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Reproduction > Lecture 4 Pharmacology in Pregnancy and Breast Feeding > Flashcards

Lecture 4 Pharmacology in Pregnancy and Breast Feeding Flashcards

1
Q

What are the absorption changes in pregnancy

A

Decrease in gastric emptying and gut motility, blood flow increased, increased cardiac output and decreased tidal volume

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2
Q

What are the distribution changes in pregnancy

A

Increase in plasma volume and fat

Greater dilution of plasma will decrease relative amount of plasma proteins- increased fraction of free drugs

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3
Q

What are the metabolism changes in pregnancy

A
  • Oestrogen and progestogens can induce or inhibit liver P450 enzymes, increasing or reducing metabolism
  • Phenytoin levels reduced (due to induction of metabolism)
  • Theophylline levels increased (due to inhibition of metabolism)
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4
Q

What are the excretion changes in pregnancy

A

GFR increases

Increased excretion of drugs

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5
Q

What is the distribution like in foetuses

A

Less protein binding than adults, therefore more free drug available, little fat and more blood flow to the brain

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6
Q

What is the metabolism of like in foetuses

A

Reduced enzyme

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7
Q

What is the excretion of like in foetuses

A
  • Excretion is into amniotic fluid – which the fetus swallows leading to recirculation.
  • Drugs and metabolites can accumulate in amniotic fluid.
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8
Q

What does folate antagonism result in

A

Neural tube, oro-facial or limb defects

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9
Q

What are the 2 mechanism of folate antagonism

A

Block conversion of folate to THF by binding irreversibly to the enzyme (methotrexate, trimethoprim)
Block other enzymes in the folate pathway (valproate, carbamazepine, phenytoin)

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10
Q

What drugs cause neural crest cell division

A

Retinoid drugs

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11
Q

What drugs cause enzyme-mediated teratogenesis

A

NSAIDs- inhibit or stimulate enzymes to produce therapeutic effects

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12
Q

Name a drug that causes Fetotoxicity

A

ACE inhibitors/ARBs- renal dysfunction and growth retardation

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13
Q

What is the effect of anticonvulsants such as valproate, carbamazepine and phenytoin on babies

A

Neural tube defects

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14
Q

What is the effect of anticoagulants such as warfarin on babies

A

Haemorrhage in the foetus as well as multiple malformations in the CNS and skeletal system

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15
Q

What is the effect of antihypertensive agents such as ACE-I

A

Causes renal damage and may restrict normal growth patterns

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16
Q

What is the effect of NSAIDs on babies

A

Premature closure of ductus arteriosus

17
Q

What is the effect of alcohol of unborn babies

A

Foetal alcohol syndrome/effects

18
Q

Name 7 drugs to avoid during breast feeding

A 
Cytotoxics
Immunosuppressants
Anti-convulsants
Drugs of abuse
Lithium
Radio-iodine
19
Q

What 2 herbal medicines should be avoided for mothers

A

Fenugreek and Comfrey

Reproduction (29 decks)

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