Pregnancy and lactation

How can community pharmacists impact this population?

first point of contact and can help answer questions

how are ambulatory care pharmacists important for this condition

answer questions about safe and effective meds

What percent of women take OTC while preg

80%

what percent of birth defects are caused by OTC meds

10%

does efficacy change for fetus?

yes based on gestational age

why have many meds not been studied for pregnancy

ethical reasons

When do maternal physiological changes happen

throughout but peak in 2nd trimester

what can be impacted by maternal physiologic changes

subtheraputic or supratheraputic drug levels impacting mom and baby

What maternal physiologc changes occur for

volume of distribution

renal and liver clearence

gastric emptying

protein binding

gastric pH

increase

increase

decrease

decrease

increase

What does delayed fastric emptying impact

slows drug absorption

what drugs are impacted by high renal and liver clearence

decreased levels due to high renal clerance

which formualtions may be decreased in preg

enteric coated and ER

placenta function

exchanges substances including meds between fetus and mom

how do medications move through placenta

diffusion

What chemical properties decrease med transfer through placenta?

short half life

solubility in water

high molecular weight

high protein binding

what weights can cross placenta

<500 Da

what quality should a drug have to cross placenta

high lipophilicity

Risk with pH

weak bases become ionized and increase fetal levels

1st trimester

weeks 1-12

high risk of birth defect development as this is when organs and structures are developed

2nd trimester

weeks 13-28

brain dev, movements, preterm delivery

3rd trimester

weels 29-40

brain dev and growth

fat

lungs mature

head down

teratogen

medications or substances causing birth defects

what can teratogens do in first 4 weeks

miscarriage potential

what can teratogens do in 1st trimester

structural abnormalitie

what can teratogens do in 2nd and 3rd trimenter

linit growth and CNS abnormalities, organ functions impare

important thing to counssel for preg patietns

drug drug and drug disease interactiosn

try nonpharm first

low dose for short duration

When choosing drugs what is good to pick for preg

least likely to be transfered, immediate release, avoid herbals

OLD PREGRNANCY CATAGORIES

A- none

B none in animals, no studies avaliable in humans

c. animal studies have risk to fetus

d. evidence of rsik in human studies but benifits may outweigh

X risk to fetus

new pregnancy catagories

pregnancy and lactation labeling rule, have to talk about impacts in pregrancncy and devlopment w dose adjustments and adverse rxn, lactation with drugs in human milk, and fertility impadts

OTCS for pain in pregrnancy

topical formulations and acetaminophen

nonpharmacological rec for pain in preg

hot and cold pack, massage, PT

what pains need evaluated and by who

back pain and abdominal pain by OBGYN

when is it recommended baby be breastfed

first 6 month

what diet changes should be made if breastfeeding

450-500 icnreased kcal and prenatal gummies

what supplements needed for infants who are brest feeding

400 u of vitamin D until baby is consuming 1L of vitamin D fortified formualr a day

When does baby need iron

1mg/kg a day agter 4th month until it can eat solid foods with iron

What impacts drugs in breastmilk

concentration in plasma, weight, ionization, protein binding, lipid solubility, half life`

what factors decresae drug transfer

short half life, high molecular weight, water soluble, high protein binding

what is amount of drug absorbed by milk detemrined by

drug conc in milk, volume consumed, GI absorption

are meds in pregnancy always safe when breastfeeding?

no

best choices for lactation OTC

least likely to trasnfer, IR products, topicals

when should you breastfeed when taking meds

right before taking dose

when should you dose

right before longest sleep interval, short half life drugs willl clear before next feeding