Pregnant and lactating

Question 1

what is perinatal period

Answer 1

time around birth - 12weeks before to 28 days after

Question 2

4 factors affecting maternal drug absorbtion

Answer 2

1. vomiting
2. incr. gastric pH due to less secretions
3. less intestinal motility
4. incr. cardiac output and tidal flow

Question 3

4 factors affecting maternal drug distribution

Answer 3

1. incr. plasma volume
2. changes in regional flow - more to kidney, placenta
3. increase in total body water
4. decrease in plasma protein binding

Question 4

2 factors influenceing maternal biotransformation

Answer 4

1. enzyme induction

2. inhibition

Question 5

2 factors affecting maternal excretion

Answer 5

1. increased renal blood flow

2. increased GFR

Question 6

changes in pharmacodynamics in pregancy

Answer 6

not many, but drugs that work on reproductive tissues may be affects by endocrine changes

Question 7

3 potential fetal diseases that might need drugs

Answer 7

1. fetal tachy - digoxin, sotalol
2. polyhydramnios - indomethacin
3. fetal lung immaturity - coritsol

Question 8

2 factors that affect tranfer of durgs to bb

Answer 8

1. placental chars

2. drug chars.

Question 9

3 placental aspects that affect tranfer

Answer 9

1. placental bloodflow
2. placental drug transport
3. placental drug transformation - has some CYPs

Question 10

4 drug factors that will affect transfer

Answer 10

1. size - smaller cross easier (under 1000Da)
2. lipid solubility - more soluble pass easier
3. protein binding - maternal binding will slow
4. ionization - less ionized pass easier

Question 11

how does ion trapping work

Answer 11

fetus more acidic, so basic drugs pass through and then become charged and trapped

Question 12

what is neonatal abstinance syndrome

Answer 12

withdrawal from drugs when born - irritable, rapid breathing, seizures

Question 13

what must be taken into account in neonatal drug therapy

Answer 13

1. renal and hepatic elim is immature

Question 14

3 considerations for drugs and breast feeding

Answer 14

1. maternal plasma [c]
2. amount of drug going into milk
3. amount of milk being consumed

Question 15

4 maternal factors influencing milk transfer

Answer 15

1. dose regimen
2. route of admin
3. maternal drug clearance
4. breast physiology

Question 16

4 drug factors affecting milk

Answer 16

1. size
2. lipid
3. protein binding
4. ionization - milk more acidic

Question 17

when to be careful of drugs in breast milk

Answer 17

be aware if neonate will get greater than 10% therapeutic dose