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Pharmacology > Pharmacology in Special Populations - Pregnancy > Flashcards

Pharmacology in Special Populations - Pregnancy Flashcards

1
Q

What are different maternal physiologic characteristics to keep in mind when prescribing medications to pregnant women?

A
  • cardiovascular function
  • respiratory function
  • renal function
  • GI function
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2
Q

What type of cardiac output (increased/decreases) do moms have during pregnancy and how does this affect blood volume?

A

mom’s have increased cardiac output, leading to increased blood volume by 40-50%

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3
Q

How is albumin affected in pregnant women? What can this cause?

A
  • albumin is decreased
  • causes edema
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4
Q

What happens to the upper airway mucosa in pregnant women?

A

there is increased edema and hypervascularity

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5
Q

What is the volume remaining in the lungs after a normal, passive exhalation?

A

residual capacity

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6
Q

How is functional residual capacity of the lungs affected in pregnant women?

A

it is decreased

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7
Q

What is more likely to happen in surgery with pregnant women due to there being a decrease in residual capacity of the lungs?

A

hypoxemia

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8
Q

How is renal blood flow affected in pregnant women? How does this affect GFR?

A
  • renal blood flow is increased
  • this leads to an increased GFR
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9
Q

Because pregnant women have an increased renal blood flow and increased GFR, how would this affect drug elimination?

A

drugs would be filtered through and removed from the body at a quicker rate than expected, so the time the drug is working may be shorter than expected

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10
Q

How is total body water affected in pregnant women (what are the numbers)?

A

total body water is increased
- 6L extracellular
- 2L intracellular

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11
Q

How is gastric emptying time affected in pregnant women? What does this mean?

A
  • gastric emptying time is increased
  • drugs/substances may take longer to empty from the stomach
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12
Q

How is bowel transit time affect in pregnant women? What about bowel motility?

A
  • bowel transit time is increased
  • motility is decreased
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13
Q

Having an increased bowel transit time means what for pregnant women?

A

substances may take longer to get through the bowel

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14
Q

What are different pharmacokinetic concepts you have to consider in pregnant women?

A
  • half-life
  • protein binding
  • absorption
  • volume of distribution
  • metabolism
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15
Q

Drugs cleared renally in pregnant women will have what type of half-life?

A

a shorter half-life

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16
Q

How does clearance affect half-life?

A
  • increased clearance, shorter half-life (pregnant women)
  • decreased clearance, longer half-life
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17
Q

In pregnant women, drugs that are highly protein bound may have (1)

A
  1. higher free levels
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18
Q

Because women have decreased albumin, free drug concentration will be (1) for drugs that are (2) protein bound

A
  1. increased
  2. highly
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19
Q

What can happen in pregnant women due to highly protein bound drugs possibly having higher free drug concentration?

A

there can be an increase in pharmacological (drug) effects

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20
Q

How is absorption of drug affected in pregnant women due to slow gastric emptying and GI motility delays?

A

absorption may be increased
- can be decreased; depends on specific drug and where in the GI tract it sits the longest

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21
Q

What can be altered (think about graphs) in absorption of drug in pregnant women?

A

Cmax and Tmax

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22
Q

What is Cmax?

A

concentration of drug to reach peak effect

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23
Q

What it Tmax?

A

time it takes for drug to reach maximum concentration

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24
Q

If a drug is sitting somewhere where it is readily absorbed, how will Cmax be affected?

A

Cmax will be higher

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25
Q

What may prohibit dose absorption completely in pregnant women (can happen to anyone)?

A

vomiting

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26
Q

Where is the best place to see how much of a drug was absorbed?

A

area under the curve

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27
Q

How do you find area under the curve (F-bioavailability)?

A

concentration following oral dose/concentration following IV dose

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28
Q

How is volume of distribution affected in pregnant women?

A

volume of distribution is increased

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29
Q

In pregnant women, there is an increase in (1) and (2) which leads to a loss of (3) from plasma into other (4)

A
  1. extracellular (and)
  2. intracellular water
  3. hydrophilic drugs
  4. water rich spaces
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30
Q

Hydrophilic drugs want to move where?

A

where water in going

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31
Q

In pregnant women, there is an increase in body fat, which increases (1) for (2)

A
  1. volume of distribution (for)
  2. lipophilic drugs
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32
Q

Lipophilic drugs want to move where?

A

where there is fat

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33
Q

What cytochromes are increased in phase I metabolism in pregnant women?

A
  • CYP3A4
  • CYP2D6
  • CYP2C9
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34
Q

Increases in cytochrome activity will lead to what?

A

drugs being metabolized at an increased rate - going through the body much faster; may have decreased effect of drug

35
Q

What cytochromes are decreased in phase I metabolism in pregnant women?

A
  • CYP1A2
  • CYP2C19
36
Q

Decreases in cytochrome activity will lead to what?

A

drugs being metabolized at a decreased rate - instead of getting out of system, may build up and lead to toxic effects (drug will have increased activity)

37
Q

What is responsible for glucuronidation of many drugs?

A

UGT1A4

38
Q

UGT1A4 in involved in what phase of metabolism?

A

phase II

39
Q

In phase II metabolism in pregnant women, how is UGT1A4 activity affected?

A

UGT1A4 activity is increased

40
Q

How does UGT1A4 activity being increased affect drugs in the body of pregnant women?

A

would clear drugs faster; may have decreased drug effect

41
Q

Changes in metabolism will effect (1)

A
  1. half-lives
42
Q

What are important drug characteristics that determine the ability to cross the placental barrier in pregnant women?

A
  • lipid solubility
  • molecular size
  • pH and ionization
  • placental transporters
  • protein binding
  • metabolism
43
Q

How can lipid solubility affect drug’s ability to cross the placental barrier?

A

if it’s more lipid soluble, it will be more likely to cross placental barrier

44
Q

How can molecular size affect drug’s ability to cross the placental barrier in pregnant women?

A

larger molecules won’t cross the placental barrier

45
Q

How can pH and ionization affect drug’s ability to cross the placental barrier in pregnant women?

A

if maternal blood is more basic than fetal blood, drugs can become trapped, which can cause toxicity

46
Q

How can placental transporters affect drug’s ability to cross the placental barrier in pregnant women?

A

transporters pump stuff out of cells away from fetus back into maternal circulation

47
Q

How can protein binding affect drug’s ability to cross the placental barrier in pregnant women?

A

it can make it harder to cross the placental barrier

48
Q

How can metabolism affect drug’s ability to cross the placental barrier in pregnant women?

A

some drugs can be metabolized in the placenta and be deactivated
- if baby has function liver, they may be able to metabolize drug but may cause toxicity if it can’t be metabolized and become trapped

49
Q

What are some different pharmacodynamic concepts you need to consider with pregnant women?

A
  • maternal physiology
  • fetal therapeutics
  • fetal toxicity
  • teratogenicity
50
Q

Pregnant women have a(n) (1) sensivity to some drugs such as inhaled and Iv anesthetics?

A
  1. increased
51
Q

Pregnant women may have (1) due to physiologic changes and may require new drug therapies

A
  1. development of new problems
52
Q

What are some issues pregnant women may develop during their pregnancies?

A
  • heart failure
  • diabetes
53
Q

In pregnant women with newly developed heart failure, circulation is (1) so there is (2) drug movement

A
  1. lower
  2. not enough (drug movement)
54
Q

What describes when medication is administered to pregnant women with the fetus as the target?

A

fetal therapeutics

55
Q

In fetal therapeutics, what can be given to the mother for lung development of the fetus if preterm birth is anticipated?

A

corticosteroids

56
Q

In fetal therapeutics, what can be given to the mother to treat fetal arrhythmias?

A

antiarrhythmics

57
Q

In fetal therapeutics, what can be given to the mother to decrease HIV transmission to the fetus?

A

antivirals

58
Q

What is often predictable based on what we know about drugs; but can sometimes not be predictable with new medications?

A

fetal toxicity

59
Q

In (1), the mechanisms are poorly understood and have many components

A
  1. teratogenicity
60
Q

What demonstrates characteristic malformations or may cause termination of the pregnancy?

A

teratogens

61
Q

What describes a substance that demonstrates characteristic malformations that occur at a specific stage of development?

A

teratogen

62
Q

What describes when a substance is dose-dependent for malformations to occur?

A

teratogenicity

63
Q

What includes physical malformations, neurocognitive deficits, growth restriction, spontaneous abortion, and stillbirth?

A

teratogenicity

64
Q

Teratogenic risk is about (1)%

A

3%

65
Q

Periods of (1) and (2) are most subject to teratogenic effects of a substance

A
  1. rapid growth
  2. cell differentiation
66
Q

What is of little benefit due to differences in fetal development when regarding teratogenicity?

A

animal testing

67
Q

Prenatal death from a teratogen may occur when during pregnancy?

A

the first 1-2 weeks

68
Q

Major morphologic abnormalities from a teratogen may occur when during pregnancy?

A

3-7 weeks

69
Q

Physiologic defects and minor morphologic abnormalities from a teratogen may occur when during pregnancy?

A

8 weeks to full term

70
Q

What is a common teratogen used for sedative effects and, later, to suppress morning sickness in pregnant women?

A

thalidomide

71
Q

What is thalidomide currently used for?

A

treatment of leprosy and cancer

72
Q

What has been shown to lead to improper blood vessel growth, short limbs, missing limbs, organ malformations, blindness, deafness, external and internal ear structure malformations?

A

thalidomide

73
Q

What is a common teratogen that can lead to:
- small eye openings
- thin upper lip
- smooth, wide philtrum
- small head circumference
- underdeveloped jaw

A

alcohol (fetal alcohol syndrome)

74
Q

What is a common teratogen that deposits in bone and teeth affecting bone growth and causing tooth discolor/defects?

A

tetracycline

75
Q

What is a common teratogen that impairs fetal renal development and causes cranial malformations?

A

ACE inhibitors/ARBs

76
Q

What is a common teratogen that can be used to treat seizures and is associated with neural tube defects and can cause:
- anencephaly
- spina bifida
- encephalocele
- iniencephaly

A

valproic acid

77
Q

What is a common teratogen that can cause:
- cleft palate
- undersized jaw
- heart defects
- ear defects?

A

isotretinoin (accutane)

78
Q

What is a common teratogen that causes:
- hypoplastic nasal bridge
- heart defects
- cartilage defects
- risk of bleeding

A

warfarin

79
Q

What is a common teratogen that causes:
- growth restriction
- premature delivery
- SIDS
- neurocognitive delays

A

nicotine

80
Q

What is a common teratogen used for treatment of seizures and migraines and causes cleft palate?

A

topiramate

81
Q

What is a common teratogen that causes:
- ebstein anomaly (tricuspid valve anomaly)
- various cardiac abnormalities
- neonatal toxicity

A

lithium

82
Q

What can cause fetal hydantoin syndrome?

A

phenytoin (epilepsy medication)

83
Q

What is a common teratogen that causes:
- abnormal dermatoglyphics
- outer ear abnormalities
- depressed nasal ridge, short nose
- intrauterine growth restriction
- microcephaly
- midfacial hypoplasia
- hypoplastic nails and phalanges
- neurological deficits

A

phenytoin

Pharmacology (13 decks)

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