Week 4: Reproductive pharmacology: Pregnancy Flashcards
(76 cards)
1
Q
Considerations of Pregnancy and Drug Distribution
A
2
Q
What are the phases of drug distribution?
A
3
Q
Physiologic Changes in pregnancy that affect drug absorption
A
- Increased GI transit time
- Decreased gastric acid secretion
- if present, frequent vomiting
- Vasodilation and increased cardiac output increased blood perfusion of the periphery
4
Q
Describe the features of transplacental distribution of drugs
A
- passive diffusion: non-ionized and lipophilic molecules
- Active transport: drugs that are structurally related to endogenous compounds
- Transcytosis: of minor importance
5
Q
Metabolism of drugs by placental enzymes
A
*
6
Q
Physiologic Changes in pregnancy that affect drug distribution
A
- increase in body fat
- expanded plasma volume and total body water increase the volume of distribution of drugs
- Reduced maternal plasma albumin concentration: α1-acid glycoprotein concentration is either reduced or unchanged
- Fetal pH is slightly lower than maternal pH, “ion-trapping” of weak bases in the fetus
7
Q
Physiologic Changes in pregnancy that affect drug metabolism
A
- Alterations in the activities of hepatic cytochrome P450 (CYP) isozymes:
- increased CYP3A4, CYP2D6, CYP2A6 and CYP2C9 activities
- Decreased CYP1A2 and CYP2C19 activities
- Increased activities of certain uridine 5’-diphosphate glucuronosyltransferase isoenzymes (UGT1A1, UGT1A4 and UGT2B7)
- Increased hepatic blood flow leads to increased first-pass clearance
8
Q
Physiologic Changes in pregnancy that affect drug elimination
A
- increased glomerular filtration rate: up to 80% at the beginning of gestation due to increase in renal blood flow, decreased renal vascular resistanceand larger cardiac output
- Glomerular filtration rate decreases during the last 3 weeks of pregnancy
9
Q
What are the potential effects of an administered drug on fetus
A
10
Q
FDA categories for drug use during pregnancy
A
11
Q
FDA category A for drug use during pregnancy
A
12
Q
FDA category B for drug use during pregnancy
A
13
Q
FDA category C for drug use during pregnancy
A
14
Q
FDA category D for drug use during pregnancy
A
15
Q
FDA category X for drug use during pregnancy
A
16
Q
Treatment of opioid addiction in pregnant women
A
17
Q
Treatment of NV in pregnancy
A
18
Q
Pharmacotherapies for NV in pregnancy
A
19
Q
Use of antinausea medications and antidepressants during the first trimester of pregnancy
A
20
Q
Drugs used to treat hypertension, pregnancy-induced hypertension and pre-eclampsia
A
- Methyldopa
- Labetalol
- Nifedipine
- Hydralazine
- Magnesium sulfate
21
Q
Methyldopa MOA in anti-HTN
A
- centrally acting α-adrenergic receptor agonist
- Considered first-line therapy by many guideline groups
22
Q
Methyldopa side effects as an anti-HTN
A
commonly produces somnolence which limits its tolerability
23
Q
Short acting agents used to treat severe HTN in pregnancy
A
- Hydralazine, labetalol and short acting (sublingual or orally administered) nifedipine are commonly used to control acute, very high blood pressure in women with severe HTN in pregnancy
24
Q
Labetalol MOA in severe HTN in pregnancy
A
Combined α and β-adrenergic receptor antagonist with relatively few side effects
25
Labetalol side effects for severe HTN in pregnancy
relatively few side effects
26
Hydralazine MOA in severe HTN in pregnancy
↑ cGMP leads to smooth muscle relaxation (vasodilation)
27
Hydralazine side effects in severe HTN in pregnancy
* HA
* Nausea
* Vomiting
\*Pregnancy Category C\*
28
Hydralazine pregnancy category
Pregnancy category C
29
Nifedipine pregnancy category
Category C
30
Nifedipine Clinical use in pregnancy
* Given orally for the acute management of severe HTN during pregnancy
* Also used in postpartum patients with preeclampsia for BP control
31
Nifedipine side effects in severe HTN in pregnancy
* Tachycardia
* palpitations
* HAs
\*Concomitant use of Ca2+ channel blockers and Magnesium Sulfate is to be avoided\*
32
Nifedipine contraindications in severe HTN in pregnancy
Concomitant use of Ca2+ channel blockers and Magnesium Sulfate is to be avoided
33
ACE inhibitors in pregnancy
34
ARBs in pregnancy
35
ACE and ARBs during pregnancy associated with?
Their use in the second half of pregnancy has been associated with
* Oligohydramnios
* Neonatal anuria
* Growth abnormalities
* Skull hypoplasia
* Fetal death
36
Considerations of women taking ACE inhibitors or ARBs that wish to become pregnant
Women taking ACe inhibitors or ARBs should be **switched** to another antihypertensive class of drugs before conception
37
Treatment of HTN due to preeclampsia and eclampsia during pregnancy?
38
Early-onset preeclampsia is linked to?
Cardiac remodeling
39
What is Eclampsia?
Eclampsia is the onset of **seizures** (convulsions) in a woman with pre-eclampsia.
Pre-eclampsia is a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction. Onset may be before, during, or after delivery.
40
What is preeclampsia?
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.
Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby. If you have preeclampsia, the most effective treatment is delivery of your baby. Even after delivering the baby, it can still take a while for you to get better.
41
Drugs used in the treatment of Eclampsia
* Magnesium sulfate
42
Clinical uses of Magnesium Sulfate during pregnancy
* Treatment of Eclamptic seizures
* Prophylaxis against seizure in women with preeclampsia
* Treatment of preterm labor
43
Magnesium Sulfate used for seizure treatment
44
Side effects and complications of Magnesium Sulfate for eclampsia
45
Magnesium Sulfate MOA in treating Eclampsia
46
Drugs used in preterm labor
Prevention
* Progesterone
Tocolysis
* Magnesium sulfate
* Ca2+ channel blockers (nifedipine)
* β-adrenergic receptor agonists (terbutaline)
* Cyclooxygenase inhibitors (indomethacin)
47
Progesterone for preterm labor prevention
48
Magnesium Sulfate for Tocolysis
49
Use of magnesium sulfate for tocolysis
50
What is Tocolysis?
Tocolytics (also called anti-contraction medications or labor suppressants) are medications used to suppress premature labor
51
Nifedipine for tocolysis
52
Terbutaline for tocolysis
53
Terbutaline FDA warning
54
Indomethacin for tocolysis
55
Prostaglandins and labor induction
56
Oxytocin for induction of labor
57
Administration of oxytocin for induction of labor
58
Prevention/Treatment of postpartum hemorrhage
59
Methylergonovine uses and MOA
60
Methylergonovine elimination and adverse reactions
61
Carboprost for postpartum hemorrhage
62
Misoprostol for postpartum hemorrhage
63
Considerations of Ibuprofen during pregnancy
64
Considerations of aspirin and pregnancy
65
Aspirin MOA in Preeclampsia
66
Potential complication associated with co-administration of multiple analgesics
67
NSAIDs and Miscarriage
68
Treatment of Depression during pregnancy
69
What is Imipramine?
The first tricyclic antidepressant
FDA Pregnancy category D
70
Imipramine MOA
71
SSRIs during pregnancy
72
Paroxetine and CV risks during pregnancy
73
Suicidal ideation and Antidepressants
74
Prenatal SSRI exposure
75
Treatments for menopausal symptoms
76
Treatments for endometriosis
