Wk 2 - Pregnancy Pharmacology Flashcards
Placental exchange routes:
Passive transfer (most common)
Facilitated diffusion (minor role)
Active transport
Phagocytosis / pinocytosis
Placental passive transfer occurs across concentration gradient, and is affected by:
Surface area
Thickness of membrane
Drugs are most likely to cross placenta with these characteristics:
Low molecular weight
Lipid soluble
Un-ionized
Unbound to proteins
Decreased placental blood flow will…
…decrease drug transfer, and decrease drug clearance from fetus
Heparin is _____ for pregnant mothers because the molecules are ______ and won’t cross placenta
Safe
Large
Active transfer for placental transport requires ____ and ______ in placenta
Energy,
carrier proteins
P-gp _______ the fetus.
INHIBITION of P-gp will ______ fetal exposure to drugs (verapamil, cyclosporine inhibit p-gp).
Protects
increase exposure
These two drugs (and others) inhibit P-glycoprotein (which can as a result expose the fetus to harmful drugs):
verapamil, cyclosporine
More breast milk = more ______ the drug
diluted
_____ pH drug more likely to remain in plasma vs milk.
Higher
Lipophilic drugs will _______ milk
transfer into
Low protein binding of drug will result in _______ milk
transfer into
Low molecular weight drugs will _________ milk
transfer into
Low ionized drugs will _______ milk
transfer into
Only ______ drug will cross placenta
unbound “free drug” crosses (i.e. highly protein bound drugs WON’T cross placenta)
Pregnancy registries purpose is to
monitor outcomes of pregnancies exposed to medical products
Pregnancy registries are ______
Prospective observational data; NOT random controlled trials
The anti-epileptic drug can cause _______ in the baby
lamotrigine / lamictal; cleft palette
This acne drug can cause these congenital malformations in the fetus:
Isotretinoin / Accutane; abnormalities of the face, eyes, ears, skull, central nervous system, cardiovascular system, thymus, and parathyroid glands
This SSRI antidepressant can cause these congenital malformations in the fetus ______
Paxil / paroxetine; cardiac (ASD, VSD)
In pregnancy, plasma albumin ______, and unbound drug _______
plasma albumin decreases
unbound drug increases
In pregnancy, both body weight and plasma volume ______, and volume of distribution _______
increases
increases
In pregnancy, body fat ______, and volume of distribution of lipophilic drugs _______
increases
increases
In pregnancy, gastric motility is ________, leading to ______ drug absorption
delayed
delayed
In pregnancy, hepatic drug flow ______, and drug clearance _______
increases
increases
In pregnancy, renal drug flow and GFR ______, and renal clearance _______
increases
increases
In pregnancy, gastric acid secretion ______, and oral bioavailability of anionic drugs ________.
decreases
decreases
In prenancy, CYP450 enzyme activity and drug metabolism _______
changes
In pregnancy, ________ result in decreased drug absorption, bioavailability, and blood concentration
nausea and vomiting
