Psychotropic Medications and Pregnancy Flashcards
Drugs that will cross the placental barrier
more lipophilic, small molecular weight, and non-ionized at physiologic pH
Two large molecule agents that don’t cross the placental barrier
insulin and heparin
Trimester with risk for anatomic malformation
1st
time period of fetal development where drug effects may be less obvious than anatomic malformations; may be functional defects
days 60 to delivery
Physiologic changes associated with pregnancy that affect pharmacokinetics of medications
increased plasma volume, GFR, binding, and liver action
How can you change dosing to counteract the effects of the physiologic changes associated with pregnancy?
multiple doses per day more likely to have a sustained effect rather than once daily medications that would be cleared too rapidly
T/F Overall, congenital anomalies are not more common in SSRI exposed offspring compared to unexposed offspring
true
Birth defects associated with citalopram
neural tube defects
Sx in a neonate include: tremor, restelessness, increased muscle tone, increased crying. resolves 1-4 days after birth
neonatal withdrawal syndrome
Why should you not decrease or discontinue dose of antidepressants close to end of pregnancy term?
may increase risk of postpartum exacerbation of mood disorder
Mood stabilizer used in bipolar disorder that protects against suicide
lithium
Affects of lithium on fetus/neonate
Epstein’s anomaly, floppy baby syndrome, hypothyroidism, diabetes insipidus
Dosing of lamotrigene (Lamictal) during pregnancy
<200mg in first and second trimesters.
Mood stabilizers that are human teratogens and should not be used during pregnancy
Valproate (Depakate) and Carbmazepine (Tegretol)
Pharmacokinetics of drugs unlikely to enter breast milk
drugs with low oral bioavailability (unlikely to cause systemic effects)
