Drugs in pregnancy

Question 1

effect on creatinine clearance

Answer 1

increases

Question 2

effect on protein binding

Answer 2

most increase protein binding

hihgly protein bound drugs effected

Question 3

effect on gastric emptying

Answer 3

decreased therefore increased absorption

Question 4

effect on plasma volume

Answer 4

increases by 50%

can get anemia if RBC mass lags behind

Question 5

effect on skin absorption

Answer 5

increased becuase increased vascularity

Question 6

effect on cardiac output

Answer 6

increases 2 fold

if heart cant pull it off get edema in the legs

Question 7

effect on peripheral resistance

Answer 7

decreases

Question 8

effect on diastolic BP

Answer 8

decreases

Question 9

effect on pulmonary resistance

Answer 9

increases

Question 10

effect on colloid oncotic pressure

Answer 10

decreases

Question 11

change in blood gas

Answer 11

increase ppH

decrease CO2

Question 12

placentas major functions

Answer 12

transfer nutrient and oxygen 
remove waste products
synthesize hormones, peptides, steroids
link between the circulations 
barrier to protect from drugs/toxin in the maternal blood

Question 13

what happens to blood flow through the placenta to maternal side during pregnancy

Answer 13

increases

Question 14

why is metabolism different in the fetus

Answer 14

liver enzymes are different

kidney is immature, filtration reduced

Question 15

what are some adverse drug reactions that occur

Answer 15

teratogenesis 
osteoporosis 
uterin stimulation or suppression 
deug dependent infant 
breathing difficulties in neonat 
impaired intellectula or social development

Question 16

what is the risk of malformations with most teratogens

Answer 16

10%

Question 17

Why is it hard to prove a drug is teratogenic

Answer 17

incidence of congenital anomalies is low
animal tests not applicable
exposure needs to be prolonged
controlled experiment cant be done in humans
behavioural issues hard to identiy or link

Question 18

requirements to prove a drug is a teratogen

Answer 18

must cause specific set of malformations
act only between 4-7 weeks of gestation
incidence should increase with increasing dose and duration of exposure

Question 19

if there is no proof for teratogenicity is the drug safe

Answer 19

no

Question 20

shepards principles of teratolofy

Answer 20

agent must be rpesent during critical periods of developmetn
acts directly on the embryo
experimental models corroborating the findings

Question 21

preimplantation/presomite period

Answer 21

conception to 2 weeks

Question 22

somite period

Answer 22

2-4 weeks

Question 23

organ structure formation period

Answer 23

4-8 weeks

Question 24

organ function/substructure period

Answer 24

8+ weeks

Question 25

what occurs if teratogen exposed during first trimester embryonic period (3-8wks)

Answer 25

gross (structural) abnormalities

Question 26

what occurs if teratogen exposed during the fetal period (9-40wks)

Answer 26

functional problems
learning deficits
behavioural abnormalities

Question 27

what are two commone types of teratogenic drugs

Answer 27

antieliptics
antipsychotics
live vaccines
nsaids

Question 28

problems from diethylstilbesterol

Answer 28

vaginal cancer
female children born with vaginal and cervical carcinomas and uterine anomalies
male children abnormal genitalia/sperm

Question 29

thalidomide malformations

Answer 29

absence of limbs (phocomlia) 
gongenital heart defects
eye defect
urogenital 
GI 
hearing loss

Question 30

SSRIs in pregnancy

Answer 30

disocntinuing high risk because stress bad
treated with low doses appears safe
maybe cardiac malformations

Question 31

what do women think is the teratogenic risk

Answer 31

25%