Drug use in pregnacy and lactation

Question 1

what are some of the issue with use of drugs in pregnancy

Answer 1

lack of studied 
societal beliefs - exaggerated 
risk to mother and fetus of not taking meds
overly cautious HCP 
first doctor visit weeks into pregnancy

Question 2

conditions that may require drug use during pregnancy

Answer 2

cough,cold, AR 
NV 
depression 
epilepsy 
gestational diabetes 
asthma
UTI hypertension 
prenatal supplementation

Question 3

define teratogen and examples

Answer 3

agent that irreversibly alters growth, structure, or function of the developing embryo or fetus
virus, chemicals, drug, environment

Question 4

define teratology

Answer 4

study of birth defects

Question 5

what is the implantation period

cause of malformations?

Answer 5

from implantation to contraception, first 2 weeks

significant insult will cause death, will not cause malformations

Question 6

describe embryonic period

Answer 6

2-8 weeks after conception

organogenesis - time of formation of organs

Question 7

when is the period of greatest vulnerability to teratogens

Answer 7

embryonic

Question 8

describe the fetal period

Answer 8

9 weeks to birth
growing and maturation
can still get abnormalities

Question 9

potential adverse effects of teratogens

Answer 9

spontaneous abortion
cogenital anomalities - structural
fetal effects- functional, greoth restriction

Question 10

when can adverse effects of teratogens manifest

Answer 10

immediately or in the future

Question 11

mechanism of toxicity

Answer 11

covalent bonding
inhibition of proteins/enzymes
peroxidation of lipids and proteins
receptor-ligand interactions

Question 12

pysiological changes during pregnancy

Answer 12

decrease gastric emptying
increased blood volume, decrease plasma proteins
increase liver blood flow

Question 13

what effect does pregnancy have on drugs

Answer 13

decrease t1/2, clearance, and peak plasma concentrations

increase clearance

Question 14

how do drugs cross the placenta

Answer 14

passive diffusion

Question 15

criteria for a teratogen

Answer 15

teratogenic in animals
effect can be characterized
can cross the placenta 
consistent epidemiological studies 
exposure during critical development period

Question 16

anticonvulsant defects

Answer 16

neural tube development

cranialfacial, cleftplate

Question 17

ace inhibitor defects

Answer 17

microencephaly
renal disease
cardiovascular malformations
death

Question 18

coumadin derivatives defects

Answer 18

warfarin syndrome
hemorrhage
embyropathy

Question 19

methotrexate defects

Answer 19

cranial facial
skeletal
neural
mental retardation

Question 20

isotretinoin defects

Answer 20

cranial facial
cardiac defects
hydrocepalus
spontaneous aborption

Question 21

signs of fetal alcohol syndrome

Answer 21

small eye openings
flattened cheek bones
mental retardation
growth retardation

Question 22

cigarette defect

Answer 22

cleft plalate and lip
toxic
decreased oxygen
decreased fetal growht

Question 23

FDA classifications of risk in pregnancy

Answer 23

A: good studies showed no risk
B: no evidence of risk to humans 
C: risks can't be ruled out
D: evidence of risk 
X: contraindicated

Question 24

drawbacks of FDA classification

Answer 24

limited data
infrequenctly updated
inconsistent assignment
simplified, doesnt take a lot of things into account

Question 25

population birth defect rate

Answer 25

1-3%

Question 26

problems with codiene in breast feeding

Answer 26

metabolized by cyp 219 and some mothers are extensive metabolizers accumulates after 4 days and can cause death

Question 27

treatment goals

Answer 27

treat mother if possible prevent adverse effects to baby preserve ability to breast feed provide education

Question 28

hwo does drug transfer into breast milk

Answer 28

diffusion: transcellular, intercellular, inophore

Question 29

explain difference in ph of milk and plasma and where drugs will concentrate

Answer 29

plasma = 7.4 and milk = 7.1 acidic drugs will be trapped in plasma basic drugs will be trapped in the milk

Question 30

drug factors to consider for drugs in lactation

Answer 30

type of drug and adverse effcts how much excreted in breast milk is it prescribed for infants? likely safe pharmacokinetics - bioavaialability, half life

Question 31

patient factors to consider for drugs in lactation

Answer 31

age of patient indciation - benefit vs risk duration underlying conditions

Question 32

ideal medication in breast feeding

Answer 32

``` low lipophilicity large molecule short half life used in infants weak acid high protein binding low oral bioavailability ```

Question 33

what is the milk plasma ratio

Answer 33

concentration in milk/ concentration in plasma

Question 34

formula for infant dosage

Answer 34

drug concentration in milk x volume of milk

Question 35

formula for daily dose

Answer 35

avg concentration in milk x volume ingested in 24 hours

Question 36

formula for infant dose

Answer 36

daily infant dose / standard infant dosing

Question 37

relative infant dose formula

Answer 37

infant dosage / maternal dose

Question 38

are antibiotics compatible with breastfeeding? some side effects?

Answer 38

yes diarrhea rash

Question 39

which analgesics are safe in breast feeding

Answer 39

``` acetaminophen nsaids except ASA morphine hydromorphone methadone ```

Question 40

which analgesics should you caution in breast feeding

Answer 40

codiene because ultra metabolizers oxycodone meperidine

Question 41

which benzos should you choose when breast feeding

Answer 41

lorazepam | short half life and short course

Question 42

are vaccines compatible when breast feeding

Answer 42

yes

Question 43

is alcohol compatible with breast feeding

Answer 43

in moderation large doses decrease milk production chronic use may delay psychomotor development try delay breastfeeding 2 hours after

Question 44

is nicotine compatible with breast feeding

Answer 44

no increased risk of SIDS better to use NRT M/P ratio = 2.9

Question 45

whens the best time to take meds when breast feeding

Answer 45

right after breast feeding