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Flashcards in Pharm Deck (35)
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1
Q

What are the maternal adaptation in pregnancy?

A

expanded intravascular volume
increased min ventilation
increased progesterone activated hepatic metabolism
increased renal blood flow and GFR
increased thinning of fetomaternal barrier w/ advanced gestation
increased body fat
increased cardiac output
decreased peripheral vascular resistance for plasma volume expansion
decreased GI motility
decreased albumin

2
Q

What haps when intravascular volume is expanded?

A

body gets diluted –> higher dose MAY be needed to BUT there is less protein binding –> more drug in free space –> balances out

3
Q

Why do women get morning N&V?

A

the increase in progesterone

4
Q

Which maternal adaptation has the most impact on the body?

A

increase in renal blood flow and GFR

5
Q

Why do pregnant women get constipation?

A

decreased GI motility

6
Q

What haps when there is thinning of fetomaternal barrier w/ advanced gestation?

A

when mom is infxn’d the baby is at very high risk for same infxn

7
Q

What is the purpose of the placenta?

A

prevents the mixing of the blood between mom and baby

can also be used to check the gender of the baby and genetic abnormality

8
Q

What type of diffusion haps in the placenta?

A

passive diffusion

9
Q

Why is passive diffusion imp re: the placenta?

A

small, lipophilic, and low protein bound rugs can pass through the placenta

10
Q

When is the placenta the most permeable?

A

early and late

middle pregnancy is LEAST permeable

11
Q

What haps to the drug in the fetus?

A

some go into the heart, some go right into the bloodstream - drug is ACTIVE and does NOT go through metabolism

12
Q

Fetus brain to be aware?

A

FIRST to develop

NO BBB –> highly vulnerable to drugs

13
Q

When is the fetus most vulnerable to physical defect/malformation?

A

early: 3-9wks

14
Q

What types of abnormalities can occur - early stages?

A
neural tube
cardiac
extremities
cleft lip
ears
15
Q

When is the fetus most vulnerable to CNS defects?

A

later: 9-38wks

16
Q

What drugs should be used in pregnant moms?

A
low lipid solubility*
high protein binding*
high molecular wt*
*think about the placenta and what can and can't cross
lowest dose possible
short half life
17
Q

What are the drugs called that can cause severe/fatal defects?

A

teratogenic drugs

18
Q

What are Category X drugs?

A

Isotretionin
methotrexate
warfarin - use heprin!

19
Q

What are Category D drugs?

A

Anticonvulsants

Antithyroid

20
Q

Why are anticonvulsants used? Are they useful to the baby?

A

some docs think anticonvulsants are outweigh the benefit vs harm
causes the baby to be at higher risk for epilepsy when used

21
Q

Baby has scalp defect and goiter - cx of drug? What should be advised for the mom?

A

antithyroid

tx the thyroid prob before getting pregnant

22
Q

Mom has aches and pains - drug?

A

aceteminophen

23
Q

Mom has constipation and N/V?

A

diet - no drugs

24
Q

Mom has GERD? What to avoid?

A
smaller meals
upright after eating
first line - tums
second line - zantac/pepcid/reglan
last resort - PPI and H2 blockers
avoid - cimetidine
25
Q

Mom has infxn - what to AVOID?

A

nitrofuratonin - NOT in 3rd trimester

Sulfa - BEFORE 3rd trimester

26
Q

Mom has HTN - what to AVOID?

A

thiazide and ACE - I

27
Q

Mom has depression?

A

may discontinue if BOTH mom and provider is OK

SSRI and TCA

28
Q

Mom has DM II?

A

Insulin

29
Q

Mom has allergic rhinitis - what to AVOID?

A

pesudoephderine
cetrizine
loratidine - ESP during 1st trimester

30
Q

What drugs to avoid in moms?

A

tetracylcine
antifungal therapy unless topical
erythromycin
streptomycin

31
Q

What vaccines to avoid in pregnant moms?

A

MMR
smallpos
varicella

32
Q

Pregnant mom’s drugs are safe in breast feeding moms - Y/N? Then who?

A

NO

if safe for BABY then OK for breast feeding

33
Q

What factors to consider when breast feeding?

A

volume of distribution
high % of maternal protein binding - decrease exposure
large molecular wt - decrease exposure
hydrophilic - b/c milk is fat

34
Q

What to avoid in breast feeding moms?

A
ergotamine
HD narcotics
aminoglycosides
sulfonamides
OCP
benzodiazapine
beta blockers
35
Q

What renal infxn risk increases in pregnancy?

A

ASU
UTI
pyelonpehritis