Lec 18: Perinatal Pharmacology Flashcards
prenatal/antenatal
before birth
postnatal/post partum
after birth
perinatal
around birth
what is the post conceptional age? what is the issue with the 38 week due date?
post fert age
due date is 38 weeks post conception, but dont always know when conception happened
how is the estimated due date calculated? why?
40 weeks after first day of last period, gives wiggle room
when is the first trimester? what happens
day 1 lmp to 13 weeks and 6 days
fert and major organ dev
when is the second trimester? what happens
14 weeks to 27 weeks and 6 days
rapid growth and dev
when is the third trimester? what happens
28 weeks to 40 weeks and 6 days
organ mat
how can drugs be used before/during/after pregnancy?
preg prevention
preg helping
preg maintainance
termination
labour delaying labour inducing
breastfeed helping
t/f: during pregnancy you might need to change drug therapy and initiate new drug therapy. and why?
body may handle drugs differently
what are the maternal effects to drugs during preg
change or initiate new drug therapy
are materna pd altered during preg? is this apparent in most drugs?
someone, but not usually
drugs acting on repord tissues might be impacted, but effect will remain same
physiological changes, you might need new drugs
how might pk be altered during preg>
reluctance to take meds, physio changes in adme in mom
what might affect maternal drug abs during preg
vomiting, inc gastric ph, descreased motility, increased cardiac output and breathing
what might affect maternal drug dist
more body weight and tbw, more plasma volume, more blood to uterus kidney skin and mamaries, less to skel muscle, less pp binding
what happens to total body water during preganancy
increases
whta hppens to albumin during pregnancy? why isnt the first trimester eveluated in studies?
decreased albumin conc
want women who are already preg, easier to get them from second trimester onwards
use post partum period to get baseline measurements
what affects biotrans during preg?
enzyme induction (3a4, 2d6, 2c9, 2a6, ugt) and enzyme inhibition (1a2, 2c19)
is induction or inhibtion more common during preg? what do you need to do as a result?
induction (ie: phenytoin, nicotine)
adjust and inc dose
what affects maternal drug excretion during preg?
inc renal plasma flow
inc gfr
inc drug secretion
what happens to the fetus during preg?
can have toxicity from moms drugs
mom can be used as vessel for drug
how can the fetus be treated in the womb? exampleS?
drugs given to mom
lung immaturity –> steroids.
tachycardia –> digoxin, sotalol)
what are drug considerations for neonates
neonatal abstinance and withdrawal
neonates handle drugs differently (less clearance)
expore to drugs through breast milk
explain connection between breast milk and drug exposure? considerations?
baby gets drugs through milk
considerations:
drug conc in moms blood
drug in breast milk
milk consumed by infant
drug clearance by infant
