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Reproduction > Pharmacology in Pregnancy and Breast Feeding > Flashcards

Pharmacology in Pregnancy and Breast Feeding Flashcards

1
Q

4 basic kinetic processes

A
  • Absorption
  • Distribution
  • Metabolism and Elimination
  • Excretion
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2
Q

Why may the oral route of administration be affected during pregnancy

A
  • Morning sickness => vomiting

- Increased gastric emptying and motility (unlikely to be a problem with regular dosing but may affect single doses

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3
Q

Why would the IM route be affected during pregnancy

A

Blood flow is increased, so absorption from this route increases

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4
Q

Why would the inhalation route be affected during pregnancy

A
  • Increased cardiac output
  • Decreased tidal volume
  • Both lead to increased absorption of inhaled drugs
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5
Q

What effect does the greater dilution of plasma, and therefore the decreased relative amount of plasma proteins, have on the distribution of drugs during pregnancy

A

Increased fraction of free drug

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6
Q

The effect of oestrogen and progestogens of P450 enzymes

A

Can inhibit or induce

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7
Q

In what way and why is excretion changed in pregnancy

What should be done to deal with this

A
  • Increased
  • GFR increased by 50%
  • Increase the dosages of renally excreted drugs
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8
Q

Effect on absorption via oral route in pregnancy and why

A
  • Reduced

- Increased vomiting, gastric emptying and gut motility

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9
Q

What 3 factors determine placental transfer of a drug

A
  • Molecular weight (smaller crosses better)
  • Polarity (non-polar crosses better)
  • Lipid solubility (Lipid soluble drugs will cross)
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10
Q

At what molecular weight will drugs cross the placenta

A

MW < 500 Da (Dalton)

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11
Q

At what molecular weight will drugs NOT cross the placenta

A

MW > 1000 Da (Dalton)

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12
Q

Difference in foetal drug-protein binding vs adults and the result of this

A
  • Less protein binding vs adults

- More “free” drug available

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13
Q

Foetal blood flow to brain vs adult

A

Relatively more blood flow to brain vs adult

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14
Q

Foetal enzyme activity (metabolism) vs adults

A

Less enzyme activity vs adults (increases with gestation)

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15
Q

Describe foetal excretion of drugs

A
  • Excretion is into amniotic fluid
  • Amniotic fluid is then swallowed, allowing for recirculation
  • Drugs and metabolites and accumulate in the amniotic fluid
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16
Q

When does Teratogenicity refer to

When does Fetotoxicity refer to

A
  • First trimester

- Second and third trimester

17
Q

What period of gestation is the risk of teratogenicity at its highest

A

During organogenesis (3-8 weeks)

18
Q

6 mechanisms of Teratogenicity

A
  • Folate antagonism
  • Neural crest disruption
  • Endocrine disruption (sex hormones)
  • Vascular disruption
  • Oxidative stress
  • Specific rector or enzyme mediate teratogenesis
19
Q

5 Drugs that can cause folate antagonism and the result of it

A
  • Methotrexate
  • Trimethoprim (antibiotic for bladder infections)
  • Phenytoin
  • Carbamazepine
  • Valproate

Tends to result in neural tube, oro-facial or limb defects

20
Q

Drug that causes neural crest disruption

A

-Retinoid drugs (isotretinoin, used to treat severe acne or occasionally prevent skin cancers)

21
Q

5 problems that result from neural crest disruption

A
  • Aortic arch abnormalities
  • Craniofacial malformations
  • Oesophageal atresia (oesophagus ends in blind-ended pouch)
  • Pharyngeal gland abnormalities
  • Ventricular septal defects
22
Q

Type of drug that causes enzyme-mediated teratogenesis and what that leads to

A
  • NSAIDs

- Orofacial clefts and Cardiac septal defects

23
Q

Define Fetotoxicity

A

Toxic effect on the foetus later in pregnancy (second and third trimester)

24
Q

2 types of drugs that cause Fetotoxicity and what that leads to

A
  • ACE inhibitors
  • ARBs (Angiotensin II receptor blocker)
  • Renal dysfunction and growth retardation
25
Q

Scoring system for how safe a drug is during pregnancy

A
  • A, Controlled human studies show no foetal risk
  • B, Animal studies show no risk but no human studies have been conducted OR animal studies show risk to foetus but well controlled human studies don’t
  • C, No adequate human or animal studies have been conducted OR risks shown in animals but no human data available
  • D, Human foetal risk evident but benefits may outweigh the risk
  • X, Proven foetal risk outweigh any possible benefit
26
Q

3 anticonvulsants that are teratogens and their effects

A
  • Valproate
  • Phenytoin
  • Carbamazepine

Neural tube defects

27
Q

Anticoagulant that is a teratogen and its effect

A

Warfarin

Haemorrhage of foetus + multiple malformations of CNS and skeletal system

28
Q

Antihypertensive drugs that are teratogens and their effect

A

ACE inhibitors + ARB’s

Renal damage + growth retardation

29
Q

Effect of NSAIDs on foetus

A

-Premature closure of the ductus arteriosus

30
Q

Retinoid that is a teratogen and its effect on the foetus

A

Isotretinoin

Neural crest disruption

31
Q

6 drugs to avoid during breast feeding

A
  • Cytotoxics (chemo)
  • Immunosuppressants
  • Anticonvulsants (not all)
  • Amiodarone
  • Lithium
  • Radio-iodine
32
Q

If prescribing Isotretinoin, to a woman of child bearing age, what 2 things must also be done with regards to the patient, according to the BNF

A
  • Monthly pregnancy checks

- Use at least one (preferably 2) methods of contraception

33
Q

When should you avoid using Trimethoprim for a UTI

A

BNF says avoid during 1st trimester

34
Q

6 principles of prescribing in pregnancy

A
  • Try non-pharmacological treatment first (if possible)
  • Use lowest effective dose
  • Use drug for shortest possible time, intermittently if possible
  • Avoid first 10 weeks of pregnancy, if possible
  • Consider stopping or reducing dose before delivery
  • Use drug with best safety record, avoid new drugs unless proven safe
35
Q

Principles of prescribing in breast feeding

A
  • Check on up to date info
  • If licensed and safe in paediatric use (esp. under 2yrs) a drug is likely to be safe in breast feeding
  • Choose drugs with pharmacokinetic properties that reduce infant exposure (e.g. highly protein bound)
36
Q

Baby JR

  • 3 weeks old
  • Breast feeding
  • Mother has lower back pain

What can she safely take

A
  • Paracetamol + Ibuprofen, BNF notes amounts too small to be harmful in breast milk (though some manufacturers state avoid ibuprofen)
  • Codeine USUALLY too small to be harmful, but maternal metabolism very variable so risk of morphine OD in baby

Reproduction (22 decks)

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