Sept18 A1-Drugs in pregnancy

Question 1

pregnancy related changes in drug metabolism

Answer 1

• higher GFR
• higher CO (HR and SV), lower BP
• decreased gastric emtpying, prolonged transit time, GI reflex, nausea and vomiting, decreased intestinal motility, less metabolizing enzymes
• increase or decrease in fct of certain liver enzymes (CYP1A2 decreased activity)

Question 2

caffeine metab change in pregnancy

Answer 2

increased half life (a lot) because of decreased CYP1A2 activity)

Question 3

thalidomide is what

Answer 3

anti-nausea drug

Question 4

what would happen to children of pregnant mother who took thalidomide

Answer 4

phocomelia (thalidomide embryopathy): no upper limbs

Question 5

% of babies born in Canada every year with a major malformation visible at birth

Answer 5

3%

Question 6

general principles of teratology (study of birth defects)

Answer 6

• susceptibility to a substance varies with dev stage (gestational age)
• each agent (substance) can access specific developing tissues
• abnormal dev may be manifested as death, malformation, growth retardation and or functional decficit
• more exposure = more manifestation of abnormal dev (from no effect to lethal)

Question 7

time of maximal sensitivity to thalidomide

Answer 7

when limbs are developing

-so most sensitive time to a substance = time when the organs this substance affects are developing

Question 8

teratogenic agents in humans

Answer 8

• radiation
• infections (TORCH, Zika virus, etc.)
• maternal and metabolic imbalance (diabetes is an important one)
• drugs and envrionmental chemicals

Question 9

important teratogenic drugs in humans

Answer 9

• ethanol
• retinoids
• tetracyclines
• thalidomide

Question 10

zika effects

Answer 10

• microcephaly (small head)

- fetal brain defects

Question 11

zika transmission

Answer 11

• vertical
• during intercourse
• from mosquito bite

Question 12

fetal alcohol spectrum disorder (FASD) is what

Answer 12

• all the lifelong lasting disorders and symptoms related to having been exposed to alcohol in utero (CNS abnormalities, growth retardation, facial abnormalities)
• more alcohol = more effects

Question 13

leading cause of developmental disabilities in Canadian children

Answer 13

fetal alcohol spectrum disorder

Question 14

major problem of FASD

Answer 14

effect on IQ

Question 15

other sx of FASD

Answer 15

thin upper lip, specific facial features, etc.

Question 16

how retinoids found to be teratogenic

Answer 16

isotretinoin was a retinoid used for severe acne. known to be teratognic bc of experiences on mammal species but pregnant women still took it

Question 17

tetracycline is what

Answer 17

antibacterial drug. in the embryo

• it kelates and binds minerals in teeth and bones
• bone dev and teeth dev defects

Question 18

problem with drugs in pregnancy

Answer 18

-old, legacy drugs have never had studies done for teratogenicity (like aspirin used since 1880..)
(new drugs do though)
-most commonly used meds have no evidence on risk or safety for the embryo

Question 19

how testing for developmental toxicity of drugs is done today

Answer 19

• epi studies (retro or prospective)
• animal testing (in vivo)
• in vitro (whole embryo or embryonic SCs of animals)

Question 20

when to tx disease 100% in a pregnant woman (when to give a drug)

Answer 20

if the disease presents a risk for both her and the fetus

• epilepsy (anticonvulsants are teratogenic, but new ones less)
• cancer
• depression
• others

Question 21

teratogenic anticonvulsants

Answer 21

• valproic acide
• phenytoin
• carbamazepine
• phenobarbital

Question 22

important supplement for pregnant women

Answer 22

folic acid (reduces risk of spina bifida and myelomeningocele but increased risk of congenital heart disease)

Question 23

other prevention strategies to protect the fetus

Answer 23

vaccines (rubella for ex)

Question 24

5 weeks pregnant with twins with nausea and vomiting of pregnancy (NVP) what you can do

Answer 24

dicelctin is the only med approved for that in Canada. (contains doxylamine (antihistamine) and vitamin B6)

Question 25

how much fish can a pregnant woman eat (risk of mercury?)

Answer 25

• avoid large fish like tuna
• know what fish to avoid (ones with accumulated persistent organic pollutants like Hg)
• wallet cards for pregnant women telling the doses