Lec 18: Perinatal Pharmacology

Question 1

prenatal/antenatal

Answer 1

before birth

Question 2

postnatal/post partum

Answer 2

after birth

Question 3

perinatal

Answer 3

around birth

Question 4

what is the post conceptional age? what is the issue with the 38 week due date?

Answer 4

post fert age
due date is 38 weeks post conception, but dont always know when conception happened

Question 5

how is the estimated due date calculated? why?

Answer 5

40 weeks after first day of last period, gives wiggle room

Question 6

when is the first trimester? what happens

Answer 6

day 1 lmp to 13 weeks and 6 days
fert and major organ dev

Question 7

when is the second trimester? what happens

Answer 7

14 weeks to 27 weeks and 6 days
rapid growth and dev

Question 8

when is the third trimester? what happens

Answer 8

28 weeks to 40 weeks and 6 days
organ mat

Question 9

how can drugs be used before/during/after pregnancy?

Answer 9

preg prevention
preg helping
preg maintainance
termination
labour delaying labour inducing
breastfeed helping

Question 10

t/f: during pregnancy you might need to change drug therapy and initiate new drug therapy. and why?

Answer 10

body may handle drugs differently

Question 11

what are the maternal effects to drugs during preg

Answer 11

change or initiate new drug therapy

Question 12

are materna pd altered during preg? is this apparent in most drugs?

Answer 12

someone, but not usually
drugs acting on repord tissues might be impacted, but effect will remain same

physiological changes, you might need new drugs

Question 13

how might pk be altered during preg>

Answer 13

reluctance to take meds, physio changes in adme in mom

Question 14

what might affect maternal drug abs during preg

Answer 14

vomiting, inc gastric ph, descreased motility, increased cardiac output and breathing

Question 15

what might affect maternal drug dist

Answer 15

more body weight and tbw, more plasma volume, more blood to uterus kidney skin and mamaries, less to skel muscle, less pp binding

Question 16

what happens to total body water during preganancy

Answer 16

increases

Question 17

whta hppens to albumin during pregnancy? why isnt the first trimester eveluated in studies?

Answer 17

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

Question 18

what affects biotrans during preg?

Answer 18

enzyme induction (3a4, 2d6, 2c9, 2a6, ugt) and enzyme inhibition (1a2, 2c19)

Question 19

is induction or inhibtion more common during preg? what do you need to do as a result?

Answer 19

induction (ie: phenytoin, nicotine)
adjust and inc dose

Question 20

what affects maternal drug excretion during preg?

Answer 20

inc renal plasma flow
inc gfr
inc drug secretion

Question 21

what happens to the fetus during preg?

Answer 21

can have toxicity from moms drugs
mom can be used as vessel for drug

Question 22

how can the fetus be treated in the womb? exampleS?

Answer 22

drugs given to mom
lung immaturity –> steroids.
tachycardia –> digoxin, sotalol)

Question 23

what are drug considerations for neonates

Answer 23

neonatal abstinance and withdrawal
neonates handle drugs differently (less clearance)
expore to drugs through breast milk

Question 24

explain connection between breast milk and drug exposure? considerations?

Answer 24

baby gets drugs through milk
considerations:
drug conc in moms blood
drug in breast milk
milk consumed by infant
drug clearance by infant

Question 25

what maternal factors influence drug transfer in breast milk?

Answer 25

her dosing regimen
route of admine
maternal drug clearance
breast physiology (hormones to regulate milk, milk composition, milk ph)

Question 26

what drug properties influence drug transfer in breast milk

Answer 26

weight, lipid sol, protein binding, ionization (breast milk is more acidic than blood)

Question 27

what must u consider for the neonate when breast feeding + taking drugs

Answer 27

will milk accumulate in newborn? can they clear it? what would you administer to them normally (ie not through milk) – is it the same?

Question 28

what is the rid