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Repro > pharmacology in pregnancy and breast feeding > Flashcards

pharmacology in pregnancy and breast feeding Flashcards

1
Q

why may a woman be on medication during pregnancy, childbirth and lactation

A 
htn
asthma 
epilepsy 
migraine 
mental health 
anticoagulant use
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2
Q

pharmacokinetics of drugs

A

absorption
distribution
metabolism
excretion

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3
Q

pharmacokinetic changes in pregnancy: absorption - oral route

A

may be more difficult - morning sickness

decrease in gastric emptying and gut motility - unlikely to be prob with regular dosing but may affect single dose medication

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4
Q

pharmacokinetic changes in pregnancy: absorption - intramuscular route

A

blood flow increases during pregnancy so absorption for SC/IM routes may be enhanced

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5
Q

pharmacokinetic changes in pregnancy: absorption - inhalation

A

increased cardiac output and decreased tidal volume during pregnancy which may cause increased absorption

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6
Q

pharmacokinetic changes in pregnancy: distribution changes

A

increase in plasma volume and fat will change distribution of drugs - increase volume of distribution

greater dilution of plasma will decrease relative amount of plasma proteins - increase fraction of free drug (–> pharmacodynamically active)

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7
Q

pharmacokinetic changes in pregnancy: metabolism changes

A

oestrogens and progestogens can induce or inhibit liver P450 enzymes, increasing or reducing drug metabolism

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8
Q

pharmacokinetic changes in pregnancy: excretion changes

A

GFR increased in pregnancy leading to increased excretion of many drugs and reduction in circulating drug level

can reduce plasma conc

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9
Q

pharmacodynamic changes in pregnancy

A

less well understood

pregnancy may affect site of drug action and receptor response to drugs - conc. of drug, metabolites at sites of biological action, mechanism of action (changes in receptors)

efficacy and adverse effects may be diffferent

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10
Q

factors which affect placental drug transfer and drug effects on foetus

A

drug physiochemical properties
rate at which drug crosses placenta and amount reaching foetus
duration drug exposure
distribution in different foetal tissues
stages of placental and foetal development
effects of drugs when used in combination

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11
Q

placental transfer of medication depends on

A

molecular weight of drug (smaller crosses easier)
polarity (unpolarised cross easier)
lipid solubility (lipid soluble will cross)

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12
Q

understanding of foetal pharmacokinetics

A

not well understood

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13
Q

foetal pharmacokinetics: distribution

A

circulation different to adult

less protein binding than adult so more free drug available

less fat in foetus so diff distrubution

relatively more blood flow to brain and less-well developed blood-brain barrier

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14
Q

foetal pharmacokinetics: metabolism

A

reduced enzyme activity, increases with gestation

foetus exhibits different P450 isoenzymes to adults

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15
Q

foetal pharmacokinetics: excretion

A

excretion into amniotic fluid which foetus swallows leading to recirculation

drugs and metabolites can accumulate in amniotic fluid, can cause significant toxicity

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16
Q

what trimester does teratogenicity affect

A

first

17
Q

what trimester does fetotoxicity affect

A

second and third

18
Q

principles of prescribing for women childbearing age

A

always consider possibility pregnanyc
warn of potential risks
when treating medical conditions, advise women to attend before getting pregnanct
discuss contraception if prescribed medications are teratogenic

19
Q

principles of prescribing in pregnancy

A

try non-pharma Rx first
use drug with best safety record
check SPC for most up to date info
use lowest effective dose
use drug for shortest time and intermittently if can
avoid first 10wks preg if can
consider stopping/reducing dose before delivery
never undertreat a disease which may be harmful to baby/mum

20
Q

mechanisms of teratogenic drugs

A 
folate antagonism 
endocrine disruption - sex hormones
neural crest cell disruption
oxidative stress
vascular disruption 
specific receptor or enzyme mediated teratogenesis
21
Q

folate metabolism

A

folate metabolism is key process in DNA formation and new cell production

22
Q

folate antagonism

A

two groups of drugs affect this:

  • block conversion of folate to THF by binding irreversibly to enzyme - methotrexate, trimethoprim
  • block other enzymes in folate pathway e.g. phenytoin, carbamazepine, valoprate
23
Q

what does folate antagonism do to baby

A

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

24
Q

neural crest cell disruption

A

assoc with retinoid drugs e.g. isotretinoin

aortic arch anomalies
ventricular septal defects
craniofacial malformations 
oesophageal atresia 
pharyngeal gland anomalies
25
Q

enzyme-mediated teratogenesis

A

drugs which inhibit or stimulate enzymes to produce therpeutic effects may also interact with specific receptors and enzymes damaging foetal developement

e.g. NSAIDs causing orofacial clefts and cardio-septal defects

26
Q

possible issues of fetotoxicity

A 
growth retardation 
structural malformations 
foetal death 
functional impairment
carcinogenesis
27
Q

examples of foetotoxic drugs

A

ACE-I/ARBs –> renal dysfunction and growth retardation

28
Q

ACEI effect on foetus and which trimester(s)

A

all trimesters

renal damage

29
Q

warfarin effect on foetus and which trimester(s)

A

1st - resp tract formation
2- CNS malformation
3rd - risk bleeding: IC haemorrhage

30
Q

issues with drugs and lactation

A

almost all drugs mother takes will be present in breast milk

remember, pharmacokinetics different in neonate compared to foetus

31
Q

drugs to be avoided in breastfeeding

A 
cytotoxics
immunosuppresants
anti-convulsants (not all) 
amiodarone 
lithium 
radio-iodine
32
Q

herbal medicines and breast feeding

A

should be avoided

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