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Reproductive system > Pharmacology in Pregnancy and Breastfeeding > Flashcards

Pharmacology in Pregnancy and Breastfeeding Flashcards

1
Q

What percentage of pregnant women will take a drug during pregnancy?

A

Around 50-90%

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2
Q

Why is it important to be careful of medication given for all women of child bearing age?

A

Many pregnancies are unplanned so the fetus could be affected by drugs before the woman knows she is pregnant

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3
Q

Why may a woman be on medication during pregnancy?

A 
Hypertension
Asthma
Epilepsy
Migraine
Mental health disorders
Long term anticoagulant therapy
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4
Q

What are the 4 basic pharmacokinetic processes?

A

Absorption
Distribution
Metabolism
Excretion

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5
Q

Why is data limited for pharmacokinetics in pregnancy?

A

There have been very few studies

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6
Q

How may absorption change in drugs taken orally?

A

Morning sickness causing nausea and vomiting may reduce absorption
Decrease in gastric emptying and motility may affect single dosage drugs

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7
Q

How may absorption be affected in drugs taken intramuscularly?

A

Blood flow may increase so absorption may also increase

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8
Q

How may absorption be changed in inhaled drugs?

A

Increased cardiac output and tidal volume may cause increased absorption

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9
Q

How is distribution affected in pregnancy?

A

Plasma volume increases while protein volume stays the same, leading to dilution of proteins meaning the fraction of free drug increases

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10
Q

How does metabolism change in pregnancy?

A

Oestrogen and progestogens can induce or inhibit liver enzymes leading to increased or reduced metabolism

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11
Q

How is excretion of drugs affected in pregnancy?

A

GFR is massively increased by around 50%, leading to increased excretion

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12
Q

How may pharmacodynamics be changed in pregnancy?

A

Site of action and receptor
Concentration of drug and metabolites at site of action
Efficacy may change
Adverse effects may be different

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13
Q

What does the mother give to the fetus across the placenta?

A 
Oxygen
Glucose
Amino acids
Lipids
Vitamins
Ions
Alcohol, nicotine, etc
Viruses
Antibodies
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14
Q

What does the fetus give to the mother across the placenta?

A

CO2
Urea
Other waste products

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15
Q

What does placental transfer depend on?

A

Molecular weight - small sizes cross more easily
Polarity/lipid solubility - non-polar cross more readily
Some drugs may be metabolised by placenta

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16
Q

What causes drug distribution in the fetus to be different to the mother?

A

Circulation is different
Less protein binding so more free drug
Little fat so distributed differently
Relatively more blood flow to the brain

17
Q

What is different about drug metabolism in the fetus?

A

Enzyme activity is decreased but increases with gestation

Different isoenzymes to adults

18
Q

How is fetal drug excretion different to an adults?

A

Excretion is into amniotic fluid which is swallowed again allowing recirculation
Drugs and metabolites can accumulate in amniotic fluid

19
Q

What drug groups have data for use in pregnancy?

A

Anti-convulsants
Anti-hypertensives
Analgesics
Antibacterials

20
Q

When is teratogenicity an issue?

A

First trimester

21
Q

When is fetotoxicity an issue?

A

Second and third trimester

22
Q

When in the first trimester is the biggest risk of teratogenicity?

A

Organogenesis - 3-8 weeks

23
Q

What are mechanisms of teratogenicity?

A 
Folate antagonism
Neural Crest Cell Disruption
Endocrine disruption of sex hormones
Oxidative Stress
Vascular Disruption
Specific Receptor or Enzyme-mediated Teratogenesis
24
Q

What happens as a result of folate antagonism?

A

Neural tube defect
Oro-facial defect
Limb defect

25
Q

What are mechanisms of folate antagonism?

A

Block conversion of folate to THF by irreversibly binding to the enzyme

Or Block other enzymes in the pathway

26
Q

What drugs are folate antagonists by blocking conversion of folate to THF?

A

Methotrexate

Trimethoprim

27
Q

What drugs cause Neural crest cell disruption?

A

Retinoids

28
Q

What problems can be caused by neural crest cell disruption?

A 
Aortic Arch Anomalies
Ventricular septal defects
Craniofacial malformations
Oesophogeal atresia
Pharyngeal gland abnormalities
29
Q

What drugs cause enzyme-mediated teratogenesis?

A

NSAIDs

30
Q

What is fetotoxicity?

A

Toxic effect on the fetus later in pregnancy

31
Q

What are possible issues caused by fetotoxicity?

A 
Growth retardation
Structural malformations
Fetal death
Functional impairment
Carcinogenesis
32
Q

What are issues with drugs with lactation?

A

Most drugs will be present but will be at lower doses than in utero
Important to know what concentration will be present in breast milk
Pharmacokinetics are different to the fetus

33
Q

What drugs need to be avoided completely in breast feeding

A 
Cytotoxics
Immunosuppressants
Most anti-convulsants
Drugs of abuse
Amiodarone
Lithium
Radio-iodine

Reproductive system (26 decks)

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