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Pharmacology B > Lecture 15 - Drugs in Pregnancy > Flashcards

Lecture 15 - Drugs in Pregnancy Flashcards

1
Q

Changes in Pregnancy:

Creatinine clearance

A

increases

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2
Q

Changes in Pregnancy:

Drug metabolism

A

variable

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3
Q

Changes in Pregnancy:

Most protein binding

A

increases

*albumin binding decreases

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4
Q

Changes in Pregnancy:

gastric emptying

A

decreases

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5
Q

Changes in Pregnancy:

plasma volume

A

increases by 50%

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6
Q

Changes in Pregnancy:

Absorption from skin

A

increases (increased vascularity)

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7
Q

Changes in Pregnancy:

cardiac output

A

increases by a lot

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8
Q

Changes in Pregnancy:

peripheral resistance

A

decreases

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9
Q

Changes in Pregnancy:

diastolic BP

A

decreases

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10
Q

Changes in Pregnancy:

pulmonary resistance MV

A

increases

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11
Q

Changes in Pregnancy:

colloid oncotic pressure

A

decreases

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12
Q

Changes in Pregnancy:

pH in blood

A

increases

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13
Q

Changes in Pregnancy:

pCO2 in blood

A

decreases

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14
Q

Changes in Pregnancy:

TV

A

increases

*wtf is TV

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15
Q

Changes in Pregnancy:

MV

A

increases

*wtf is MV

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16
Q

Changes in Pregnancy:

Immune response

A

decreases

*pregnant women are more susceptible to infections

17
Q

Both ___ and ___ increase, therefore CO increases tremendously

A

HR and SV

18
Q

____ decreases quite a bit over pregnancy

slide 13

A

albumin

19
Q

_____ decreases a little over pregnancy

slide 13

A

hematocrit

20
Q

see pic on slide 17

A

okay

21
Q

What are the placenta’s major functions?

A
  • Transfer nutrients and oxygen from the mother to the fetus
  • Assist in the removal of waste products from the fetus to the mother
  • Synthesis of hormones, peptides and steroids
  • Provides a link between the circulations of 2 distinct individuals
  • Barrier to protect the fetus fro drugs/toxins in the maternal blood
22
Q

Fetal kidneys are immature which means ?

A
  • filtration reduced

- increases with gestational age

23
Q

List some ADRs of drugs in pregnancy

A
  • Teratogenesis (birth defects or malformations)
  • Osteoporosis
  • Uterine stimulation
  • Uterine suppression
  • Drug dependent infant
  • Breathing difficulties in neonate
  • Impaired intellectual or social development
24
Q

List some points about Teratology

A
  • Manifests in offspring at time of delivery
  • Attributable to maternal toxins during pregnancy
  • Risk of malformation with most teratogens is about 10%
  • Interest stimulated all over world following thalidomide tragedy in 1961
25
Q

Why is it hard to prove a drug is teratogenic?

A
  • Incidence of congenital anomalies is low
  • Animal tests may not be applicable
  • Exposure often needs to be prolonged
  • Controlled experiment that cannot be done in humans
  • Neurodevelopmental and behavioural issues often hard to identify and/or link
26
Q

List the criteria to prove a drug is a teratogen

A
  • Must cause specific set of malformations
  • Act only between 4-7 weeks of gestation
  • Incidence should increase with increasing dose and duration of exposure
27
Q

What are Shepard’s Principles of Teratology?

A
  • The agent must be present during the critical periods of development
  • Acts directly on the embryo
  • Experimental models corroborating the findings (i.e. biological plausibility) fetus or on the placenta
28
Q

Fetal effects from drugs depend on several factors:

What are they?

A 
1) Time: When drug is taken in pregnancy
Preimplantation/presomite period: conception to 2 week
Somite period: 2-4 weeks
Organ/structure formation: 4-8 weeks
Organ function/substructure: 8+ weeks

2) Dose:
High dose - may be lethal/death/abortions
Low dose- may be nothing

29
Q

What kind of malformations happen in the embryonic period (3-8 weeks = first trimester)

A

gross malformations

30
Q

What kind of problems happen in the fetal period (9-40 weeks)

A

function problems rather than gross anatomy - learning deficits and/or behavioural abnormalities

31
Q

see slide 31-33

A

prob won’t but ok sam

32
Q

What happened when Diethylstilbestrol (DES) was given to pregnant women?

A
  • Given to prevent miscarriages in high risk pregnancies
  • Cases of vaginal cancer in women ages 16-20, linked to DES ingestion early in pregnancy
  • Female children born with vaginal and cervical carcinomas as well as uterine anomalies
  • Male offspring had abnormal genitalia/sperm defects
33
Q

What happened when Thalidomide was given to pregnant women?

A
  • Thalidomide is an anti-emetic, sleeping pill prescribed mid-1950’s, early 1960’s as non toxic drug
  • Single treatment used during first trimester - capable of producing teratogenesis
  • Approximately 10,000 children affected with serious malformations
34
Q

What were some malformations caused by Thalidomide?

A
  • Phocomelia (absence of limbs - hands and feet are attaches closely to the trunk)
  • Congenital heart defects
  • Eye defects
  • Urogenital defects
  • GI defects
  • Hearing loss
35
Q

How is depression in pregnancy treated?

A
  • Affects up to 20% of pregnant women (SSRIs appear safe)
  • Women commonly discontinue therapy; high morbidity associated with DC therapy
  • Those treated are usually treated with very low average doses
36
Q

Are SSRIs safe in pregnancy?

A
  • they APPEAR safe
  • after 15 years of reassuring data analysis, recent reports of excess cardiac malformations, mostly with paroxetine
  • studies are contradictory
37
Q

Describe the Perception of Teratogenic Risk

A
  • Even when exposed to non-teratogenic drugs women assign 25% teratogenic risk
  • Evidence-based counselling can prevent unnecessary pregnancy terminations

Pharmacology B (21 decks)

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