Pregnancy Flashcards
PK Changes - Absorption
- Gastric Emptying
Slows gastric emptying, delayed
PK Changes - Absorption
- Intestinal Motility
Decreased intestinal mobility
PK Changes - Absorption
- Blood Flow
Increased blood flow to GI tract
PK Changes - Absorption
- Enzymes
Changes in intestinal and hepatic metabolic enzymes
PK Changes - Distribution
- Total Body Water
Increase in total body water
PK Changes - Distribution
- Plasma Volume
Increase in plasma volume
- Is greater than erythrocyte volume resulting in hemodilution (Pregnancy Anemia)
PK Changes - Distribution
- Body Fat
Increase in body fat
PK Changes - Distribution
- Albumin
Decrease in albumin concentration
PK Changes - Distribution
- Alpha-1-acid glycoprotein
Decrease in alpha-1-acid-glycoprotein concentration
PK Changes - Distribution
- Cardiac Output
Increase in cardiac output at 9 weeks post gestation (Peaking in latter pregnancy)
- Increases blood flow to organs
PK Changes - Elimination
- CYP3A4
Increases in pregnancy
Major metabolite (more than 50% of drug is metabolized by this pathway)
Low E Drug: Increase in intrinsic clearance = Decrease concentration of drug
- Have to titrate dose up
HIV Drugs are metabolized by CYP3A4
PK Changes - Elimination
- CYP2E1
Increases in Pregnancy
PK Changes - Elimination
- CYP2D6
Increases in Pregnancy
- Except in poor-metabolizers as they do not express CYP2D6
Clearance is higher in pregnancy compared to post partum
Clearance is higher in intermediate metabolizer compared to normal
PK Changes - Elimination
- CYP2C9
Increases in pregnancy
Drug will be more cleared in pregnancy
- May have to increase dose of drugs that are major metabolites
PK Changes - Elimination
- CYP1A2
Decreases in Pregnancy
Ex. Caffeine
- Clearance in 3rd trimester is lower than 1st trimester
PK Changes - Elimination
- UGT1A4
Increase in Pregnancy
- Avoids CYP pathway
Ex. Lamotrigine
Increased clearance during pregnancy
- Will have to Increase dose
- Return dose to normal post-partum
PK Changes - Elimination
- Renal Transport
Increase in transporter activity during pregnancy
- OCT2, P-gp, OAT1
PK Changes - Elimination
- OCT2
Uptake transporter
- Increase in metformin clearance
PK Changes - Elimination
- P-gp
Efflux Transporter
- Increase in digoxin clearance
PK Changes - Elimination
- OAT1
Uptake Transporter
- Increases in amoxicillin renal clearance
PK Changes - Elimination
- Hepatic Blood Flow
No effect
PK Changes - Elimination
- Renal Clearance
- Increase in Renal Blood Flow
- Increase in Glomerular Filtration
- Increase in Creatinine Clearance
PK Changes - Elimination
- Creatinine Clearance
- Increases in 1st trimester
- Increases by 30-50% mid-pregnancy
- Decreases in last few weeks of pregnancy
High E Drug given IV
Dependent on Hepatic Rate Flow
