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Week 1 Repro > Pregnancy Pharm > Flashcards

Pregnancy Pharm Flashcards

1
Q

Increased _________ levels –> delayed gastric emptying, increased intestinal transit time, decreased gastric acid production (increased gastric pH).

A

Increased progesterone levels –> delayed gastric emptying, increased intestinal transit time, decreased gastric acid production (increased gastric pH).

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2
Q

Placenta derived hCG causes what?

A

Nausea and vomiting.

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3
Q

Why do pregnant women experience gastric reflux?

A

Due to increased gastric pressure, decreased LES tone.

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4
Q

How does pregnancy affect the liver?

A

Altered liver enzyme synthesis and decreased serum proteins (albumin).

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5
Q

In pregnancy oral drug absorption may increase. This accompanied by:

A

Increased Tmax

Decreased Cmax

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6
Q

What could potentially cause oral drug absorption to decrease in pregnancy?

A

Vomiting and/or reflux

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7
Q

How does pregnancy affect weak acids?

A

Increased ionization of weak acids –> decreased absorption

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8
Q

What some the main cardiovascular changes in pregnancy?

A

Increased blood volume
Increased HR
Increased SV
Increased CO

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9
Q

What causes vasodilation in pregnant women?

A

Progesterone, PGs, and NO –> Decreased PVR, Increased venous capacitance

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10
Q

How does pregnancy affect blood flow?

A

Increased blood flow.

Increased extravascular water (breasts, uterus, peripheral edema)

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11
Q

How do cardiovascular changes affect drug disposition?

A

Increased space for hydrophilic drug distribution –> increased Vd (may need higher doses for therapeutic levels)

Decreased protein bound drug conc. –> increased unbound drug fraction (ex: drugs w/ high albumin binding ex: phenytoin)

Enhanced IM, SC absorption

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12
Q

Renal changes in pregnancy

A

Increased renal size, dilation of urinary collecting system

Increased renal blood flow, increased GFR

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13
Q

How does renal changes affect drug disposition?

A

Increased CL of renally eliminated drugs (lithium, ampicillin, cephalosporins)

Decreased peak conc. of hydrophilic drugs

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14
Q

Respiratory changes in pregnancy

A

Increased tidal volume and minute ventilation

Decreased FRC (due to increased intra-abdominal pressure, fluid)

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15
Q

How does respiratory changes affect drug disposition?

A

Increased absorption of drugs administered via inhalation.

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16
Q

What MW can readily cross the placenta?

A

<500 Da

MW > 1000 Da do not cross the placenta

ex: heparin is large and polar

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17
Q

CYP1A2

A

Decreases metabolism of caffeine and theophylline

18
Q

CYP2A6

A

Increases the metabolism of nicotine

19
Q

CPY2D6

A

Increases the metabolisms of metoprolol and dextromethorphan

20
Q

CYP2C19

A

Decreases the metabolism of proguanil

21
Q

________ drugs of appropriate size diffuse readily across the placenta. Increases potential fetal effects.

A

Lipophilic drugs of appropriate size diffuse readily across the placenta. Increases potential fetal effects.

22
Q

__________ drugs cross the placenta slowly. Decreases potential fetal effects.

A

Hydrophilic drugs cross the placenta slowly. Decreases potential fetal effects.

23
Q

What is the exception to the lipid solubility?

A

High maternal-fetal conc. gradients –> polar compounds may cross the placenta in significant concentrations (ex: salicyclic acid)

24
Q

What is the pH of maternal blood? What is the pH of fetal blood?

A

Maternal: pH 7.4
Fetal: pH 7.3

Weakly basic drugs with pKa > 7.4 will be more ionized in fetal compartments –> more ion trapping, resulting in higher fetal drug levels.

25
Q

Complete Transfer
Exceeding Transfer
Incomplete Transfer

A

Complete Transfer: drug rapidly crosses placenta, equilibrium occurs, conc. in fetal blood = maternal blood

Exceeding Transfer: conc. in fetal blood > maternal blood

Incomplete Transfer: drug is unable to cross the placenta completely, conc. in fetal blood < maternal blood

26
Q

Route Blood Uses to Pass through the Placenta

A

Maternal blood –> intervillous spaces –> synctiotrophoblasts –> fetal connective tissue –> endothelium of fetal capillaries

27
Q

Free drugs/metabolites cross the placenta via _______ and/or ________

A

Free drugs/metabolites cross the placenta via passive diffusion and/or transporter-mediated transfer.

28
Q

Where in the placenta can drugs undergo phase I and phase II metabolism?

A

The syncytium.

29
Q

What is the milk reservoir in the lactating gland?

A

Lactiferous duct ampulla (sinus)

30
Q

Route of drugs into the breast milk

A

Alveolar capillary beds –> lactiferous ducts –> passive diffusion down conc. gradient

31
Q

Drug conc. achieved in breast milk is usually ____.

A

Drug conc. achieved in breast milk is usually low.

Daily drug conc. received by infant < therapeutic dose

32
Q

Recommendations for breast-feeding mothers taking meds:

A

Nursing mother should take meds 30-60 min after nursing or 3-4 hrs before nursing.

33
Q

The _______ the MW, the greater the penetration into milk.

A

The lower the MW, the greater the penetration into milk.

Drugs with MW <200 Da easily pass into the breast milk.
Drugs with MW >600 Da cannot.

34
Q

Lipid soluble drugs pass __________ into breast milk.

A

Lipid soluble drugs pass more freely into breast milk.

Milk contains fat –> sequestration. Increases conc. of lipid soluble drugs.

35
Q

Normal pH range of breast milk?

What kind of drugs are most likely to pass into breast milk?

A

Normal milk pH ranges from 6.5 to 7.4.

Nonionized drugs are more likely to pass into breast milk.

Basic drugs transfer&raquo_space;» acidic drugs.

36
Q

Plasma protein binding and milk:

A

Both plasma and milk contain proteins that can bind drugs: plasma > milk.

Highly plasma protein bound drugs usually remain in teh plasma and pass into the milk in small quantities.

37
Q

What are some other factors that help determine the drug transfer into breast milk?

A

Quantity of milk available

Drug bioavailability and t1/2

38
Q

ACE Inhibitors

Ethanol

Misoprostol

A

ACE Inhibitors (All esp 2 and 3) = Renal Damage

Ethanol (All) = Risk of fetal alcohol syndrome and neurodevelopmental defects

Misoprostol (1st Trimester) = Mobius Sequence (characterized by facial paralysis and the inability to move the eyes from side to side. underdevelopment of CN 6 and 7)

39
Q

NSAIDs

Smoking

A

NSAIDs (3rd trimester) = Premature closure of ductus arteriosus

Smoking (All) = Intrauterine growth retardation, prematurity, SIDS

40
Q

Tetracycline

Warfarin

A

Tetracycline (All) = discoloration and defects of teeth and altered bone growth.

Warfarin (All) = Hypoplastic nasal bridge (depressed nasal bridge) and chondropdysplasia, CNS malformations, bleeding risk

Week 1 Repro (2 decks)

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