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Pharmacology > Drugs in Pregnancy > Flashcards

Drugs in Pregnancy Flashcards

1
Q

What are the different effects of pregnancy to intake of ftug?

A
  1. DEC in intestinal motility -> enlarging uterues & hormones
  2. INC gastric pH -> weak acids more ionized
  3. Nausea & vomiting
  4. INC in maternal blood flow to the skin
  5. Hyperventilation
  6. INC body water -> plasma volume expands to 1.5L
  7. DEC plasma albumin conc
  8. Progressive INC in renal blood flow
  9. Altered oral BA & hepa elimination
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2
Q

What are the drugs that are largely bound to albumin circulation therefore inc their conc during pregnancy?

A

Diazepam
Phenytoin
Valproate
Warfarin

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3
Q

What drugs are given to relax uterine contractions in premature labor?

A

Terbutaline & Isoxsuprine

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4
Q

What are 2 drugs that can cause serious harm if taken by preggos? Why?

A

Diethylstilbestrol (Desplex)
-> used to prevent abortion, miscarriage, & premature labor
-> given at <18 wks AOG –> adenocarcinoma of cervix, vagina

Thalidomide
-> was given to prevent nausea & vomiting
-> babies were born w/ flipper-like extremities (Phocomelia)

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5
Q

What is the study of birth defects & their etiology?

A

Teratology

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6
Q

What are the 4 diff teratogens?

A

Recreational teratogens
Maternal diseases and infections
Environmental teratogens
Pharmaceutical teratogens

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7
Q

What is the primary effect of teratogens to fetus?

A

Growth restriction in utero –> SGA

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8
Q

What are diff recreational teratogens?

A

Tobacco/Cigarettes
Illegal drugs
alcohol

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9
Q

What are the facial features to confirm fetal alcohol syndrome? How many of these should be seen to confirm this condition?

A

> or equal to 2 required

Short palpebral fissures
Indistinct philtrum
Thin upper lip

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10
Q

What maternal diseases and infections are teratogens?

A

DM type 1, 2, GDM
TORCH = Topxoplasma, Others (HIV, Varicella, syphilis), Rubella, CMV, HSV
Zika virus

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11
Q

What are the diff envrionmntal teratogen?

A

Chemicals: Hg, Arsenic, lead
Ionizing radiation
Non-ionizing radioation: ultrasound, MRI, microwave, radiofrequency

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12
Q

What is CDC’s recom exposure to radiation for preggos?

A

not > 0.1Gy

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13
Q

Whata re the different phatmaceutical teratogens?

A

Thalidomide
Diethylstilbestrol
ACEis, ARBs, RAAS inhibis
Antiepileptic: Valproic acid, Phenytoin, Carbamazepine
Warfarin
Retinoids

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14
Q

What are the 3 factors that affect drug passage to fetus?

A
  1. Disruption of folic acid absorption/metab
  2. Altered fetal genetic composition
  3. altered processes of cell diff
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15
Q

What are the diff things that can disrupt folic acid absorption in preggos?

A

Carbamazepine
Iamotrigine
Phenobarbital
Valproic acid
Phenytoin
Neural tube defects –> Meningomyelocele
Cardiac defects
Oral clefts

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16
Q

When should folic acid be taken?

A

1st trim of pregnancy and women planning to get pregnant

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17
Q

What are examples of altered fetal genetic composition?

A
  1. Gene mutation resulting in low levels of Epoxide hydrolase + Exposure to drugs: Phenytoin/Carbamazepine/Phenobarbital
  2. Mutation + Folic acid def —> neural tube defects
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18
Q

What drugs can alter process of cell differentiation? How?

A

Retinoids (Isotretinoin), Valproic acid

Causes homebox genes to malfunction —> Disorganized or chaotic gene expression —> Cardiac, brain, cranium abnormalities

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19
Q

What are homeobox genes?

A

Nuclear proteins/transcription factors that control expression of other developmentally important genes

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20
Q

What are physiochemical properties of drugs that affect preggos?

A

Lipid solubility
Degree of ionization
Molecular size
Degree of protein binding
Basic drugs

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21
Q

What is an IV anesthetic that is given right before an Episiotomy or perineal cut before delivery and can easily reach the bby causing sedation & apnea?

A

Thopental

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22
Q

How does the degree of ionization affect pregnant women?

A

Higher the degree of ionization = less likely to cross the placenta

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23
Q

What drug can depolarize neuromucular blocker/muscle relaxant used prior to intubuation or cesarean secretion?

A

Succinylcholine

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24
Q

What is the rel of a drug’s molecular size to preggos? What drugs should we be aware of giving?

A

Small molecular size = can easily cross the placenta

Morphine
Alcohol
Warfarin

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25
Q

What is the anticoagulant of choice in preggos?

A

Heparin —> LMW

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26
Q

What is the rel of degree of protein binding to preggos? What are examples of these?

A

Drugs that bind to maternal proteins will cross less

Igs = large so they can cross

Propylthiouracil = more bound to maternal proteins = crosses less

Betamethasone = minimally-bound to maternal proteins -> preterm labor -> stimulates fetal surfactant production

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27
Q

How are basic drugs able to cross the placenta?

A

More ionized in the fetal comprtament —> ion trapping & higher fetal levels

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28
Q

What form of glucocorticoid is used in preggos? Why?

A

Prednisolone

Bcos this is inactivated by the placenta therefore, it won’t cross the placenta & affect the bby

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29
Q

Bcos of the presence of efflux pumps in the placenta, drugs can be ejected & cannot cross the placenta. What are these proteins?

A

P-glycoprotein
Breast cancer resistance protein

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30
Q

When does fertilization take place? How do you compute for AOG?

A

2 weeks after last menstrual period

AOG: count from LMP

31
Q

How can teratogens affect the getus during pre-impalantion (1-2wks after fertilization)?

A

“All or nonw” = either lethal/no effect

32
Q

How can teratogens affect the fetus during embryonic period (>2-8 wks after fertilzation)?

A

Anatomic abnormalities
(Bcos this is the time of organogenesis)

33
Q

How can teratogens affect the fetus during fetal period (>8-38wks until birth)?

A

Growth & Devt -> Size & Physiologic/functional abnormalities

34
Q

What can happen if Warfarin is administered during the embryonic or fetal period?

A

Embryonic: Bone abnormalities
Fetal: bleeding tendencies

35
Q

At what age of fetal devt are the CNS, heart, and external genitalia developing?

A

CNS: 6th wk to 38th wk
Heart: 6th-8th wk
External genitalia: 9th-38th wk

36
Q

What is the effect of Diabetes to babies?

A

Large gestational age (LGA)/Big babies

37
Q

What are the US-FDA drug categories for prengnat women?

A

Categ A: Controlled studies shows nO RISK
Categ B: NO EVIDENCE OF RISK in humans
Categ C: Risk CANNOT BE RULED OUT
Categ D: (+) EVIDENCE of risk
Categ X: C/I in pregnancy

38
Q

What US-FDA drug category do Levothyrozine, K supplements, prenatal vitamins fall under?

A

Category A: controlled studies shows no risk

39
Q

What US-FDA drug category do Ampicillin, Paracetamol fall under?

A

Category B: NO EVIDENCE of risk in humans

40
Q

What US-FDA drug category do Amlodipine, Tramadol, & Gapanentin fall under?

A

Categ C: risk CANNOT BE RULED OUT

41
Q

What US-FDA drug category do Diazepam & other Benzodiazepines fall under?

A

Categ D: POSITIVE EVIDENCE of risk

42
Q

What US-FDA drug category do THalidomide, HMGCoA reductase inhibtors, fall under?

A

Categ X: C/I in pregnancy

43
Q

What is the pregnancy & lactation labeling rule?

A

Provides accessible & understandible information to pregnant & lactating mothers of the risks a drug may have upon intake

44
Q

Give all 9 drugs under Category X

A
  1. Thalidomide
  2. Potential teratogens: anticancer drugs, Mycophenolate mofetil, ANtithyroid drugs
  3. Retinoids
  4. HMGCoA reductase inhib (Statins)
  5. Misoprostol
  6. Bendzodiazepines
  7. Warfarin
  8. Androgens
  9. Ergots
45
Q

What are the common conditions encountered during pregnancy?

A

Pain & fever
Infections
Allergies
Colds
HTN
Asthma
Epilepsy
DM

46
Q

What is the safest drug for pain & or fever in preggos?

A

Paracetamol

47
Q

When can we prescribe NSAIDs for pregnant women?

A

1st trim = safe to use Ibuprofen & Aspirins

3rd trimester = if it exceeds 72h —> pulmonary HTN, oligohydramnios, intraventricula rhemorrhage

48
Q

When should preggos avoid NSAIDs?

A

20wks or more

49
Q

What are the categories of NSAIDs?

A

1st-2nd trim: Categ C
3rd trim: Categ D

50
Q

What are safe drugs for infections?

A

B lactams: Penicillin, ampicillin, amox, cephalosporins
Metronidazole
Macrolides: Erythromycin, Clarithromycin
Anti-TB drugs

51
Q

What drugs are used for allergies in pregnant women?

A

H1 blockers: Diphenhydramine, Dimenhydrinate, Doxylamine, Meclizine

52
Q

What drug for allergy should be avoided in preggos?

A

Bromfirenamine

53
Q

What drugs are safe to prescribe for cold of preggos?

A

Topical decongestants: Oxymetazoline

54
Q

What is the DOC for chronic HTN in preggos?

A

Methyldopa

55
Q

What drug is used for preeclampsia?

A

Hydralazine

56
Q

What HTN can bse used in preterm labor for preggos?

A

Nifedipine

57
Q

What are the preferred glucocorticoids for asthma of preggos? What are other safe drugs for asthma?

A

Prednisone & Prednisolone

Other drugs:
Salbutamol, Formoterol
INhaled corticosteroids -> give small dose; easily absorbed

58
Q

What corticosteroid cannot be prescribed to preggos to tx asthma? Why?

A

Methylprednisolone = risk of CLEFT LIP/PALATE if given <10wks AOG

59
Q

What drug for epilepsy has the greatest risk of AEs in pregnant women? What are these conditions that can develop?

A

Valproic acid

Risks:
Neural tube defects
Significantly lower IQ scores

60
Q

What are the hormones INC during pregnancy?

A

Human placental lactogen
Prolactin
Cortisol
Progesterone

61
Q

What is the DOC for diabetes in pregnancy?

A

Insulin -> cannot cross placenta

62
Q

What are the diff drugs that can be admin to preggos for DM? What is their FDA categ?

A

Categ B:
Aspart
Lispro
NPH
Detemir
Regular insulin

63
Q

What are anti-DM drugs not recommended in preggos?

A

Metformin, Dapagliflozin, Liraglutide

64
Q

What is the use of THalidomide & its C/I to preggos?

A

Indication: Leprosy
C/I: Phocomelia

65
Q

What is the use of HMGCoA inhibitors (Statins) & its C/I to preggos?

A

Indication: Dyslipidemia
C/I: Spontaneou abortion, fetal death, congenital anomalies

66
Q

What statins are preferred if need more hydrophilic statins?

A

Rosuvastatin or Pravastatin (Lipophobic)

67
Q

What is the use of Misoprostol & its C/I to preggos?

A

Indication: Anti-ulcer drug
C/I: ABortifacient (causes abortion)

If taken @ 1st trim = Moebius syndrome (form of facial paralysis)

68
Q

What is the use of Benzodiazepines & its C/I to preggos?

A

I: Sedative, hypnotic
C/I: Facial clefting if taken @ 1st trim

69
Q

What is the use of Warfarin & its C/I to preggos?

A

I: AC
C/I: Embryopathy & Fetopathy
-> @1st trim = abn fetal long bones
-> @fetal period = hemorrhage

70
Q

What is the use of Androgens & its C/I to preggos?

A

I: Replacement therapy of HYpogonadism
C/I: Masculinizing effects

71
Q

What is the use of Ergots (Ergotamine & Ergonovine) & its C/I to preggos?

A

Ergotamine
I: Migraine
C/I: Low birth wt & preterm birth

Ergonovine
I: Powerful uterine stimulant
C/I: avoided in preg

72
Q

What is the use of Retinoid & its C/I to preggos?

A

I: Anti-acne & Anti-psoriasis
C/I: Embryopathy (CNS, <3, Thymus, facial defects) —> Microtia, High forehead, Hypoplastic nasal bridge

73
Q

What anti-thyroid drug is avoided in 1st trimester bcos it can cause Aplasia cutis? When can it be used during preg?

A

Methimazole

@13 wks of gest

74
Q

What are recom non-drug tx for fever, pain, & diabetes & HTN in preggos?

A

Fever: hydration & sponge bath
Pain: warm compress
DM & HTN: dietary adjustments

Pharmacology (19 decks)

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