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53 Cards in this Set
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- Back
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how does amniotic fluid concentrate drugs used by the mother?
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the fetus uses it to drink and breath and the urinates it out again so the drug becomes concentrated
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what can nausea and vomiting cause in phamacokinetics in pregnancy?
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may lead to electrolyte loss which changes electrochemistry
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what 3 things happen in the GI system of expecting mothers?
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reduction in intestinal motility
increase in gastric emptying time decrease gastric acidity |
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what does the decrease in albumin concentration do to the phamacokinetics in pregnancy?
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may increase free drug concentrations which means more of the drug is available for maternal clearance and placental transfer to the fetus
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what does the increase in renal blood flow do do the pharmacokinetics in pregnancy?
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may eliminate half lives, thus drug with a low therapeutic index may exhibit a magnified response
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what will the concentration of drugs be in the fetus compared to the mother?
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fetal drug concentrations will be lower yet the effects will last much longer
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what will the increase in plasma levels do to the phamacokinetics in pregnancy?
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may increase the distribution of drugs into the water compartment
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what will the increase in progesterone do to the pharmacokinetics in pregnancy?
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may stimulate metabolizing systems
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what remains unchanged in the pregnant woman?
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hepatic clearance
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what 3 enzymes are lower in the fetus?
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monoamine oxidase
alcohol dehydrogenase aldehyde dehydrogenase |
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what is absent in the fetus and what does it lead to?
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glucuronidation
can cause grey baby syndrome if chloramphenicol is ever administered |
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what is the GFR of the fetus compared to adult levels?
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30-40%
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what 4 transfer methods can a drug use to pass from mother to baby?
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diffusion
facilitated diffusion active transport pinocytosis |
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what is the greatest concern with blood pressure in pregnancy and why?
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preeclampsia
can lead to seizures |
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what is the best antihypertensive drug in pregnancy?
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methyldopa
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what is another safe way to prevent progression to preeclampsia?
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calcium supplementation
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what may be used for emergency reduction in blood pressure?
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parenteral hydralazine
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what 2 drugs may be used in acute situations to treat BP and why are they safe?
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nifedipine and labetalol
both can reduce BP without reflex tachycardia |
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what traditional BP meds should be avoided because they cause growth retardation?
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beta-blockers
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what traditional BP drugs are category X and what do they cause?
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ACE inhibitors
cause neonatal renal failure |
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what 3 major things to anti-seizure drugs cause?
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cleft palate
cleft lip spina bifida |
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what is the drug of choice for treatment of epilepsy in pregnant women?
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phenobarbitol
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how should phenobarbitol be administered?
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as a monotherapy
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when should you commence treatment for diabetes in pregnancy?
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if fasting glucose >95mg/dL or HbA1C >7%
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what is the drug of choice for diabetes?
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insulin
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what type of drug should be avoided as a diabetes treatment?
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all oral hypoglycemic agents
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why do you want to culture and treat all UTIs even if they are asymptomatic?
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e.coli can lead to pyelonephritis
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how should you treat a UTI in pregnancy?
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cephalexin for 7-10 days
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how should you treat pyelonephritis in pregnancy?
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cefazolin and gentamycin for 10-14 days
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what drugs are there no problems when administering at a low dose?
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anti-nausea
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when are category D drugs used?
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only in emergency situations where the benefit to the mother outweighs the harm to the fetus
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what drug, when used late in pregnancy has been associated with fetal toxicity-intrauterine renal insufficiency?
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ACE inhibitors
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what drug can cause:
craniofacial dysmorphology cleft lip/palate nail hypoplasia growth retardation cardiac defects and what are these group of defects called? |
phenytoin, an anti-epileptic
fetal hydrantoin syndrome |
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what causes neural tube defects in the first trimester and what is it normally used for?
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valproate, an anti-epileptic
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what is one drug that is taken by males and can be teratogenic?
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finasteride, a med for BPH
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when should NSAIDs be avoided in pregnancy and why?
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should be avoided in the third trimester because they can prematurely close the PDA and may delay the onset of labor
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what 2 drugs can cause permanent tooth staining of the fetus?
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trimethoprim
tetracycline |
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what drug should you use instead of amiodarone?
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digoxin
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what is the "all or none period" and why is it called this?
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time from conception until implanation
insults to the embryo during this time are likely to result in miscarriage |
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what happens if an embryo is exposed to a teratogen during the preimplantation stage?
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usually will not cause congenital malformations unless the agent persists
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when is the embryonic period and what crucial thing takes place?
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days 18-60 after conception
organogenesis takes place |
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if damage occurs during the embryonic period, what is the outcome?
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damage is irreparable
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what drug can cause:
abruption placentae prematurity fetal death decreased birth weight limb defects urinary tract malformations reduced neurodevelopmental performance |
cocaine
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what 5 things encompass fetal alcohol syndrome?
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microcephaly
developmental delay low nasal bridge cleft palate thin upper lip |
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how much alcohol must be ingested for FAS?
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daily ingestion of at least 2g of alcohol
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how can you tell if a newborn has FAS?
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myconeium
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what 3 things is the transfer of drugs into breast milk influenced by?
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protein binding
solubility ionization |
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how is the transfer of drugs into breast milk described and what level is considered safe?
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quantitatively as milk:plasma ratio
10% is the cut off rate |
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what 3 drugs have an inherent toxicity and are thus contraindicated in breast feeding?
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cytotoxic agents
gold salts immunosuppressive agents |
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what 2 drugs have a high infant exposure and should be avoided during breast feeding?
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lithium
amiodarone |
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how are drugs transferred from plasma to milk?
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passive diffusion
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when is transfer of a drug from plasma to milk the greatest?
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when there is low maternal plasma protein binding and the drug is highly lipid soluble
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what has a lower toxicity than aspirin?
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acetaminophen
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