Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2016 Endocrine > Test 1 Pregnancy and Lactation > Flashcards

Test 1 Pregnancy and Lactation Flashcards

1
Q

What Phase of the menstrual cycle that occurs after ovulation?

A

Luteal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do Physiologic changes peak during pregnancy?

A

Second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most will most likely result if a teratogen exposure occurred during organogenesis?

A

Structural anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A woman is classified as G3P2103 has had how many premature deliveries?

A

1

  • G – how many pregnancies
  • P – Full term, Premature, Abortion, Live
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

By what mechanism do most drugs move from the maternal circulation to the fetal circulation?

A

Diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physiologic Changes During Pregnancy

A
  • Blood Volume
  • Coagulation Changes
  • Cardiovascular
  • Pulmonary Changes
  • Renal Changes
  • Hepatic Changes
  • Gastrointestinal changes
  • Metabolism Changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Physiologic Changes During Pregnancy:

Blood Volume

A

· Blood volume increases during pregnancy – ~1.5L more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Physiologic Changes During Pregnancy:

Coagulation

A
  • Coagulation changes
    • Clotting factors increase
    • Protein S (body’s natural anticoagulant) decreases à may lead to clotting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Physiologic Changes During Pregnancy:

Cardiovascular

A
  • Cardiovascular changes
    • CO increases (~50%)
    • HR increases (~10 bpm)
    • BP decreases (mostly in the second trimester)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Physiologic Changes During Pregnancy:

Pulmonary

A
  • Pulmonary changes
    • Tidal volume (the amount of air between inhalation and exhalation) increases
    • Residual capacity (how much air is left after you exhale) decreases
    • Dyspnea (partly due to progesterone) increases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Physiologic Changes During Pregnancy:

Renal

A
  • Renal changes
    • SCr decreases
    • CrCl increases
    • Renally eliminated drugs will be cleared faster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physiologic Changes During Pregnancy:

hepatic

A
  • Hepatic changes (don’t memorize enzymes)
    • P450 2A6, 3A4, 2C9, 2D6 increased
    • P450 1A2 and 2C19 decreased
    • UGT 1A1, 1A4, 2B7 increased
    • Albumin decreases (may want to get free drug levels if the drug is highly protein bound)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physiologic Changes During Pregnancy:

Gastrointestinal

A
  • Gastrointestinal changes
    • Transit time decreases→constipation (progesterone is the culprit)
    • Gastric secretion decreases – may impair drug absorption if gastric acid is needed (low pH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Physiologic Changes During Pregnancy:

Metabolism

A
  • Metabolism changes
    • Weight gain (average acceptable weight gain is about 25 lbs)
    • Vd will increase for fat-soluble drugs (may need to adjust dose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Teratogenicity

A
  • Placenta provides a structure for complete exchange of nutrients, to facilitate gas transfer from mother to fetus, to assist in removal of carbon dioxide and other waste products from the fetal circulation, and to produce hormones
    • Natural barrier – prevents the passage of some medications
  • Teratogens are agents that act to irreversibly alter growth, structure, or function of the developing embryo or fetus
    • 1% of birth defects are due to drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Developmental Toxicity

A
  • Growth alternation – intrauterine growth retardation, small for gestational age
    • Child is small
    • Increases risk of neonatal abnormalities
    • May be caused by steroids and beta-blockers
  • Structural anomalies – cosmetic or causes a functional impairment
    • Heart defect, neural tube defect
    • Background prevalence (w/o drugs) is 2 – 6%
  • Functional-neurobehavioral deficits
    • Fetal-alcohol syndrome
    • Toxicities are hard to prove – deficit may not appear for years
  • Embryo-fetal death
    • Miscarriage (spontaneous abortion)
    • Stillbirth
    • 12 – 20% of pregnancies result in spontaneous abortion (80% are due to chromosomal abnormalities)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Criteria for proof of human teratogenicity

A
  • Proven exposure at critical times during human development
    • Preimplantation period – from fertilization à implantation (about 2 weeks)
      • An all or none period – if there is exposure to harmful drugs, the cells may die off
    • Embryonic period (3 – 8 weeks conception)
      • When organs are developing
      • Structural malformations most likely to occur
      • If the organ is already formed, the drug will not affect the organ formation
    • Fetal period (9 weeks +)
      • May affect the function of the organ that has already developed
  • Consistent dysmorphic findings recognized in well-conducted epidemiologic studies
    • If you see the same result in at least 2 studies, it adds proof
  • Specific defects or syndromes associated consistently with specific teratogens
    • May be from case reports
  • Rare anatomic defects associated with environmental exposure
    • Exposure due to pollutants/toxins rather than drugs
  • Proven teratogenicity in experimental animal models
    • May mean that there will be a problem in humans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

FDA Risk Categories – will still be around until 2020

A
  • A
  • B
  • C
  • D
  • X
  • Limitations:
    • A drug could fall into multiple categories depending on route of administration
    • Must consider the disease state and it’s effect on the baby
    • Studies are not done on pregnant women, so effects are not known
    • All drugs in the same category do not share the same risk
    • Does not account for the human experience of drugs in the same class
    • The timing, dose, route, frequency are not taken into account for most drugs
      • Ex. Fluconazole one time dose is a C
      • Ex. Fluconazole multi dose is a D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

FDA risk category A

A
  • A =
    • studies in women show no risk to the fetus in the first trimester (and there is no evidence of a risk in later trimesters)
    • the possibility of fetal harm appears remote.
      • Folic acid, levothyroxine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

FDA risk category B

A
  • B =
    • Animals studies show no risk but no studies available in women
  • OR
    • Animals studies showed risk (besides fertility decrease) but women studies did not show same risk in 1st trimester (and there isn’t risk in later trimesters)
    • Acetaminophen, loratadine, penicillin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

FDA risk category C

A
  • C =
    • Animal studies have revealed adverse effects and there aren’t women studies
      • (teratogenic or embryocidal or other)
    • OR
      • women and animal studies aren’t available
  • Give only if potential benefit justifies potential risk.
    • Fluconazole, levofloxacin
    • Largest category of drugs
    • We don’t know if it’s safe or not
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

FDA risk category D

A
  • D =
  • There is positive evidence of human fetal risk
    • the benefits from use in pregnant women may be acceptable despite the risk
      • ex. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective
    • Fluconazole, lithium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

FDA risk category X

A
  • X =
    • Studies in animals or human cause fetal abnormalities
  • OR
    • there is evidence of fetal risk based on human experience
  • OR
    • both
  • the risk of the use of the drug in pregnant women clearly outweighs any possible benefit.
  • The drug is contraindicated in women who are or may become pregnant.
    • Misoprostol, oral contraceptives, pravastatin, warfarin
24
Q

Pregnancy and Lactation Labeling Rule:

Section 8.1

A
  • Began in June 2015
  • Pregnancy Section
  • Created Pregnancy registry (if they are in one) –
    • a way for the FDA to track side effects
      • Drugs with known problems
      • Some new drugs (to watch for things)
  • Gives Risk summary
    • If the drug is contraindicated in pregnancy
    • Summary of human, animal, pharmacologic data
  • Provides Clinical considerations
    • The effect of the disease on the fetus
    • Dosing adjustment information
  • Provides Data
    • Detailed information about the studies à you can make your own interpretation
25
Q

Pregnancy and Lactation Labeling Rule:

Section 8.2

A
  • Began in June 2015
  • Lactation Section
  • Gives Risk summary
    • If the drug is contraindicated in breastfeeding
    • If the drug is found in the breast milk
    • The effects of the drug on the mother
    • The effects of the drug on the baby
  • Provides Clinical considerations
    • Strategies to minimize exposure
    • How to monitor the baby if exposure occurs
  • Provides Data
    • Data from studies to make a clinical decision
26
Q

Pregnancy and Lactation Labeling Rule:

Section 8.3

A
  • Began in June of 2015
  • Females and Males of Reproductive Potential Section
  • Provides Pregnancy testing information
    • If the drug requires pregnancy testing
  • ContraceptionInformation
    • If the drug requires the woman to be on contraception
  • Infertility Information
    • What the drug will do the man or woman’s fertility
27
Q

What the Pregnancy and Lactation Labeling Rule will change

A
  • It will be implemented over the next 5 years
    • there will be no more A – X classification
28
Q

Factors to Consider for Drug Use During Pregnancy

A
  • Is there human pregnancy data for the drug?
  • Do other drugs in the same class cause developmental toxicity?
  • Does the drug cause developmental toxicity in animals?
  • Does the drug reach the embryo-fetus?

·

29
Q

Factors to Consider for Drug Use During Pregnancy:

Is there human pregnancy data for the drug?

A
  • Is there human pregnancy data for the drug?
    • 90% of drugs - NO
30
Q

Factors to Consider for Drug Use During Pregnancy:

Do other drugs in the same class cause developmental toxicity?

A
  • Do other drugs in the same class cause developmental toxicity?
    • If one drug causes a problem, other drugs in the class may cause the same problems
31
Q

Factors to Consider for Drug Use During Pregnancy:

Does the drug cause developmental toxicity in animals?

A
  • Does the drug cause developmental toxicity in animals?
    • The FDA requires at least 1 rodent and 1 non-rodent study
    • Problem in animals DOES NOT guarantee probelm in humans
      • If animal gets a high dose (100x human dose) and there’s no effect
        • → consider it to be safe
      • If animal gets a low dose (<10x human dose) and there IS effect
        • → consider teratogenic
32
Q

Factors to Consider for Drug Use During Pregnancy:

Does the drug reach the embryo-fetus?

A
  • Does the drug reach the embryo-fetus?
    • Transfer of drugs to the placenta
      • Passive diffusion (most common)
      • Active transfer
      • Facilitated diffusion
      • Phagocytosis
      • Pinocytosis
33
Q

Factors known to determine whether a drug crosses the placenta

A
  • Factors known to determine whether a drug crosses the placenta
    • Maternal blood concentration
      • If concentration in the mother is high=more likely to cross the placenta
    • Molecular weight
      • Low molecular weight drugs cross the placenta very easily
    • Plasma elimination half-life
      • longer the half-life=more time to cross the placenta
    • Lipid solubility
      • more lipophilic=more likely to cross the placenta
        • Opiates
    • Ionization at physiologic pH
      • Ionized drugs do not transfer across the placenta
    • Plasma protein binding
      • highly protein bound drugs do not cross well
        • Only cross when they are free
    • Placental metabolizing enzymes
      • placenta has some P450 enzymes and can deactivate some drugs
34
Q

General Considerations for Drug Use in Lactation

A
  • Physiology of lactation
  • Benefits of breastfeeding
  • Duration of breastfeeding:
  • Healthy People 2020 Goals for infants exclusively breastfed
  • When is breastfeeding not advised?
35
Q

General Information for Drug Use in Lactation:

Physiology of Lactation

A
  • Physiology of lactation
    • Progesterone decreases abruptly after delivery
      • allows prolactin to stimulate production of breast milk
      • After delivery, the baby stimulates production of prolactin
      • Breast emptying also stimulates production
    • Oxytocin stimulates milk ejection by causing contraction of myoepithelial cells in alveoli and small milk ducts
      • baby stimulates oxytocin production after delivery
    • Colostrum – the very first milk that is produced in the 1st 48 hours after birth
      • Very small amount that’s rich in antioxidants and immunoglobulins
      • If the mother is on high concentrations of drugs, it could pass into the colostrum (Even lets large molecules in)
    • Foremilk: produced in the first 5 minutes of breast feeding
      • Mostly water, small amounts of lipids
    • Hindmilk:produced after the first 5 minutes of breast feeding
      • Mostly lipid
      • Lipophilic drugs will go mostly into hindmilk
36
Q

General Information for Drug Use in Lactation:

Benefits of breastfeeding to the infant

A
  • Benefits of breastfeeding
    • To the infant:
      • Decreases a wide range of infectious diseases
        • lowers incidence and/or severity
        • Reduce otitis media, meningitis
      • Decreased postneonatal infant mortality
      • Decreased rates of SIDS
      • Decreased incidence of diabetes, overweight and obesity, hypercholesterolemia, asthma, lymphoma, leukemia, Hodgkin disease
      • Slightly enhanced cognitive development on performance tests
      • Provides analgesia during painful procedures
37
Q

General Information for Drug Use in Lactation:

Benefits of breastfeeing to the mother

A
  • Breastfeeding benefits To the mother:
    • Decreased postpartum bleeding and more rapid uterine involution
    • Decreased menstrual blood loss
    • Increased child spacing
    • Earlier return to pre-pregnancy weight
    • Weigh loss
    • Decreased risk of breast cancer and ovarian cancer
    • Decreased risk of hip fractures and osteoporosis in the postmenopausal period
38
Q

General Information for Drug Use in Lactation:

Benefits of breastfeeding to the community

A
  • Benefits of breastfeeding To the community:
    • Decreased annual health care costs
    • Decreased parental employee absenteeism
    • Decreased environmental burden and energy demands
39
Q

General Information for Drug Use in Lactation:

Duration of breastfeeding

A
  • Duration of breastfeeding:
    • 6 months exclusive breastfeeding
      • no other nourishment except breast milk
    • Continue for 1 year
    • Then, until mutually desired
40
Q

General Information for Drug Use in Lactation:

Healthy People 2020 Goals for infants exclusively breastfed

A
  • Healthy People 2020 Goals for infants exclusively breastfed:
    • 3 months 46.2%
    • 6 months 25.5%
41
Q

General Information for Drug Use in Lactation:

When is breastfeeding not advised

A
  • When is breastfeeding not advised?
    • Infant diagnosed with galactosemia
    • Mother Has been infected with HIV
    • Mother on antiretroviral medications
    • Mother has untreated, active tuberculosis
    • Mother Is infected with human T-cell lymphotropic virus type I or II
    • Mother Is using or is dependent upon illicit drugs
    • Mother Is taking prescribed cancer chemotherapy agents that interfere with DNA replication and cell division
    • Mother is undergoing radiation therapy
42
Q

Factors to Consider for Drug Use During Lactation

A
  • Molecular weight
  • Lipid solubility
  • Maternal plasma level of drug
  • Protein binding
  • Ionization
  • Bioavailability
  • Milk/Plasma ratio
  • Relative infant dose
  • Infant factors
  • Options to minimize infant exposure to drugs in breastmilk
43
Q

Factors to Consider for Drug Use During Lactation:

Molecular Weight

A
  • Molecular weight
    • Low molecular weight drugs are more likely to transfer
    • Colostrum allows large molecular weight drugs to transfer
44
Q

Factors to Consider for Drug Use During Lactation:

lipid solubility

A
  • Lipid solubility
    • If the drug is lipophilic, it is more likely to transfer into the milk
45
Q

Factors to Consider for Drug Use During Lactation:

Maternal plasma level of drug

A
  • Maternal plasma level of drug
    • If the level is low in the mother, it is less likely to transfer into the milk
46
Q

Factors to Consider for Drug Use During Lactation:

Protein binding

A
  • Protein binding
    • Highly protein bound drugs do not transfer into the milk
    • For warfarin, the protein binding outweighs the half-life and warfarin does not cross into the breast milk
47
Q

Factors to Consider for Drug Use During Lactation:

Ionization

A
  • Ionization
    • Ionized drugs are less likely to transfer to the milk
48
Q

Factors to Consider for Drug Use During Lactation:

Bioavailability

A
  • Bioavailability
    • The baby’s liver can sequester some drugs (makes them inactive)
49
Q

Factors to Consider for Drug Use During Lactation:

Milk/Plasma ratio

A
  • Milk/Plasma ratio
    • Ratio of concentrations of a drug in milk and plasma may be used as a measure of a drug’s passage into breastmilk
      • 1 = equal amounts in milk and plasma
      • > 1 = drug is concentrated in the milk
      • < 1 = drug is concentrated in the plasma
50
Q

Factors to Consider for Drug Use During Lactation:

Relative Infant Dose

A
  • Relative infant dose
    • Standardized means of referencing infant exposure to maternal exposure on a dose/weight basis
    • RID (%) = absolute infant dose (mg/kg/day) via milk
      • maternal dose (mg/kg/day)
      • < 10% = acceptable for breast feeding
      • > 25% = unacceptable for breast feeding
      • Between 10 – 25% → must consider the effects on the baby
51
Q

Factors to Consider for Drug Use During Lactation:

Infant Factors

A
  • Infant factors
    • Drug clearance
      • Can the baby clear the drug?
        • They do not have full renal/liver function for several months after birth
    • Reduced stability of red cell membrane in neonates
      • Will the drug promote hemolysis
      • Do not give sulfonamides to babies
    • Immaturity of the blood-brain-barrier
      • If the drug crosses in adults, it will cross much easier in babies
    • Pharmacogenetics
      • Genetic polymorphisms
52
Q

Factors to Consider for Drug Use During Lactation:

Options to minimize infant exposure to drugs in breastmilk

A
  • Options to minimize infant exposure to drugs in breastmilk:
    • Breastfeed before medication is given
    • Pump the milk, then dump it
      • If you skip feedings, milk production will decrease
    • Recommend a drug with a short half-life if possible
    • Pick a different route of drug delivery
    • Pump milk and freeze it for a time when it is needed
    • Stop breast feeding if other options don’t exist
53
Q

Drugs Affecting Lactation

A
  • Drugs that decrease milk ejection
  • Drugs that decrease milk production
  • Drugs that increase milk supply (galactagogues)
54
Q

Drugs Affecting Lactation:

Drugs that decrease milk ejection

A
  • Drugs that decrease milk ejection
    • Ethanol
      • Shown to decrease milk letdown, increase agitation in babies
      • Barley in beer increases prolactin, but the alcohol in beer will inhibit oxytocin
55
Q

Drugs Affecting Lactation:

Drugs that decrease milk production

A
  • Drugs that decrease milk production
    • Anticholinergics (cough/cold products)
    • Diuretics
    • Dopaminergic agents
    • Estrogens
      • Also causes an increase in blood clots
    • Cigarette smoking
    • Sympathomimetic vasoconstrictors (pseudoephedrine) – Big deal for the first few weeks of breastfeeding.
56
Q

Drugs Affecting Lactation:

Drugs that increase milk supply

A
  • Drugs that increase milk supply (galactagogues)
    • Dopamine antagonists (metoclopramide)
    • Fenugreek (herbal)
      • No good evidence

2016 Endocrine (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions