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Pharm II exam 3 > pregnancy and lactation > Flashcards

pregnancy and lactation Flashcards

1
Q

What are some counseling tips for pregnant women?

A

balanced diet

prenatal vitamins

decreased caffeine

no raw meat/fish

eat fruits & veggies daily (washed)

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2
Q

what are some PK changes seen in pregnancy?

A

Maternal plasma volume, cardiac output, and glomerular filtration increase by 30% to 50% or higher

increased body fat > increased volume of distribution in fat soluble drugs

plasma albumin concentration decreases

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3
Q

How does a decrease in plasma albumin concentration effect drugs in pregnancy?

A

increases the volume of distribution of drugs that are highly protein bound

unbound drugs are more rapidly cleared by the liver and kidney during pregnancy, resulting in little change in concentration

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4
Q

Effect of pregnancy of hepatic perfusion?

A

perfusion increases

theoretically increases the hepatic extraction of drugs

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5
Q

PK changes due to nausea and vomiting?

A

delayed gastric emptying

alters the absorption of drugs

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6
Q

Effect of gastric pH in pregnancy?

A

increased gastric Ph

affects the absorption of weak acids and bases

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7
Q

Effect of higher levels of estrogen and progesterone?

A

alter liver enzyme activity and increases the elimination of some drugs but result in accumulation of others

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8
Q

What is important when dealing with drugs during pregnancy?

A

super important to look up dosing and monitoring recommendations for a given drug

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9
Q

Usual change in drug dosing during pregnancy?

A

usually lower maternal drug levels

on average, increased clearance wins out most of the time,

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10
Q

What are some factors that affect movement of drug from maternal > fetal circulation?

A

Lipophilicity

Protein binding

Molecular weight

Drug pKa

Placental CYP450

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11
Q

Describe lipophilicity in pregnancy.

A

Highly lipophilic drugs more easily cross placental cell membranes (endothelial, placental) to enter into the fetal circulation

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12
Q

When can hydrophilic agents cross the placenta?

A

if protein binding is low enough and molecular weight is small enough

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13
Q

Describe protein binding in pregnancy

A

Highly protein-bound drugs have a lower free fraction that is available to diffuse into the fetal circulation

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14
Q

Which reach higher concentrations in the fetus: least maternal protein bound drugs or highly protein bound drugs?

A

LEAST maternal protein bound drugs

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15
Q

During pregnancy, while there is a gradual lowering of maternal albumin, there is a ___ fetal albumin

A

gradual rise in

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16
Q

True or false, during pregnancy, the ratio of maternal-fetal albumin concentrations remains that same.

A

FALSE

different ratios of fetal: maternal concentrations occur

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17
Q

Drugs with molecular weights___ readily cross the placenta

A

less than 500 Da

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18
Q

Do larger molecules (600-1000Da) cross the placenta? What about those greater than 1000 Da?

A

YES: they just cross more slowly

NO: not in sig. amounts

19
Q

Fetal pH compared to maternal pH?

A

fetal pH is slightly lower than maternal

So, some deg of ion trapping can concentration some drugs on the fetal side

20
Q

If a pregnant women needs a corticosteroid, which one should you give? Why?

A

Prednisolone

the placenta converts prednisolone to the inactive prednisone - does not expose fetus to active corticosteroid

21
Q

effects of drugs used for anesthesia/analgesia on fetus?

A

generally cross well and produce fetal effects that can be seen at delivery: respiratory depression from narcotics

(why we need to get baby out soon during c-section)

22
Q

When do CYP450s begin to appear?

A

as early as 14 weeks and increase throughout pregnancy

23
Q

What aspect of fetal drug metabolism remains immature until near or after birth?

A

glucuronidation

24
Q

What antihypertensives are believed to be safe during pregnancy?

A

Beta blockers

Methyldopa

Hydralazine

Calcium blockers

Magnesium sulfate

25
Q

When is magnesium sulfate used for HTN in preg?

A

for serious pregnancy-induced hypertension which is usually accompanied by proteinuria, peripheral edema and hyperreflexia

given IV

26
Q

What HTN drugs are contraindicated in preg?

A

ACE-I

ARBs

27
Q

What abx are safe during pregnancy?

A

UTIs are common

  • Nitrofurantoin
  • Penicillin and Derivatives
  • Cephalosporins
28
Q

Which abx are avoid in pregnancy? Why?

A

sulfonamides

mainly near term, because they displace bilirubin from albumin and may enhance kernicterus

29
Q

What antiemetics are thought to be safe in pregnancy?

A

Promethazine (Phenergan)

Ondansetron

30
Q

Drug class of Promethazine (Phenergan)? ADEs?

A

anticholinergic

dystonias, akathisia

31
Q

what drug can be used to suppress lactation?

A

Bromocriptine was previously used but no longer used due to increased reports of stroke, MI, seizures and HTN

32
Q

What effects whether a drug will enter breast milk?

A

Lipophilicity

Molecular weight

Pharmacokinetics (e.g., half-life)

Protein binding

Ionization

33
Q

How do drugs move into breast milk?

A

by passive diffusion and carrier-mediated transporters

34
Q

What is the milk-to-plasma drug concentration ratio?

A

Ratio of drug concentration in breast milk to that in plasma

generally meaningless, what matters is how much total drug is ingested and absorbed by the baby

usually small compared to oral therapeutic dose for the infant

35
Q

What is the “safe” exposure index?

A

value of no more than 10% of a therapeutic dose for infants

used as a conservative cutoff

36
Q

What drugs are exceptions to the “safe” exposure index value?

A

drugs that cause hemolysis in infants with G-6-PD deficiency

chemotherapeutic agents

37
Q

Are ADEs from drugs in breast milk common?

A

No, but always use caution

38
Q

What drugs should you use caution with when prescribing to pregnant women?

A

ACEs, alkylating agents, analgesics, abx, anti-epileptics, antidepressants, antihistamins, BB, mood stabilizers

39
Q

What abx should you avoid in preg?

A

ciprofloxacin

Doxycycline

40
Q

Use of oxycodone and Meperidine in pregnancy ?

A

Avoid in large doses

41
Q

use of Methadone in pregnancy?

A

considered safe

42
Q

What drugs should be avoided in breast feeding women?

A

methotrexate, lithium, Phenobarbital, Primidone and ethosuximide, chemo drugs, sedatives, Amiodarone, Atenolol, Betadine

43
Q

What BBs are safe during pregnancy?

A

Propranolol

Labetelol

Pharm II exam 3 (8 decks)

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