Pharmacology in Pregnancy and Breast Feeding Flashcards
What are the different aspects of pharmacokinetics?
- Absorption
- Distribution
- Metabolism
- Excretion
What are some common reasons for prescribing during pregnancy?
- Hypertension
- Asthma
- Epilepsy
- Migraine
- Mental health disorders
- Long term anticoagulant use
What are some absorption changes during pregnancy?
Oral route:
- Morning sickness
- Decrease in gastric emptying and gut motility
Intramuscular route (IM):
- Blood flow increase, so absorption enhanced
Inhalation:
- Increased cardiac output and decreased tidal volume may increase absorption
What are some distribution changes during pregnancy?
- Increase in plasma volume and fat
- Increases volume of distribution
- Greater dilution of plasma
- Decrease relative amount of plasma proteins so increase fraction of free drug
What are some metabolism changes during pregnancy?
Oestrogen and progestogens can induce or inhibit liver P450 enzymes, increasing or reducing metabolism
What are some excretion changes during pregnancy?
GFR increased in pregnancy by 50%, causing increased excretion of many drugs:
- Can reduce plasma concentration and necessitate an increase in dose
What is pharmacodynamics?
Drug effect on body
What is pharmacokinetics?
Bodies effect on drugs
What pharmacodynamic changes can occur during pregnancy?
- Site of drug action
- Receptor response to drugs
- Efficacy may be difference
- Adverse effects may be different
What do drugs need to cross before reaching the foetus?
The placenta, which most drugs can
What are some factors affecting placental drug transfer and drug effect on the foetus?
- Drug physiochemical properties
- Rate at which drug crosses placenta and amount reaching foetus
- Duration of drug exposure
- Distribution in different foetal tissues
- Stage of placental and foetal development
- Effect of drugs when used in combination
What does placental transfer depend on?
- Molecular weight
- Smaller sizes cross more easily
- Polarity
- Unionised molecules cross more readily
- Lipid solubility
- Lipid soluble drugs will cross
How is distribution different in a foetus?
- Circulation is different
- Such as umbilical vein to liver
- Less protein binding than adults therefore more free drug available
- Little fat, so distribution different
- Relatively more blood flow to brain
How is metabolism different in a foetus?
- Reduced enzyme activity, although increases with gestation
- Different P450 isoenzymes to adults
How is excretion different in a foetus?
- Excretion is into amniotic fluid, which foetus then swallows leading to recirculation
- Drugs and metabolites can accumulate in amniotic fluid
- Placenta not functioning at delivery so can be issues with excretory function