?
It doubles.
To compensate for accelerated excretion, dosage must be increased.
(p. 81)
What change occurs in the bowel during pregnancy?
What is the implication of this?
There is a decrease in tone and motility of the bowel.
Because of prolonged transit time, there is more time for drugs to be absorbed. This also increases the time for reabsorption of drugs that undergo enterohepatic recirculation.
A reduction in dosage may be needed.
(p. 81)
For practical purposes, the clinician should assume that any drug taken during pregnancy…
…will reach the fetus.
p. 81
Which drugs cross the placenta easily?
Which do not cross easily?
Lipid-soluble drugs.
Ionized, highly polar, or protein-bound
(p. 82)
What adverse reaction can result from taking heparin during pregnancy?
osteoporosis, which can result in spinal compression fractures.
(p. 82)
Where does the term ‘teratogenesis’ come from?
the Greek word for ‘monster’; literally translated, it means ‘to produce a monster’.
(p. 82)
Gross malformations are produced by exposure to teratogens during the…
…embryonic period (weeks 3 through 8).
p. 82
Teratogen exposure during the fetal period usually disrupts ________ rather than _____ _______.
function gross anatomy
(p. 82)
What are the 3 criteria to prove that a drug is a teratogen?
- must cause a characteristic set of malformations
- must act only during a specific window of vulnerability
- incidence of malformations should increase with increasing dosage and duration of exposure
(p. 84)
Lack of teratogenicity in animals is not…
…proof of safety in humans.
p. 84
What are the 5 FDA pregnancy risk categories and what do they mean?
Categories A, B, C, D, and X
Category A is the safest. B, C, and D are progressively more dangerous.
Category X contains those drugs that are known to cause human fetal harm.
(p. 85)
Factors that determine entry into breast milk are the same factors that…
…determine passage of drugs across membranes.
p. 86
