Drugs & Pregnancy

Question 1

3 physiologic changes in pregnant women that affect drug metabolism

Answer 1

1. increased volume
2. increased flow
3. reduced plasma protein binding

Question 2

What happens to GFR during pregnancy?

Answer 2

increased

Question 3

Rule of thumb for drugs in pregnany

Answer 3

None unless absolutely necessary

Question 4

Two main concerns when considering drug therapy in pregnant women…

Answer 4

teratogenic?

affect fetus near term?

Question 5

Which category?

animal/human studies demonstrate risk.

Risk outweighs benefits

Answer 5

Category X

Question 6

Which category?

Human studies demonstrate risk

potential benefits may outweigh risk

Answer 6

Cat D

Question 7

Which Category?

animal studies demonstrate risk, no human studies performed

benefits may outweigh risk

Answer 7

Cat C

Question 8

Under new label, 8.1 indicates not safe for…

Answer 8

pregnancy

Question 9

Under new label, 8.2 indicates not safe for…

Answer 9

lactation, nursing mothers

Question 10

Under new label, 8.3 indicates not safe for…

Answer 10

females and males of reproductive potential

Question 11

Why is drug absorption slowed in pregnancy?

Answer 11

high progesterone = slow gut motility/emptying

Question 12

Why are drugs more rapidly metabolized during pregnancy?

Answer 12

pregnancy induces hepatic metabolizing enzymes

Question 13

Why are drugs eliminated more rapidly during pregnancy?

Answer 13

increased RPF and GFR

Question 14

What causes the change in volume of distro, absorption, excretion, plasma binding during pregnancy?

Answer 14

increased blood volume

Question 15

The placenta is a _____ barrier that has many transporters on the surface, making it a ________

Answer 15

semipermeable

site of metabolism

Question 16

drugs that have crossed the placenta enter fetal circulation via
_________.

About ________ of the venous blood flow enters the fetal liver

Answer 16

umbilical v.

40-60% to fetal liver

Question 17

If the fetal liver only partially metabolizes a drug, what 2 mechanisms can allow the drug to re-enter the fetal ciruculation?

Answer 17

exit via umb. a. and subsequent reentry via umb. v.

OR

elimination in fetal urine and re-entry via swallowing amniotic fluid

Question 18

What lipid solubility diffuses rapidly across placenta?

Answer 18

lipophilic

Question 19

MW < ________ crosses placenta easily while > ________ crosses poorly.

Answer 19

< 500 = easy passage

> 1000 = poor passage

Question 20

Do ionized or non-ionized molecules pass the placenta more easily?

Answer 20

non-ionized

Question 21

What fetal transporter can pump drugs back into maternal circulation and out of fetal circ?

Answer 21

MDR-1

Question 22

Which 3 conditions during pregnancy may require treatment?

Answer 22

HTN

Hyperglycemia

Thyroid Hormone Replacement

Question 23

Diethyl stilbestrol taught us what?

Answer 23

teratogenic effects not always seen immediately

Question 24

What teratogen?

• intellectual disability
• underdeveloped top of ear
• short nose
• thin upper lip
• small eye openings
• low nasal bridge
• epicanthal folds
• indistinct philtrum
• curved fifth finger

Answer 24

FAS

Question 25

The buildup of ______ leads to FAS

Answer 25

acetaldehyde and EtOH

Question 26

Patient presents with: ``` saddle nose depressed nasal bridge epiphyseal stippling vertebral calcification short neck ```

Answer 26

warfarin syndrome

Question 27

What can be used instead of warfarin for mothers who need anticoagulation?

Answer 27

LMWH

Question 28

Describe the exposure needed for isotretinoin to cause birth defects...

Answer 28

once in first 3 weeks

Question 29

Women taking isotretinoin must follow the iPLEDGE program, which requires what?

Answer 29

neg preg 2 forms bc continue one month after therapy

Question 30

Which 4 anticonvulsants represent the safest option for pregnant women?

Answer 30

Gabapentin Levetiracetam Lamotrigine Clonazepam

Question 31

Which anticonvulsant is the most dangerous?

Answer 31

valproate

Question 32

Which anticonvulsant can cause the below? What is the condition called? - cleft lip/palate - congenital heart disease - slowed growth - mental deficiency

Answer 32

Phenytoin Fetal hydantoin syndrome

Question 33

Which anticonvulsant can cause the below? craniofacial anomalies developmental delay mental deficiency

Answer 33

Carbamazepine

Question 34

This anticonvulsant has a 20-fold incrase in neural tube defects

Answer 34

valproate

Question 35

Patient presents with: - short left forearm and absent thumb - left ulnar deviation, contracture of fingers at PIP - broad forehead, thin eyebrows - flat nasal bridge - thin upper lip

Answer 35

fetal valproate syndrome

Question 36

Ribavirin can cause...

Answer 36

intrauterine fetal death

Question 37

Is ribavirin teratogenic in men, women, or both?

Answer 37

both