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Reproductive Pharmacology > Neonatal > Flashcards

Neonatal Flashcards

1
Q

What are the most used maternal drugs that effect the fetus?

A

Antibiotics

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2
Q

Do most drugs cross the placenta?

A

Yes… nearly all. Short and long term effects to fetus possible.

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3
Q

What types of drugs usually cross placenta?

A 
Lipophilic
Non-ionized
Low Molecular weight
Non-protein bound free
Unmetabolized
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4
Q

What is the molecular weight cut off for placental crossing?

A

1000 will not cross

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5
Q

What is variable in placental drug exposure?

A

genetic polymorphisms

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6
Q

How does the placenta metabolize drugs?

A

Aromatic oxidation:
hydroxylation
alkylation
methylation

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7
Q

What percent of fetal blood goes directly into fetal liver?

A

40-60%

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8
Q

What 6 ways can drug cause teratogenicity?

A
  1. folate
  2. neural crest
  3. endocrine
  4. ROS
  5. vascular
  6. receptor/enzymes
    * NSAIDS
    * SSRIs
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9
Q

What does thalidomide cause?

A

phocomelia (seal limbs)

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10
Q

What must a drug show to be called a teratogen?

A
  1. classic defined effects
  2. stage of effect
  3. dose dependency
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11
Q

What percent of US pregnancies are unplanned?

A

50%

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12
Q

What percent of births have some defect?

A

4% - not all from drugs though

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13
Q

What is of utmost importance in teratagenicity?

A

Timing of exposure

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14
Q

What do earlier exposures cause? later?

A

Early: organs
Late: psychologic

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15
Q

What two species are drugs usually tested in?

A

Rat

Rabbit

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16
Q

What are SSRIs used to treat? Does this cause problems?

A

Depression: chronic lipophilic drug can cause problems

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17
Q

What are pregnancy exposure registries?

A

Women can volunteer their experiences with any drug in pregnancy

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18
Q

What can a retrospective cohort study not establish?

A

Causality: can only show associations

Bias and time-elapsed recall are problems

19
Q

What can show causality?

A

Case control study

20
Q

What did the 2007 FDA act do?

A

Post marketing surveillance

21
Q

What is a major teratogen in acne treatment?

A

Isotretinoin: ignorant women ignore labels!

22
Q

What does SSRIs cause in fetus?

A

Pulmonary artery HTN

23
Q

What is Cat A? B? C? D? X?

A

A: no effect in animals and women
B: animals ok, women untested. OR animals effected, women unaffected
C: Animal positve, women untested (or neither)
D: Risk to fetus: balance need
X: risk to fetus outweighs benefit to mother

24
Q

What is Cat A?

A

No effect in animals or women in 1st trimester

No evidence of 2nd or 3rd trimester effect

25
Q

What is Cat B?

A

Animals ok, women untested
***OR
Animals effected, but women unaffected

26
Q

What is Cat C?

A

Animals positive, no human studies
**OR
Neither animals or humans studied

27
Q

What is Cat D?

A

Definitely a risk to fetus, but benefit to mother might outweigh it

28
Q

What is Cat X?

A

Risk to fetus outweighs risk to mother

29
Q

What are 8 differences in neonate pharmacokinetics?

A
  1. Slower GI, faster IM absorption
  2. More water than lipid
  3. limited protein binding
  4. Larger liver/body ratio and immature enzymes (low CYP function)
  5. Larger brain/body ratio and BBB is more permeable
  6. Renal function immature
  7. Drug half life is longer, changes daily
  8. Dosing is done by body surface area
  9. Newborn skin is thinner, less vasodilator control
30
Q

What is notable about new born GI/IM?

A

GI slow

IM fast

31
Q

What is notable about new born lipid content?

A

Low lipid
High water
Watch lipid soluble drugs

32
Q

What is notable about newborn binding proteins?

A

Lower… more effect of bound drugs

33
Q

What is notable about newborn liver/brain to body ratio?

A

Larger:
Liver: less CYPs, metabolism
Brain: BBB is more penatrable

34
Q

What is notable about newborn renal function?

A

Renal funciotn is lower, less drug excretion

35
Q

What is notable about drug half lives in neonates?

A

Longer

Changes daily!

36
Q

How are neonatal drugs dosed?

A

By body surface area

37
Q

What is notable about neonatal skin?

A

Thinner: more absorption

Less vasodilator control: erratic thermoregulation

38
Q

How much milk to neonates consume a day? What is milk characteristics?

A

~1L…. milk is:
acidic
high fat content (lipophilic)

39
Q

What drugs concentrate in milk?

A

Basic
Lipophilic
*High protein bound drugs don’t transfer
*Dose dependent

40
Q

What does chloramphenicol cause in baby?

A

Grey baby in utero

Blood dyscrasia in breast feeding

41
Q

How long does it take to make sperm?

42
Q

What drugs should men be worried about?

A 
Nuclear drugs action:
Anti-virals
Anti-cancer
Retinoids
DMARDs
Androgen antagonists
43
Q

What protein does thalidomide mess with?

A

Celeblon (seal-e-blon)

Reproductive Pharmacology (11 decks)

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