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Reproduction > Pharmacology in Pregnancy > Flashcards

Pharmacology in Pregnancy Flashcards

1
Q

What ‘high risk’ woman should be put on aspirin during pregnancy?

A

Elderly, HTN, high BMI, prev pregnancy problems

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2
Q

How will absorption via oral route change in pregnancy?

A

May decrease due to nausea and vomiting but unlikely to affect continuous therapy

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3
Q

How will IM absorption change in pregnancy?

A

BF increases so likely to increase

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4
Q

How will inhalatory absorption change in pregnancy?

A

Increases as CO increased and TV decreased so drug sits in lungs for longer

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5
Q

How is the Vd affected in pregnancy?

A

Increases (increase in fat and plasma volume)

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6
Q

What is the volume of distribution?

A

Volume of water that would contain the total amount of the substance in the same concentration as it is in the plasma

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7
Q

How do you work out Vd?

A

Total volume of drug/concentration in plasma

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8
Q

Greater dilution of plasma in pregnancy results in what?

A

Relatively less plasma proteins –> increased free drug

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9
Q

What plasma protein is often reduced in pregnancy?

A

Albumin

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10
Q

How does metabolism change in pregnancy?

A

Oestrogen/progesterone tend to induce P450 enzymes –> increased metabolism

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11
Q

How is excretion changed in pregnancy?

A

Increased GFR (by 50%) leads to increased excretion of some drugs

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12
Q

What are the pharmacodynamic changes in pregnancy?

A

Receptor/action of drug can change –> different efficacies and different ADRs

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13
Q

What are the functions of the placenta?

A

Attach foetus to uterine wall
Provide nutrients to foetus (e.g. lipids, oxygen, glucose, viruses, antibodies etc..)
Take waste away from foetus (e.g. urea, CO2)

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14
Q

What features of a drug would increase its chances of crossing the placenta?

A 
Small size (MW <500Da), lipophilic, non-polar
Doesn't matter if protein bound or not (will set up equilibrium)
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15
Q

What can the placenta do to drugs?

A

Allow their transfer or not

May also metabolise them

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16
Q

How does the foetal distribution of drugs differ to ours?

A

Different circulation (umbilical vein to liver)
Less plasma proteins –> increased free drugs
Less fat –> different distribution
More BF to brain
Inefficient BBB

17
Q

How does foetal metabolism differ?

A

Different isoenzymes
Less enzymes
So less metabolic activity

18
Q

How does foetal excretion differ?

A

Excretion into amniotic fluid which leads to accumulation/recirculation of the drug

19
Q

Define teratogenicity

A

An agent that disturbs development of the foetus/embryo in the first trimester

20
Q

What are the key ways that teratogens can affect development?

A 
Folate antagonism 
Neural crest cell disruption 
Endocrine disruption 
Oxidative stress
Vascular disruption 
Specific receptor/enzyme effect
21
Q

Why are trimethoprim and methotrexate teratogenic?

A

Block enzyme converting folate into tetrahydrofolate

22
Q

What other drugs block enzymes in the folate metabolism pathway?

A

Phenytoin, carbamazepine, Na valproate

23
Q

What is the action of folate?

A

Involved in new DNA formation

24
Q

What does folate antagonism lead to?

A

Neural tube defects, orofacial/limb defects

25
Q

What drugs cause neural crest cell disruption?

A

Retinoids

26
Q

What is the result of disruption of crest cells?

A

Aortic arch anomalies, VSDs, pharyngeal gland abnormalities, oesophageal atresia, cranio-facial malformations

27
Q

Define fetotoxicity

A

Toxicity to the foetus in the 2nd/3rd trimester

28
Q

Describe the classification of safety of drugs on foetuses

A

A - safe as shown by human studies
B - safe as shown by animal studies
C - no studies
D - unsafe, but benefits may outweight risks of use in certain scenarios
X - benefits won’t outweight risks, e.g. Na valproate

29
Q

What are the effects of anticonvulsants?

A

Neural tube defects

30
Q

What are the effects of warfarin?

A

Haemorrhaging foetus, CNS/skeletal malformatiosn

31
Q

What are the effects of ACEi/ARBs?

A

Renal damage and IUGR

32
Q

What are the effects of NSAIDs?

A

Premature closing of AD

33
Q

What are the effects of alcohol?

A

Foetal alcohol syndrome

34
Q

What are the effects of retinoids?

A

Ear, CNS, CV and skeletal disorders

35
Q

What drugs should you avoid in breast feeding?

A 
Cytotoxics
Lithium 
Amiodarone 
Drugs of Abuse
Anti-convulsants
Immunosupressants
Radio-iodine
36
Q

What are the key things to remember when prescribing to pregnant woman?

A

Use safest drug, for shortest time/intermittently, try avoid 1st 10wks or consider stopping/reducing before birth, don’t under Rx (esp in asthma, epilepsy etc.)

37
Q

What are the key things to remember when prescribing to a breast feeding woman?

A

Try use highly protein bound drugs and those safe in <2y

Possibly avoid herbals

Reproduction (28 decks)

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