exam 1 Flashcards
(50 cards)
Factors to consider for Drug Use During Pregnancy
Look at all factors together!
- maternal blood concentration
- molecular weight
- plasma elimination half-life
- lipid solubility
- ionization at physiologic pH
- plasma protein binding
- placental metabolizing enzymes
_______ - stimulates production of milk
prolactin
_______ - stimulates ejection of milk
oxytocin
Physiology of lactation:
o Abrupt decrease in progesterone after delivery allows __________ to stimulate production of breast milk
o ________ stimulates milk ejection by causing contraction of myoepithelial cells in alveoli and small milk ducts
o ________ produced during the 1st few days, small quantity; full of immunoglobulins & anti-oxidants
o ________ milk produced in the first 5 minutes of nursing, 2-3% lipid
o ________ produced after 5 minutes of nursing, 10% lipid; more nutrition/calories
- prolactin
- oxytocin
- colostrum
- foremilk
- hindmilk
Duration of breastfeeding:
exclusively 4-6 months
Factors to consider for Drug Use During Lactation
Look at all factors together!
- molecular weight
- lipid solubility
- maternal plasma level of drug
- plasma protein binding
- ionization at physiologic pH
- bioavailability
Milk/plasma ratio
- Ratio of concentrations of a drug in milk and plasma may be used as a measure of a drug’s passage into breastmilk
o Milk/plasma ratio > 1 means:
(more/less) drug in the milk ?
more drug in the milk
o Milk/plasma ratio = 1 means:
baby is taking in drug (ex. Alcohol)
Relative infant dose
- Standardized means of referencing infant exposure to maternal exposure on a dose/weight basis
Relative infant dose: RID (%)
= absolute infant dose (mg/kg/day) via milk / maternal dose (mg/kg/day)
Drugs that decrease milk ejection
o Ethanol – inhibits oxytocin
Drugs that decrease milk production
– decrease prolactin o Anticholinergics o Diuretics o Dopaminergic agents o Estrogens o Cigarette smoking o Sympathomimetic vasoconstrictors
Drugs that increase milk supply (galactagogues)
o Dopamine antagonists (metoclopramide)
o Fenugreek
Contraception effectiveness are measured by ________ ____ in the first year of use.
failure rates
Contraception typical use:
= unintended or accidental pregnancy during the year but not all use the method perfectly for a year; condom broke, not consistently, missing dose
Contraception perfect use:
= % of couples who used the method correctly and consistently everytime they had intercourse for a year but had an accidental pregnancy (even if used correctly and consistently)
Non-Hormonal Forms of Contraception:
- lactational amenorrhea
- fertility awareness-based (cycle beads, symptothermal)
- barrier techniques (diaphragm, cervical cap, male condom, female condom)
- spermicides
- sponge
Latex condom can be used with _____-based lubricants
water
What types of method are more effective?
IUD, implanon, sterilization
What types of method tend to be used longer (higher continuation rates) and are more effective?
Hormonal methods
Diaphragm
- Fill with spermicides and covers cervix (dome shape);
- Can be put in 6 hours before needed and can be left in at least 6 hrs and no more than 24 hours (longer can cause toxic shock syndrome);
- If more than one intercourse within the time period need to use a condom
Cervical cap
- smaller in size and fits snuggly;
- fill with spermicide and can be put/left in 6/6 hrs and can be left in up to 48 hours
- if longer Toxic shock syndrome
Male condom - latex
- Oil-based drug formulations and lubricants can decrease the barrier strength of latex by 90% in 60 seconds
- **Latex condom can be used with water-based lubricants
- can prevent bacterial STDs
