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
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**example of a DIRECT physiological change
Direct Effects - ex. Placental transfer
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*** Even after delivery drugs may affect
breastfeeding
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*** example of a INDIRECT physiological change
Indirect Effects - Changes in placental and uterine function
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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
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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
****
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**concerns of medications during pregnancy:
Teratogenicity Effects ( not only congenital abnormalities but non-birth development such as puberty) **
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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
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Pregnancy does not obviously modify
pharmacogenetic
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Obstetric conditions are related to
complex genetic factors
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**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) **
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*** 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
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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
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physiologic changes in pregnancy alter Intestinal motility
decreases
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physiologic changes in pregnancy on gastric emptying
Gastric emptying only delayed during labor or administration of opioids
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physiologic changes in pregnancy on FRC
Reduced FRC (functional residual capacity)
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physiologic changes in pregnancy on minute ventilation:
Increased minute ventilation
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increased minute ventilation increases pulmonary uptake of:
increases pulmonary uptake of inhalation anesthetic agents
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renal blood flow increases what percent
60-80%
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GFR increases what percent
50%
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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
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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
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**exam - during pregnancy what two drugs do you decreases metabolism of
caffeine
theophylline.
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