Pregnancy/Lactation Flashcards
How does absorption change in pregnancy?
lots of progesterone= low motility
higher pH
more mucous= less permeability
nausea/vomit
How does pulmonary absorption change in pregnancy?
increased due to more TV
How does distribution change in pregnancy?
more body water= low Cmax
diluitional hypoalbuminemia
How does Metabolism change in pregnancy?
more CYP 3A4/2D6(fluoxetine)
less 1A2/UGT(lamotrigine)
IN relation to mom, how is albumin different in baby?
more
If a teratogen was present roughly 15 days post conception what happens?
survives or dies no in-between
What does a teratogen do in first trimester?
organs/physical formation issues
What does a teratogen do in 2nd and third trimester?
functional and behavioural defects
What can cause premature labour?
cigarette and illicit drugs
What is the general rule for medications in pregnancy?
lowest dose for the shortest amount of time
Why don’t we have data for pregnancy people?
ethical issues, birth defects are rare so hard to establish a pattern
What do we have for evidence in pregnant people?
case reports, case control, cohort, registries
What is the issue with the evidence for pregnant people?
recall bias, selection bias (not randomized), no control of confounding variables, sample size
When selecting a drug what should we choose?
one drug vs multiple
older has more data vs newer maybe more safe
local
lowest/shortest duration
lowest half life
Best resource for drug use in pregnancy?
Brigss drugs in pregnancy and lactation
Other resources for drug use in pregnancy?
lexicomp,CPS, RX, Dyna
How long is breast feeding recommended for?
at least first 6 months
What medications could cause insufficient milk production?
COC (estrogens), decongestants, antihistamines, nicotine, diuretics
Would a drug with a longer half life have more or less amount in milk?
MORE
Would a drug with a higher Bioavailability have more or less amount in milk?
MORE
Would a drug with a smaller size have more or less amount in milk?
more
Would a drug with a basic property(unionized in base) have more or less amount in milk?
more
Would a drug with a low lipid solubility have more or less amount in milk?
less
Would a drug with a low protein binding have more or less amount in milk?
more
Would a drug with a high Vd have more or less amount in milk?
less
When is concentration of a drug in milk the highest?
at the end of a milk supply
When does renal function become like adult?
6-12 months
Why is there no evidence for lactation?
exclusion criteria
Why do we have more data for lactation than pregnancy?
direct observation with a baby vs fetus
What is a M/P > 1 mean?
concentrates in milk
Why is M/P not used?
because does not show safety
only a ratio not an absolute amount
What is a safe RID for an infant vs preterm infant?
Infant= <10%
preterm= <1%
What is the best way to know a infant exposure to a drug from milk?
plasma concentration because it shows ADME
Once a drug is at steady state, is there any point to space feeding from peak drug concentrations?
NO
What is the pump and dump method?
time half life with discarding all milk that might have the drug in it
What drugs increase milk production?
metoclopramide, domperidone, antipsychotics
Is the evidence good for galactagogues?
unproven, s/e seen in kids and adult, often not provided lactation support
When do you see qt effects of domperidone?
> 30-60mg/day
Dose for domperidone?
10mg TID for 4-10 days
s/e in adult for domperidone?
anticholinergic, nausea, SOB, fatigue, withdrawal
S/e for infant with domperidone?
constipation, hematuria, diaper rash
Dose for metaclopramide?
10 mg BID-TID for 7-14 days
Why do we need a taper for metaclopramide?
avoid a abrupt decline in milk
s/e of metaclopramide for mom?
tardive, depression, ND, hair loss, breast sore
s/e of metaclopramide for baby?
gas, gi discomfort
Are herbals good for milk production?
HELL NO
