Pregnancy/Lactation

Question 1

How does absorption change in pregnancy?

Answer 1

lots of progesterone= low motility
higher pH
more mucous= less permeability
nausea/vomit

Question 2

How does pulmonary absorption change in pregnancy?

Answer 2

increased due to more TV

Question 3

How does distribution change in pregnancy?

Answer 3

more body water= low Cmax
diluitional hypoalbuminemia

Question 4

How does Metabolism change in pregnancy?

Answer 4

more CYP 3A4/2D6(fluoxetine)
less 1A2/UGT(lamotrigine)

Question 5

IN relation to mom, how is albumin different in baby?

Answer 5

more

Question 6

If a teratogen was present roughly 15 days post conception what happens?

Answer 6

survives or dies no in-between

Question 7

What does a teratogen do in first trimester?

Answer 7

organs/physical formation issues

Question 8

What does a teratogen do in 2nd and third trimester?

Answer 8

functional and behavioural defects

Question 9

What can cause premature labour?

Answer 9

cigarette and illicit drugs

Question 10

What is the general rule for medications in pregnancy?

Answer 10

lowest dose for the shortest amount of time

Question 11

Why don’t we have data for pregnancy people?

Answer 11

ethical issues, birth defects are rare so hard to establish a pattern

Question 12

What do we have for evidence in pregnant people?

Answer 12

case reports, case control, cohort, registries

Question 13

What is the issue with the evidence for pregnant people?

Answer 13

recall bias, selection bias (not randomized), no control of confounding variables, sample size

Question 14

When selecting a drug what should we choose?

Answer 14

one drug vs multiple
older has more data vs newer maybe more safe
local
lowest/shortest duration
lowest half life

Question 15

Best resource for drug use in pregnancy?

Answer 15

Brigss drugs in pregnancy and lactation

Question 16

Other resources for drug use in pregnancy?

Answer 16

lexicomp,CPS, RX, Dyna

Question 17

How long is breast feeding recommended for?

Answer 17

at least first 6 months

Question 18

What medications could cause insufficient milk production?

Answer 18

COC (estrogens), decongestants, antihistamines, nicotine, diuretics

Question 19

Would a drug with a longer half life have more or less amount in milk?

Answer 19

MORE

Question 20

Would a drug with a higher Bioavailability have more or less amount in milk?

Answer 20

MORE

Question 21

Would a drug with a smaller size have more or less amount in milk?

Answer 21

more

Question 22

Would a drug with a basic property(unionized in base) have more or less amount in milk?

Answer 22

more

Question 23

Would a drug with a low lipid solubility have more or less amount in milk?

Answer 23

less

Question 24

Would a drug with a low protein binding have more or less amount in milk?

Answer 24

more

Question 25

Would a drug with a high Vd have more or less amount in milk?

Answer 25

less

Question 26

When is concentration of a drug in milk the highest?

Answer 26

at the end of a milk supply

Question 27

When does renal function become like adult?

Answer 27

6-12 months

Question 28

Why is there no evidence for lactation?

Answer 28

exclusion criteria

Question 29

Why do we have more data for lactation than pregnancy?

Answer 29

direct observation with a baby vs fetus

Question 30

What is a M/P > 1 mean?

Answer 30

concentrates in milk

Question 31

Why is M/P not used?

Answer 31

because does not show safety only a ratio not an absolute amount

Question 32

What is a safe RID for an infant vs preterm infant?

Answer 32

Infant= <10% preterm= <1%

Question 33

What is the best way to know a infant exposure to a drug from milk?

Answer 33

plasma concentration because it shows ADME

Question 34

Once a drug is at steady state, is there any point to space feeding from peak drug concentrations?

Answer 34

NO

Question 35

What is the pump and dump method?

Answer 35

time half life with discarding all milk that might have the drug in it

Question 36

What drugs increase milk production?

Answer 36

metoclopramide, domperidone, antipsychotics

Question 37

Is the evidence good for galactagogues?

Answer 37

unproven, s/e seen in kids and adult, often not provided lactation support

Question 38

When do you see qt effects of domperidone?

Answer 38

>30-60mg/day

Question 39

Dose for domperidone?

Answer 39

10mg TID for 4-10 days

Question 40

s/e in adult for domperidone?

Answer 40

anticholinergic, nausea, SOB, fatigue, withdrawal

Question 41

S/e for infant with domperidone?

Answer 41

constipation, hematuria, diaper rash

Question 42

Dose for metaclopramide?

Answer 42

10 mg BID-TID for 7-14 days

Question 43

Why do we need a taper for metaclopramide?

Answer 43

avoid a abrupt decline in milk

Question 44

s/e of metaclopramide for mom?

Answer 44

tardive, depression, ND, hair loss, breast sore

Question 45

s/e of metaclopramide for baby?

Answer 45

gas, gi discomfort

Question 46

Are herbals good for milk production?

Answer 46

HELL NO