Pharmacology of Pregnancy - Linger Flashcards
lipophilic drugs
cross placenta easily
small molecular weight
cross placenta easily
polar compounds
need high concentration gradient to cross placenta
fetal metabolism of drugs
slower rate
-due to lack of enzyme expression, reduced activity of metabolic enzymes, reduced availability of cofactors
teratogen
results in characteristic set of malformation
- exerts effects at particular stage
- dose-dependent incidence
prenatal death
1-2 weeks
major morphologic abnormalities
3-8 weeks
physiologic defects
> 9 weeks
vit B6
pyridoxine
antiemetic drug
MOA pyridoxine
precursor to pyridoxal - function in metabolism
also aids in release of liver and muscle glycogen and GABA synthesis and heme
antihistamines
H1 antagonists
antiemetic
doxylamine
diphenhydramine
dimenhydrinate
meclizine
diphenhydramine
H1 antagonist
dopamine antagonists
used as antiemetic
promethazine
prochlorperazine
droperidol
muscarinic blocking
ondansetron
serotonin antagonist
- selective for 5-HT3 receptor
- prevention of nausea and vomiting
preeclampsia in pregnancy tx
tx if BP > 150/100
-severe HTN
labetalol - non-selective beta blockers
hydralazine - dilates arterioles
nifedipine and nicarpidine - CCBs
nifedipine
CCB
tx for preeclampsia
preexisting HTN tx in pregnancy
ACE (-), ARBs, direct renin inhibitor - NOT in pregnancy**
labetalol
methyldopa
nifedipine
thiazides
methyldopa
reduces BP by stimulating central alpha adrenergic receptors
-decreased sympathetics to heart, kidney, vasculature
reduces peripheral vascular resistance
also reduction in HR and CO
undesired effect - sedation
moderate to severe HTN in pregnancy
methyldopa
thiazide MOA
inhibit NaCl cotransporter in distal convoluted tubule
management of gestational DM
exercise
pharm - anti-hyperglycemics - insulin**
insulin prep with low antigenicity
minimize transplacental transport
rapid acting insulin analogs
lispro
aspart
both used for GDM
leading cause of infant mortality
preterm birth
in US
tocolytics
suppress preterm labor
beta-adrenergic receptor agonists
bind beta2 receptors
- increases adenylyl cyclase
- increased cAMP
- decrease myometrial contractility
eventially desensitized
ritodrine
beta-adrenergic receptor agonist - not in US
adverse beta-adrenergic receptor agonists
tachy, low BP, bronchial relaxation
mag sulfate
tocolytic
- MOA unknown
- thought to compete with calcium at plasma membrane
- hyperpolarize membrane - inhibit myosin - reduce myometrial contractility
CI for mag sulfate
mother with myasthenia gravis
women with myocardial compromise or cardiac conduction defects
careful use of mag sulfate
indomethacin
COX inhibitor
-most commonly used tocolytic of this class
reduce PG formation - reduce myometrium contraction
concerns with indomethacin
constriction of ductus arteriosus and oligohydramnios
oxytocin
induction of labor
MOA oxytocin
stimulate uterine muscle contraction
- activating oxytocin receptors
- stimulates PG release
- milk ekection
misoprostol
prostaglandin E
induction of labor
ripen cervix
management of pain during childbirth
systemic or local
local - epidural, spinal - most popular
neuraxial - local - most effective - bupivicaine, ropivacaine
benzos and barbituates
not analgesis - anxiolytic
-cross placenta and affect fetus - bad
systemic for pain
morphine
fentanyl
meperidine
opiod agonist-antagonists
nalbuphine
butorphanol
