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Pharmacology III > Drugs & Pregnancy > Flashcards

Drugs & Pregnancy Flashcards

1
Q

3 physiologic changes in pregnant women that affect drug metabolism

A
  1. increased volume
  2. increased flow
  3. reduced plasma protein binding
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2
Q

What happens to GFR during pregnancy?

A

increased

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3
Q

Rule of thumb for drugs in pregnany

A

None unless absolutely necessary

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4
Q

Two main concerns when considering drug therapy in pregnant women…

A

teratogenic?

affect fetus near term?

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5
Q

Which category?

animal/human studies demonstrate risk.

Risk outweighs benefits

A

Category X

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6
Q

Which category?

Human studies demonstrate risk

potential benefits may outweigh risk

A

Cat D

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7
Q

Which Category?

animal studies demonstrate risk, no human studies performed

benefits may outweigh risk

A

Cat C

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8
Q

Under new label, 8.1 indicates not safe for…

A

pregnancy

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9
Q

Under new label, 8.2 indicates not safe for…

A

lactation, nursing mothers

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10
Q

Under new label, 8.3 indicates not safe for…

A

females and males of reproductive potential

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11
Q

Why is drug absorption slowed in pregnancy?

A

high progesterone = slow gut motility/emptying

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12
Q

Why are drugs more rapidly metabolized during pregnancy?

A

pregnancy induces hepatic metabolizing enzymes

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13
Q

Why are drugs eliminated more rapidly during pregnancy?

A

increased RPF and GFR

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14
Q

What causes the change in volume of distro, absorption, excretion, plasma binding during pregnancy?

A

increased blood volume

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15
Q

The placenta is a _____ barrier that has many transporters on the surface, making it a ________

A

semipermeable

site of metabolism

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16
Q

drugs that have crossed the placenta enter fetal circulation via
_________.

About ________ of the venous blood flow enters the fetal liver

A

umbilical v.

40-60% to fetal liver

17
Q

If the fetal liver only partially metabolizes a drug, what 2 mechanisms can allow the drug to re-enter the fetal ciruculation?

A

exit via umb. a. and subsequent reentry via umb. v.

OR

elimination in fetal urine and re-entry via swallowing amniotic fluid

18
Q

What lipid solubility diffuses rapidly across placenta?

A

lipophilic

19
Q

MW < ________ crosses placenta easily while > ________ crosses poorly.

A

< 500 = easy passage

> 1000 = poor passage

20
Q

Do ionized or non-ionized molecules pass the placenta more easily?

A

non-ionized

21
Q

What fetal transporter can pump drugs back into maternal circulation and out of fetal circ?

A

MDR-1

22
Q

Which 3 conditions during pregnancy may require treatment?

A

HTN

Hyperglycemia

Thyroid Hormone Replacement

23
Q

Diethyl stilbestrol taught us what?

A

teratogenic effects not always seen immediately

24
Q

What teratogen?

  • intellectual disability
  • underdeveloped top of ear
  • short nose
  • thin upper lip
  • small eye openings
  • low nasal bridge
  • epicanthal folds
  • indistinct philtrum
  • curved fifth finger
A

FAS

25
Q

The buildup of ______ leads to FAS

A

acetaldehyde and EtOH

26
Q

Patient presents with:

saddle nose
depressed nasal bridge
epiphyseal stippling
vertebral calcification
short neck
A

warfarin syndrome

27
Q

What can be used instead of warfarin for mothers who need anticoagulation?

A

LMWH

28
Q

Describe the exposure needed for isotretinoin to cause birth defects…

A

once in first 3 weeks

29
Q

Women taking isotretinoin must follow the iPLEDGE program, which requires what?

A

neg preg
2 forms bc

continue one month after therapy

30
Q

Which 4 anticonvulsants represent the safest option for pregnant women?

A

Gabapentin
Levetiracetam
Lamotrigine
Clonazepam

31
Q

Which anticonvulsant is the most dangerous?

A

valproate

32
Q

Which anticonvulsant can cause the below? What is the condition called?

  • cleft lip/palate
  • congenital heart disease
  • slowed growth
  • mental deficiency
A

Phenytoin

Fetal hydantoin syndrome

33
Q

Which anticonvulsant can cause the below?

craniofacial anomalies
developmental delay
mental deficiency

A

Carbamazepine

34
Q

This anticonvulsant has a 20-fold incrase in neural tube defects

A

valproate

35
Q

Patient presents with:

  • short left forearm and absent thumb
  • left ulnar deviation, contracture of fingers at PIP
  • broad forehead, thin eyebrows
  • flat nasal bridge
  • thin upper lip
A

fetal valproate syndrome

36
Q

Ribavirin can cause…

A

intrauterine fetal death

37
Q

Is ribavirin teratogenic in men, women, or both?

A

both

Pharmacology III (15 decks)

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