Pharmacology in Pregnancy and Lactation Ch. 14 Flashcards
How can physioogical changes of pregnancy alter drug diposition and effect?
Physiological changes of pregnancy may alter drug disposition and effect through:
Direct Effects - ex. Placental transfer
Indirect Effects - Changes in placental and uterine function
Even after delivery drugs may affect breastfeeding
At least 10 % of pregnant women taking these drugs?
At least 10% taking drugs with long term effects on CNS
●Antidepressants
●Anticonvulsants
●Antipsychotics
What was recognized of mothers who are ultra-rapid metabolizer of codeine?
●Recently recognized mothers who are ultra-rapid metabolizers of codeine may transfer morphine through breast milk to cause neonatal CNS depression and even death
Major physiologic changes during pregnancy alter drug disposition:
Absorption and Uptake
●Oral absorption and bioavailability not usually affected by pregnancy
●Intestinal motility decreases
●Gastric emptying only delayed during labor or administration of opioids
●Reduced FRC (functional residual capacity)
●Increased minute ventilation increases pulmonary uptake of inhalational anesthetic agents
●Body fat increases on average 4kg (unimportant) given large volume of ________ and lipophilic drug ________binding
●Body fat increases on average 4kg (unimportant) given large volume of distribution and lipophilic drug protein binding
What 2 drugs require monitoring and modification of dose because of changes in protein binding?
●Theophylline and phenytoin require monitoring and modification of dose because of changes in protein binding
What drugs are increased because of metabolism?
Increases Metabolism
●Phenytoin
●Morphine
●MIdazolam
What drug decrease metabolism?
Decreases Metabolism
●Caffeine
●Theophylline
No anesthetic drugs have been shown to be ____________
No anesthetic drugs have been shown to be teratogenic
Which is the preferred mild analgesic and antipyretic during pregnancy?
There is no know teratogenic risk associated with the use of acetaminophen which is preferred mild analgesic and antipyretic during pregnancy
What have been associated with an increase risk for some birth defects
NSAIDs have been associated with an increase risk for some birth defects
What usually avoided in the third trimester because of fetal risk for:
●Renal injury
●Oligohydramnios
●Intrauterine constriction of the ductus arteriosus
Aspirin
What are not considered to have a teratrogenic risk?
Opioids are not considered to have a teratogenic risk
What drug exposure in early pregnancy was associated with a higher number of spontaneous abortions and it should be avoided in the first trimester?
Tramadol has analgesic effects from weak opioid activity and inhibition of serotonin and norepinephrine uptake
Tramadol exposure in early pregnancy was associated with a higher number of spontaneous abortions and it should be avoided in the first trimester
What psychotropic drugs do not appear to be associated with congenital abnormalities or neurodevelopmental problems
●Tricyclic antidepressants do not appear to be associated with congenital abnormalities or neurodevelopmental problems
What psychotropic drugs should be avoided during pregnancy?
●Monoamine oxidase inhibitors (MAOIs) should be avoided
What are the first lline of drugs for depression?
●Serotonin reuptake inhibitors (SSRIs) are now the first-line therapy for depression.
These drugs cross the placenta to varying degrees.
As a class they increase the rate of cardiac malformations and risk complications.
What drug is associated with Ebstein’s anomaly?
●Lithium therapy is associated with a small increased risk for cardiac defects, especially Ebstein’s anomaly
What antihypertensive agents are safe in preegancy?
Antihypertensive agents such as methyldopa, labetalol, calcium entry-blocking agents, and hydralazine are safe in pregnancy
Spironalactone should be _______
Spironalactone should be AVOIDED
What antihypertensive drugs should be avoided?
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) should be avoided.
These drugs can cause fetal renal failure and oligohydramnios, which may result in fetal limb contractures, craniofacial deformities, and pulmonary hypoplasia.
What is relatively comon in pregnancy?
●Maternal asthma is relatively common in pregnancy.
What have not been associated with congenital malformations to treat maternal asthma?
●B2adrenergic receptor agonist, and corticosteroids have not been associated with congenital malformations.
What is the preferred short acting B2 adrenergic receptor agonist?
●Albuterol is the preferred short acting B2adrenergic receptor agonist
What is the preferred long-acting B2 agrendergic receptor agonist?
and salmeterol is the preferred long-acting B2adrenergic receptor agonist
Which respiratory drug is not recommended for pregnancy?
●Zileuton is not recommended
●Pregnancy is a _________ _______ because of relative increases in many coagulation factors and increased venous statis
●Pregnant women have 5 times the normal risk for venous thromboembolism and thrombosis is a significant cause of maternal death
●Pregnancy is a hypercoagulable state because of relative increases in many coagulation factors and increased venous statis
●Pregnant women have 5 times the normal risk for venous thromboembolism and thrombosis is a significant cause of maternal death
What anticoagulant does not cross the placenta?
●Heparins do not cross the placenta
What is the preferred over unfractionated heparin (UFH) because it is easy to administer and does not require monitoring during pregnancy?
●Low-molecular-weight (LMWH) is the preferred over unfractionated heparin (UFH) because it is easy to administer and does not require monitoring.
●LMWH is less likely to cause heparin induced ____________
●LMWH is less likely to cause heparin induced thrombocytopenia
What is a vitamin K antagonist that can cause an embryopathy,especially in 1st trimester?
●Warfarin is a vitamin K antagonist that can cause an embryopathy,especially in 1st trimester
What anti coags cross the placenta and are not recommended?
●Rivaroxaban and the thrombin inhibitor dabigatran (Pradaxa) cross the placenta and are not recommended
What antiemetic does the ACOG (American College of Obstetricians and Gynecologists) recommends with or without doxylamine (antihistamine) as the initial drug of choice?
ACOG (American College of Obstetricians and Gynecologists) recommends vitamin B6 (pyridoxine) with or without doxylamine (antihistamine) as the initial drug of choice
What is a nonsedating dopamine antagonist but has a black box warning because chronic usage can cause tardive dyskinesia?
Metoclopramide is a nonsedating dopamine antagonist but has a black box warning because chronic usage can cause tardive dyskinesia
What is used for refractory vomiting during pregnancy?
Ondansetron (5-hydroxytryptamine receptor antagonist) has been used for refractory vomiting during pregnancy
What meds are safe in pregnancy for gestation diabetes?
Treatment of gestational diabetes mellitus with insulin, metformin or glyburide is safe with debate of which should be first line drug of choice.
What are the first line treatments of snti-infective drugs?
●First line treatments are penicillins and cephalosporins
What anti infective e is considered safe but some recommend avoiding during first trimester?
●Metronidazole is considered safe but some recommend avoiding during first trimester
What should not be administered after 5th week pregnancy?
●Tetracyclines should not be administered after 5th week pregnancy
*Can affect baby’s teeth
●Pregnant women should avoid traveling to malaria endemic areas but _______ or ________ can be used.
●Pregnant women should avoid traveling to malaria endemic areas but chloroquine or mefloquine can be used.
What are some HIGHLY Tetragenic Drugs?
Highly Teratogenic Drugs include Thalidomide, ribavirin, isotretinoin , acitretin, valproate
Highly Teratogenic Drugs include Thalidomide, ribavirin, isotretinoin , acitretin, valproate what do you tell women of child bearing age?
These drugs so high risk that two form of birth control are recommended when taken
●Pharmaceutical information leaflets from manufacturers highly _________the use of drugs during breast feedings.
●Pharmaceutical information leaflets from manufacturers highly discourage the use of drugs during breast feedings.
What drugs are strongly contraindicated during breast feeding?
●Only a few types of drugs such as cytotoxic and immunosuppressive drugs and radioactive compounds are strongly contraindicated during breastfeeding.
●Transfer of drugs to breast milk occurs mainly by passive diffusion. What does the rate of passive transfer into breast milk depends on ?
●Transfer of drugs to breast milk occurs mainly by passive diffusion. The rate of passive transfer into breast milk depends on the lipid solubility, molecular weight, degree of ionization and protein binding
What Drugs generally no concern regarding anesthetic drugs in breast milk?
●Anesthetic Drugs generally no concern regarding anesthetic drugs in breast milk
What infusion to avoid in breast feeding mom?
●Adjunct anesthetic drugs should be considered. Postoperative infusions of ketamine best avoided due to limited safety data
What concentrations in infant are unpredictable but may be suffciently high to cause cardiac eefects?
●Cardiovascular most first line safe. Amiodarone concentrations in the infant are unpredictable but may be sufficiently high to cause cardiac effects. Iodine released during its metabolism may cause thyroid dysfunction
What antidiabetic medication should be used with caution in breast feeding mother?
● Metformin should be used with caution while nursing preterm infants and neonates
What anti infective should be avoided in breast feeding moms?
●Anti-infectives such as penicillin and cephalosporins are considered safe but sulfonamides should be avoided due to displacement of bilirubin from binding sites
