What are 4 physiological changes in a pregger woman that influence the effect of drugs on the body?
1. GI changes: decrease gastric acid secretion, high pH
2. CV changes: plasma volume expansion, increased cardiac output (which influences change in drug distribution and elimination)
3. Blood composition: decreased albumin levels (changed binding of drugs)
4. Renal changes: increased blood flow and increased GFR (increased renal clearance of drugs)
What are the changes in hepatic enzyme activity in pregger women?
Increased metabolism by CYP3A4, CYP2D6 (often need more drugs to get same effect. Example: methadone)
Caudal regression syndrome is associated with what disorder?
Maternal diabetes mellitus.
This drug was tested in dogs, which metabolize drugs differently than we do. The dogs were fine, but in humans it caused severe limb abnormalities in children (there was specific link between time of exposure and defect). This taught us that the placenta is not a barrier, we need to pick our testing animal carefully and that there is a precise relationship between time of exposure to drug and the defect
FDA category A drug
Category A: No risk, human studies done
FDA category B drug
Category B: Animal studies show no risk but no human studies OR animal studies show increased risk and human studies show no risk.
FDA category C drug
Category C: Animal studies show increased risk, no human studies OR no human or animal studies
FDA category D drug
Category D: Proven risk for humans, but benefits may outweigh risks
FDA category N drug
Category N: Drug is not classified
FDA category X drug
Category X: Proven risk for humans, animals or both, risks outweigh benefits.
Example of Category A drug
Prenatal vitamins, T4
Example of Category B drugs
Penicillin or Acetaminophen
Example of Category C drugs
Nifedipine, Sumatriptan (migraine meds) Lamotrigine
Example of Category X drug
What category do ACE inhibitors fall under?
C and D
Example of Category D drug
What can ACE inhibitors cause in children
Fetal Renal failure
Anti-seizure medications increase your risk for
Neural tube defects
What's an example of an acne medication that can cause spontaneous abortion in 40% of cases
Based on the trimester of warfarin exposure, what are the possible effects on the fetus?
1st trimester: Fetal Warfarin Syndrome
2nd trimester: Mental retardation, blindness
3rd trimester: hemorrhage, stillbirth
What kind of problems can result from the use of Diethylstilbestrol (DES)
Mullerian Anomalies or Vaginal Clear Cell Carcinoma
What can DES be used for now (not contraception)
Palliative care for inoperable breast cancer and progressive inoperable prostate cancer
What are the adverse effects of using Metronidazole in pregnancy?
NONE in pregnancy but....
1. Carcinogenic in rodents
2. Mutagenic in bacteria
3. No associated malformation in humans
4. Avoid 1st trimester
What are the adverse effects of using Sulfonamides during pregnancy?
1. Competes with bilirubin-binding sites
2. Potential for hyperbilirubinemia
3. No known malformations
What are the adverse effects of using Aminoglycosides in pregnancy??
1. Potential for ototoxicity (ear problems) (1-2%)
2. No associated malformations
What are some adverse effects of Quinolones in pregnancy?
1. High affinity for bone/cartilage
2. Arthropathy in children
3. No known malformations
What's bad about drinking whisky* while pregnancy?
￼￼￼￼≥ 3 oz. EtOH/day: 50% abnormal
1-2 oz EtOH/day:functional & growth disturbances
<1 oz EtOH/day: usually no effect
Real bad outcome of drinking alcohol while pregnancy (hint: it has FETAL and ALCHOL in the name)
Fetal Alcohol Syndrome:
• Absent Philtrum (space between base of nose and upper lip)
• Midface Hypoplasia
• Low Nasal Bridge
• Low Set Ears
• Microcephaly (small head)
• Shortened Palpebral Fissures (opening between the eye lids)
On a practice question, saddle nose came up. I jumped straight to Syphilis. Don't do that, it could be FAS...
What's a bad outcome associated with cocaine use during pregnancy (that's right folks, cocaine)
What about using LSD during pregnancy?
NO CLINICAL EFFECTS. Huh.