pregnancy Flashcards
pregnancy: nasal congestion
avoid guaifenesin
decongestants are per MD only
pregnancy: diarrhea
avoid bismuth
loperamide is per MD only
pregnancy: constipation
avoid senna
bulk, bisacodyl, docusate OK
pregnancy: pain
avoid aspirin 3rd tri
NSAIDs are ok 1st try
generally avoid/use APAP minimally
pregnancy: nausea, mild
can use ginger, pyridoxine, cyclizine
pregnancy: nausea, moderate
can use doxylamine, reglan, zofran
pregnancy: anti-infectives
prefer penicillins, cephalosporins, macrolides
pregnancy: hypertension
avoid: ACEi, ARB
options are labetalol, nifedipine, methyldopa, hydralazine
pregnancy: anticoagulation
UFH/LMWH safe
pregnancy: antidepressants
sertraline, citalopram OK
pregnancy: CNS agents
amphetamines can cause withdrawal
benzos rarely used, floppy baby syndrome
postpartum: contraception
avoid CHC until 3-6 weeks postpartum
at any time, options are progestin only implant or pill, IUD
physiologic changes in pregnancy: blood volume
blood volume increased, expands Vd
physiologic changes in pregnancy: RBC
increased RBC– depletes iron stores & requires supplements
physiologic changes in pregnancy: HR, BP
decreased blood pressure
increased cardiac output/HR
physiologic changes in pregnancy: hepatic perfusion
increased hepatic perfusion with some CYP enzymes being more active
physiologic changes in pregnancy: GFR
increased GFR= enhanced drug removal
physiologic changes in pregnancy: albumin
reduced albumin= less drug binding= more free drug concentrations
physiologic changes in pregnancy: antithrombin
decreased antithrombin, increased risk VTE
physiologic changes in pregnancy: weight
average weight gain is 25-30 pounds
generalizations for PK in pregnancy
absorption generally unaffected
distribution: more free drug, higher Vd
clearance is higher
almost all drugs cross placenta
definition of teratogen
produces permanent alteration in form/function in offspring
true or false: a drug is clearly either a teratogen or not
false
need to consider other factors, exposure, dose
definition of a congenital malformation
prenatal structural abnormalities present at birth that interfere with viability or physical well-being
ex cleft lip, club foot, spina bifida
true or false: drugs are 1% of the causes of congenital malformations
true
teratogenicity depends upon
genetic constitution of mother and fetus– there can be genetic mutations or polymorphisms in drug metabolism genes
8 principles of teratology
- 1 teratogen can cause many different malformations
- many teratogens cause the same malformations
- teratogens don’t have to be hazardous to mother
- teratogens must be present at a critical period
- teratogens can act directly or indirectly
- dose-relationship presumed, rarely defined
- genetic susceptibility of infant to toxic metabolites may be unifying pathway to injury
- malformation may be animal species/strain specific
what is the mechanism by which drugs cross the placenta
mostly simple diffusion, concentration driven
drugs in category X
valproate
methotrexate
ribavirin
triazolam
bosentan
aliskiren
emergency contraception
griseofulvin
isotretinoin
most common congenital abnormality
neural tube defects
all women take 0.4 folic acid daily
which drugs are associated with risk of neural tube defects
classic anti-epileptic agents such as valproic acid
cardiovascular drugs of concern for pregnancy
warfarin
ACEi/ARB
beta blockers without ISA
CNS drugs of concern for pregnancy
SSRIs, lithium
other drugs of concern for pregnancy
misoprostol, tetracyclines, androgens, estrogens, fluconazole, chemotherapy, mycophenolate, NSAIDs
implications of alcohol use during pregnancy
fetal alcohol syndrome
implications of nicotine use during pregnancy
premature rupture of membranes
abruptio placentae
low birthweight
preterm birth
stillbirth
SIDS
implications of cannabis use during pregnancy
unsafe, low birth weight, premature birth, NICU care
