Therapeutics in Pregnancy Flashcards

1
Q

do the pharmacokinetics of drugs change during pregnancy

A

yes

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2
Q

pharmacokinetics changes of drugs during pregnancy widely includes

A
  • absorption: oral; IM/SC/transdermal
  • distribution
  • metabolism
  • excretion: renal; hepatobiliary
    (ADME)
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3
Q

oral absorption has what pharmacokinetic change in pregnancy

A

tends to decrease

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4
Q

why does oral absorption tend to decrease as a pharmacokinetic change in pregnancy

A
  • delayed gastric emptying due to progesterone (smooth muscle relaxant)
  • reduction in gut motility due to physical effect of uterus
  • decreased gastric acid production-> increases gut pH -> variable effects on drug absorption
  • nausea and vomiting that may occur from morning sickness
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5
Q

how is oral absorption decrease attenuated in some cases

A

increases in gastrointestinal blood flow

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6
Q

why does IM/SC/transdermal absorption tend to increase as a pharmacokinetic change in pregnancy

A
  • there is increased regional blood flow
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7
Q

IM/SC/transdermal absorption has what pharmacokinetic change in pregnancy

A

tends to increase

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8
Q

some significant changes in distribution that occur during pregnancy result in which - decreased or increased volume of distribution of drugs?

A

increased volume of distribution

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9
Q

what do the increased distributions of volume affect in medication administration

A

in general, greater dosage of drug required to achieve a therapeutic effect

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10
Q

what happens to total plasma volume throughout pregnancy

A
  • increases
  • increased total body water (increase total plasma volume)
    -> affects serum protein
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11
Q

what drugs does increased body fat from pregnancy increase the volume of distribution for

A

lipophilic drugs

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12
Q

describe how can increase unbound fraction of medications -> greater therapeutic effect for a given dose in some medications

A
  • decreased serum protein (dilutional)
  • serum proteins bind drugs in bloodstream => more free drug in bloodstream
  • can result in greater therapeutic effect for a given dose in pregnant vs non pregnant
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13
Q

what is volume of distribution in pharmacokinetics

A

distribution of a drug within the body relative to its concentration in the bloodstream

drug distributes more extensively throughout the body beyond the bloodstream. It suggests that the drug is distributed into tissues and organs beyond the bloodstream

more widely distributed within the body’s compartments

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14
Q

what changes in pregnancy lead to decreased serum protein

A
  • serum protein is protein levels in blood serum
  • during pregnancy plasma volume increases which has diluting effect on serum protein
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15
Q

how does metabolism of drug change during pregnancy

A

drug clearance may be increased or decreased based on the particular metabolic pathway

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16
Q

during pregnancy what happens to hepatic (liver) enzymes, which can have an effect on drug metabolism

A
  • activity of hepatic (liver) enzymes can be either inhibited or induced by pregnancy hormones (eg/ progesterone - induce; oestrogen - inhibit)
    -> variable effects, highly dependent on genetics
17
Q

during pregnancy does hepatic blood flow change and can this have an effect on drug metabolism

A
  • changes
  • which can affect hepatic clearance of some drugs
18
Q

during pregnancy there is significant increase in ___ excretion

A

renal excretion

19
Q

why is there an increase in renal excretion during pregnancy

A
  • GFR increases during pregnancy
20
Q

why does GFR increase during pregnancy

A

mainly due to increase in cardiac output during pregnancy

21
Q

what would increase renal excretion in pregnancy have a significant imapct on

A

renally cleared drugs

22
Q

what does the concomitant increase of tubular resorption in pregnancy result in

A
  • unpredictable effects on renal clearance of some drugs
23
Q

what is the relevance of the unpredictable effects of increased tubular resorption on renal clearance of some drugs

A

renal clearance not always directly proportional to renal changes in GFR

24
Q

in general, does renal excretion of drugs in pregnancy decrease or increase

A

increase

25
Q

in pregnancy does hepatobiliary (liver, bile ducts, and / or gallbladder) excretion increase or decrease

A

decrease

26
Q

why does hepatobiliary excretion of drugs reduce during pregnancy

A

effects of oestrogen

27
Q

some medications will require modification of therapy when:

A
  • during pregnancy
  • after birth
28
Q

based on pharmacokinetic changes of drug (increase / decrease in absorption, metabolism, distribution, or renal and hepatobiliary excretion in body) during pregnancy what may be required

A

modification of therapy
- change in amount or frequency of drugs taken

29
Q

drug disposition changes occur throughout pregnancy - T or F

A

true

30
Q

are changes the same for people using same drug

A

inter-individual variability is common