Flashcards in Week 3 pregnancy & lactation (everything) Deck (125)
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1
***Physiological changes of pregnancy may alter drug disposition and effect through:
Indirect and Direct effects
2
**example of a DIRECT physiological change
Direct Effects - ex. Placental transfer
3
*** Even after delivery drugs may affect
breastfeeding
4
*** example of a INDIRECT physiological change
Indirect Effects - Changes in placental and uterine function
5
Pregnant women in U.S. average 4.2 medications (study from 2006-2008)
97% take at least
1 medication
30.5% of the 97% take at least 5 medications
6
Most common medications taken during pregnancy
Antiemetics
Antibiotics
Analgesics
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***most common medications taken during pregnancy; at least 10% taking drugs with long term effects on CNS**
Antidepressants
Anticonvulsants
Antipsychotics
****
8
**concerns of medications during pregnancy:
Teratogenicity Effects ( not only congenital abnormalities but non-birth development such as puberty) **
9
Teratogenicity Effects of medications results
examples
Fetal Loss
Congenital Malformation
Fetal Growth Restriction
Preterm Labor
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Genetic difference responsible for
some variations in genetic response
11
Pregnancy does not obviously modify
pharmacogenetic
12
Obstetric conditions are related to
complex genetic factors
13
**Metabolism of codeine to morphine greatly affected by
polymorphisms ( means “many form” and it occurs when we have many classes that are related to each other by inheritance) **
14
*** exam** Recently recognized mothers who are ultra-rapid metabolizers of codeine may transfer morphine
through breast milk to cause neonatal CNS depression and even death
15
Major physiologic changes during pregnancy alter drug disposition
Absorption and Uptake
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physiologic changes in pregnancy alter Oral absorption and bioavailability
not usually affected by pregnancy
17
physiologic changes in pregnancy alter Intestinal motility
decreases
18
physiologic changes in pregnancy on gastric emptying
Gastric emptying only delayed during labor or administration of opioids
19
physiologic changes in pregnancy on FRC
Reduced FRC (functional residual capacity)
20
physiologic changes in pregnancy on minute ventilation:
Increased minute ventilation
21
increased minute ventilation increases pulmonary uptake of:
increases pulmonary uptake of inhalation anesthetic agents
22
renal blood flow increases what percent
60-80%
23
GFR increases what percent
50%
24
If a drug is excreted unchanged by the kidneys - how do we adjust the dose
increase the dose
(due to increased GFR - renal BF increases 60-80%)
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if a drug is metabolized by the liver - what must we do to the dose
increase or decrease depending on metabolic pathway involved
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bioavailability- the fraction of an administered drug that reaches systemic circulation- how is this changed in pregnancy
not usually changed significantly
27
physiologic changes of pregnancy will affect individual drugs depending on what?
their physicochemical characteristics (physical and chemical) and metabolic pathways
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**exam during pregnancy what three drugs do you increase metabolism of?
phenytoin
morphine
midazolam
29
**exam - during pregnancy what two drugs do you decreases metabolism of
caffeine
theophylline.
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