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.
-
1)epilepsy
2)diabetes
3)HTN - 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.
-
1)absorption
2)distribution
3)elimination - 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?
- Inhalants
- 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.
- TRUE
- 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.
- FALSE
- 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
2)Isotretinoin
3)Alcohol/ACE-inhibitors
4)Busulfan
5)Lithium
6)Etretinate - 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
-
1)Aminoglycosides
2)Tetracycline - Name eight antimicrobials given a C rating in pregnancy
-
1)Aminoglycosides
2)Aztreonam
3)Chloroquine
4)Fluoroquinolones
5)Imipenem
6)Quinolones
7)Trimethoprim
8)Vancomycin - TRUE or FALSE: Women with epilepsy have higher incidence of fetal malformations compared with non-epileptic mothers
- TRUE
- 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.
- TRUE
- NSAIDs may cause what two problems in embryonic development?
-
1)Closure of the ductus areteriosus
2)oligohydramnios - TRUE or FALSE: narcotics have no significant teratogenesis
- TRUE
- What are three components of lactation you need to consider when prescribing medication?
-
1)dose
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
- TRUE or FALSE: milk is more acidic then plasma
- TRUE
- High lipid solubility facilitates or impedes solute passage into milk?
- Facilitates
- 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
- TRUE
- 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.
- Tocolytics
- This drug is a labor stimulant
- Oxytocin
- These two drugs are cervical ripening agents
- Prostaglandin E and F2 alpha
- These five drugs are used as uterotonics to prevent postpartum hemorrhage
-
1)oxytocin
2)methergine
3)prostaglandin
4)F2 alpha
5)E1 - TRUE or FALSE: when considering whether or not to prescribe a drug, trimester is not an issue
- FALSE