Pregnancy Flashcards Preview

Pharmacology > Pregnancy > Flashcards

Flashcards in Pregnancy Deck (30):
1

Physiological changes during pregnancy

Reduced GI motility, inc pH, dec serum albumin binding capacity, variability in hepatic metabolism, inc renal drug clearance, inc total body water (8L), placental drug transfer

2

Drug selection criteria during pregnancy

pregnancy category, timing of drug, lowest effective dose, does drug have inc protein binding

3

Category A classification

adequate and well controlled studies fail to show risk to fetus in 1st trimester or later

4

Category B classification

animal studies have failed to show risk, but no adequate studies in humans

5

Category C classification

Animal studies show adverse effects in fetus, no studies in humans, potential benefit may warrent use of drug

6

Category D classification

positive evidence in human fetus, but benefits may warrant use despite, no other drug option

7

Category X classification

studies in animal and humans have shown fetal abnormalities, the risks of using the drug outweighs the benefit, there are other alternatives

8

Antibiotics category B

penicillins, cephalosporins, macrolides, aztreonam, clindamycin, daptomycin, fosfomycin, carbapenems, metronidazole, nitrofurantoin, vancomycin (PO)

9

Antibiotics category C

fluoroquinolones (cartilage damage, last line only), linezolid, clarithromycin, sulfa/trimethoprim (Bactrim)- avoid during first trimester and after 32 weeks, vancomycin (IV)

10

Bactrim risks

risk of kernicterus, neural tube defects, may use for prophylaxis of PCP, or toxoplasmic gondii encephalitis

11

Vancomycin (IV)

no adverse effects reported, usually for prophylaxis of strep B

12

Antidepressants in pregnancy

TCA- Cat C, Nortriptyline preferred, taper 10-14 days before expect DOD, SSRIs- cat C (paroxetine cat D), no effects in late 3rd, taper 10-14 days, SNRIs- cat C, mirtazapine, trazodone- cat C, DRI- Cat B

13

Antibiotics Category D

Aminoglycosides (CN 8 toxicity), Tigecycline (tooth discoloration), tetracyclines (tooth discoloration)

14

Other Category D drugs

aspirin, lithium, paroxetine, ACE-I, ARBs, anticonvulsants

15

Category X drugs

Statins, warfarin, thalidomide, methotrexate, isotretinoin (Accutane), ergotamines

16

OTC pregnancy drugs to avoid

aspirin, NSAIDs, pepto-bismol, kaopectate, sodium bicarbonate, lomotil

17

Vaginal azole antifungals

clotrimazole, terconazole-DOC, use 7 days, avoid during 1st trimester

18

OTC category A

dextromethorphan, doxylamine

19

OTC category B

APAP, chlopheniramine, cetirizine, loratadine, diphenhydramine

20

OTC category C

oxymetazoline

21

Things to consider during lactation

consequences of infant exposure, amt of infant drug exposure, necessity of therapy, alternating forms of nutrition

22

Assessment of wt

low birth wt= 2500 g, very low

23

Challenges to neonatal therapy

the unknown, volumes, safety (details!)

24

Pediatric PK/PD absorption

higher gastric pH compromises bioavailability of acid stable drugs, irregular gastric emptying times, absorption in skin is much higher

25

Pediatric PK/PD metabolism

compromised hepatic metabolism, dec blood flow and enzyme activity

26

Pediatric PK/PD distribution

better distribution because of inc body water/dec fat, inc BBB penetration, altered perfusion, altered plasma protein binding

27

Pediatric PK/PD elimination

renal blood flow dec in utero, GFR improves slowly before 32 weeks, then rapidly, tubular secretion matures at 6 mo, assess fx w/ urine output

28

Goal urine output for assessing renal fx

>1 ml/kg/hr

29

SCr in neonates

caution w/SCr, baby has mom's SCr up to 7 days

30

Dosing in pediatrics

use mg/kg, never give more than adult dose, dose varies w/age, disease states, organ fx