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Block 4: Drugs for Pregnant and Lactating Women


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Name three medical conditions where women have to continue taking their meds through pregnancy.
TRUE or FALSE: in pregnancy, you take a medicine or you don't. You don't just mess with dosages.
FALSE-- you may need to alter dosages for pregnant women
Name three pharmacokinetic parameters pregnancy may alter.
In pregnancy, gastric emptying is *blank* and intestinal transit time is *blank*
"decreased" and "increased"
Pregnancy-induced increased pulmonary blood flow, hyperventilation and increased tidal volume will increase absorption of what?
The dramatic increase in blood volume seen in pregnancy may lead to what?
Dilutional hypoalbuminemia
In what trimester are you most likely to see dilutional hypoalbuminemia?
Third trimester
Dilutional hypoalbuminemia may lead to what effect on drugs?
Decreased drug binding capacity
Spontaneous abortion and potential teratogenesis are complications of drug use in what trimester?
First trimester
Growth retardation, sedation, functional development, altered metabolism and withdrawal are complications of drug use in what trimester?
Second *and* third trimesters
What are your concerns for drug use during lactation?
Similar concerns as second and third trimester
TRUE or FALSE: birth defects are a common occurrence.
Name four essential criteria for proof of human teratogenicity.
1)Proven exposure to agent at critical time in prenatal development
2)Consistent findings by 2 or more epdemiological studies of high quality
3)Careful delineation of clinical cases
4)Rare environmental exposure associated with rare defect
Name three helpful but not essential criteria for proof of human teratogenicity.
1)Teratogenicity in experimental animals
2)Association makes biological sense
3)Proof in an experimental system that agent acts in unadulterated state
A highly teratogenic drug is more or less likely to cause birth defects?
More likely (duh)
Name three mechanisms by which a drug gets across the placenta.
1)simple diffusion
2)facilitated diffusion (ex: glucose)
3)active transport (ex: vitamins, amino acids)
Which is more likely to cross the placenta: a drug with molecular weight < 600 daltons or a drug with mw > 1000 daltons?
Drug weighing < 600 daltons
Which is more likely to cross the placenta: a drug ionized at physiological pH (H20-soluble) or a drug non-ionized at physiologic pH (lipid soluble)?
Non-ionized (lipid soluble) drugs cross the placenta more effectively
Higher protein-binding capacity will assist or impede placental crossing?
Impedes placental crossing
TRUE or FALSE: dose, synergism with other drugs and duration of exposure have nothing to do with teratogenic potential.
Name four mechanisms of teratogens
1)Cell death
2)Mitotic delay
3)Slowing/cessation of differentiation
4)Inhibition of cell migration
Controlled studies have demonstrated no fetal risks.
Category A (ex: vitamins)
Animal studies indicate no fetal risks but there are no human studies; *OR* adverse effects have been demonstrated in animals but not in well-controlled human studies.
Category B (ex: penicillin)
No adequate studies, either animal or human *OR* there are adverse fetal effects in animal studies but no available human data.
Category C (many drugs taken during pregnancy are in this category)
Evidence of fetal risk but benefits are thought to outweigh these risks.
Category D (ex: carbamazepine and phenytoin)
Proven fetal risk clearly outweighs any benefits
Category X (ex: the acne medication isotretinoin)
Name some drugs that make babies un-VIABLE (e.g. proven teratogens)
1)Valproic acid
Name the five features of Fetal Alcohol System
1)Growth restriction
2)Behavioral disturbances
3)Brain defects
4)Cardiac defects
5)Craniofacial abnormalities
Name three points in the framework for describing drugs that are pregnancy-specific.
1)Maternal considerations
2)Fetal considerations
3)Breast feeding safety
Name two antimicrobials given a D rating in pregnancy
Name eight antimicrobials given a C rating in pregnancy
TRUE or FALSE: Women with epilepsy have higher incidence of fetal malformations compared with non-epileptic mothers
Malformations are more likely in people with decreased activity of *this* enzyme (responsible for elimination of phenytoin and other anticonvulsants)
Epoxide hydroxylase
The neural tube closes on what days of embryonic life?
Days 20-25
TRUE or FALSE: acetominophen is safe in therapeutic doses for pregnant women.
NSAIDs may cause what two problems in embryonic development?
1)Closure of the ductus areteriosus
TRUE or FALSE: narcotics have no significant teratogenesis
What are three components of lactation you need to consider when prescribing medication?
2)portion excreted in milk
3)amount absorbed by infant
TRUE or FALSE: weight-corrected percent of maternal dose ingested by 3-kg newborn and resulting neonatal blood levels are important aspects of lactation to consider when prescribing meds.
TRUE or FALSE: milk is more acidic then plasma
High lipid solubility facilitates or impedes solute passage into milk?
High molecular weight solutes do or do not cross into milk easily?
Do not cross easily
TRUE or FALSE: high protein binding limits passage into milk
What do bromocriptine, cyclophosphamide, methotrexate, lithium and doxorubicin all have in common?
All are contraindicated in breastfeeding
This class of drug is used to prevent preterm birth and includes magnesium sulfate, beta-mimetics and Indocin.
This drug is a labor stimulant
These two drugs are cervical ripening agents
Prostaglandin E and F2 alpha
These five drugs are used as uterotonics to prevent postpartum hemorrhage
4)F2 alpha
TRUE or FALSE: when considering whether or not to prescribe a drug, trimester is not an issue

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