19. Pharmacology in Pregnancy / Breast Feeding Flashcards Preview

3rd Year - Reproductive Diseases > 19. Pharmacology in Pregnancy / Breast Feeding > Flashcards

Flashcards in 19. Pharmacology in Pregnancy / Breast Feeding Deck (15)
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1
Q

What are common medications a woman may be on during Pregnancy / Childbirth / Lactation?

A
  1. Hypertension
  2. Asthma
  3. Epilepsy
  4. Migraine
  5. Mental Health Disorder - Depression / Anxiety
  6. Long-Term Anticoagulant Therapy - e.g. A. Fib.
2
Q

What are the 4 basic Kinetic Processes, which can change during pregnancy?

A
  1. Absorption (Administration)
  2. Distribution
  3. Metabilism (and Elimination)
  4. Excretion
3
Q

What Absorption Changes occur in Pregnancy, at:

  1. Oral Route?
  2. Intramuscular Route?
  3. Inhalation Route?
A
  1. Increase in Gastric Emptying and Gut Motility / May be more difficult due to Morning Sickness
  2. Blood flow may be Increased, so absorption may also increase using this route
  3. Increased Cardiac Output and Decreased Tidal Volume may cause an Increased Absorption using this Route
4
Q

What Distribution Changes occur in Pregnancy?

A
  1. Increased in Plasma Volume and Fat - Increased Vd

2. Greater Dilution of Plasma, decreasing relative amount of Plasma Protein - Increased Fraction of Free Drug

5
Q

What Metabolism Changes occur in Pregnancy?

A

Oestorgen and Progestogens can Induce / Inhibit Liver P450 Enzymes - Increasing / Reducing Metabolism

6
Q

What Excretion Changes occur in Pregnancy?

A

Glomerular Filtration Rate is increased by 50% - Increased Excretion of Many Drugs
This can reduce the plasma concentration, and necessitate an increase in dose of Renally Cleared Drugs

7
Q

What are the Pharmacodynamic Changes which occur in Pregnancy?

A

Pregnancy may affect the Drugs Site of Action / Receptor:

  1. Concentration of Drugs / Metabolites at Sites of Biological Action (Changes in Blood Flow)
  2. Mechanism of Action (Changes in Receptors)
  3. Efficacy may be different
  4. Adverse effects may be different
8
Q

What are the functions of the Placenta?

A
  1. Attach the Foetus to the Uterine Wall
  2. Provide nutrients to the Foetus - O2 / Glucose / Amino Acids / Vitamins / Ions / Lipids, Fatty Acids and Glycerol
  3. Allow the Foetus to transfer Waste Product to the Mothers Blood - CO2 / Urea
9
Q

What does Placenta Transfer depend on?

A
  1. Molecular Weight - Smaller Sizes will cross more easily
  2. Polarity - Non-Polar Cross more Readily
  3. Lipid Solubility - Lipid Soluble Drugs will Cross
  4. Placenta may metabolise some drugs
    Note - Safest to assume all drugs will cross the Placenta
10
Q

What differs in the Foetal Pharmacokinetics?

A
  1. Distribution - Circulation is different / Less Protein binding / Little Fat / Relatively more Blood Flow to Brain
  2. Metabolism - Less Enzyme Activity (increase with Gestation) / Different Isoenzymes to Adults
  3. Excretion - Into Amniotic Fluid where they can accumulate (Swallowed and can allow recirculation)
11
Q

What is the difference between:

  1. Teratogenic?
  2. Fetotoxicity?
A
  1. Teratogenic is in the First Trimester

2. Fetotoxicity is in the Second / Third Trimester

12
Q

By what Methods does Teratogenicity work?

A
  1. Folate Antagonism - DNA Formation / Cell Production
  2. Neural Crest Cell Disruption - Retinoid Drugs
  3. Endocrine Disruption - Sex Hormones
  4. Oxidative Stress
  5. Vascular Disruption
  6. Specific Receptor (or Enzyme) Mediated Teratogenesis - NSAID’s
    Note - Biggest Risk is Organogenesis
13
Q

What are the possible issues of Fetotoxicity?

A
  1. Growth Retardation
  2. Structural Malformations
  3. Foetal Death
  4. Functional Impairment
  5. Carcinogenesis
    E.g. ACE Inhinhibitors / ARB’s
14
Q

What are the Common Teratogens to avoid during Pregnancy?

A
  1. Anticonvulsants - Valproate / Carbamazepine / Phenytoin
  2. Anticoagulants - Warfarin
  3. Antihypertensives - ACE Inhibitors / ARB’s
  4. NSAID’s
  5. Alcohol
  6. Retinoids
15
Q

What are Drugs to avoid in Breastfeeding?

A
  1. Cytotoxics
  2. Immunosuppressants
  3. Anti-Convulsants (Not all)
  4. Drugs of Abuse
  5. Amiodarone
  6. Lithium
  7. Radio-Iodine

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