Pharmacology in Pregnancy and Breastfeeding

Question 1

Why could a woman be on medicines during pregnancy, childbirth and lactation?

Answer 1

Hypertension
Asthma
Epilepsy
Migraine
Mental health disorders
Long-term anticoagulant therapy use

Question 2

What are the routes of drug administration?

Answer 2

Oral
Intramuscular
Inhalation

Question 3

Why is the oral route more complicated in pregnancy?

Answer 3

Nausea/vomiting

Increase in gastric emptying and gut motility

Question 4

Why is the intramuscular route more complicated in pregnancy?

Answer 4

Blood flow may be increased, so absorption may also increase using this route

Question 5

Why is inhalation more complicated in pregnancy?

Answer 5

Increased cardiac output and decreased tidal volume may cause increased absorption of inhaled drugs

Question 6

How will a greater dilution of plasma affect the relative amount of plasma proteins?

Answer 6

Decreased

Question 7

What affect does pregnancy have on GFR?

Answer 7

Increased - leads to increased excretion of many drugs

Can reduce plasma concentration and necessitate an increase in dose of renally cleared drugs

Question 8

What are the functions of the placenta?

Answer 8

Attach the fetus to the uterine wall
Provide nutrients to the fetus
Allow the fetus to transfer waste products to the mother’s blood

Question 9

When is teratogenicity a concern?

Answer 9

First trimester

Question 10

When is fetotoxicity a concern?

Answer 10

Second and third trimester

Question 11

What is folate antagonism?

Answer 11

Key process in DNA formation and new cell production

Question 12

What are the mechanisms of folate antagonism?

Answer 12

Block the conversion of folate to THF by binding irreversibly to the enzyme
Block other enzymes in the pathway

Question 13

What are the defects from folate antagonism?

Answer 13

Neural tube, oro-facial or limb defects

Question 14

Which drugs can cause neural cell crest disruption?

Answer 14

Retinoid drugs (eg isotretinoin)

Question 15

What problems are associated with neural crest cell disruption

Answer 15

Aortic arch anomalies 
Ventricular septal defects
Craniofacial malformations
Oesophageal atresia 
Pharyngeal gland abnormalities

Question 16

What are possible fetotoxicity issues later in pregnancy?

Answer 16

Growth retardation
Structural malformations
Fetal death
Functional impairment
Carcinogenesis

Question 17

What effects do anticonvulsants have on the foetus?

Answer 17

Valproate is associated with neural tube defects, as is carbamazepine and phenytoin

Question 18

What effects do anticoagulants have on the foetus?

Answer 18

Warfarin is associated with haemorrhage in the fetus, as well as multiple malformations in the central nervous system and skeletal system

Question 19

What effects do antihypertensive agents have on the foetus?

Answer 19

ACE inhibitors cause renal damage and may restrict normal growth patterns in the unborn child

Question 20

What effects do NSAIDs have on the foetus?

Answer 20

Premature closure of the ductus arteriosus

Question 21

What effects does alcohol have on the foetus?

Answer 21

Foetal alcohol syndrome

Question 22

What effects do retinoids have on the foetus?

Answer 22

Ear, CNS, cardiovascular, and skeletal disorders

Question 23

What are the symptoms of foetal alcohol syndrome?

Answer 23

Small head
Poor growth
Distinctive facial features        
Cerebral palsy
Learning difficulties
Mood, attention, or behavioural problems
Hearing and vision problems

Question 24

Which types of drugs should be avoided whilst breast feeding?

Answer 24

Cytotoxics
Immunosuppressants
Anti-convulsants (not all)
Drugs of abuse
Amiodarone
Lithium
Radio-iodine