Pharmacology Across Lifespan: Pharmacotherapy During Pregnancy and Lactation

What drugs are used for cesarean section

bupivicaine

midazolam

remifentanil

acetaminophen / NSAIDS

Drugs with a molecular weight of --- can easily cross the placenta

250 - 500

Chloramphenicol causes ---- and ---

bone marrow suppression and gray baby syndrome via inhibition of UDP glucoronyl transferasePhar

--- drugs diffuse across the placenta

lipid soluble (lipophilic)

Which drugs cross the placenta slowly: highly ionized or non-ionized

ionized

Drugs with a molecular weight of --- do not easily cross the placenta

> 500

Which has a higher molecular weight and is highly ionized: warfarin or heparin

heparin

The degree to which a drug is bound to ---- may also affect the rate of transfer and the amount transferred

plasma protein

True / False: if a compound is highly lipid soluble it will not be affected greatly by protein binding

true

Drugs that can cross the placenta enter via the ---

umbilical vein

About 40 - 60% of umbilical vein flow enters the ---

fetal liver

Category A drugs

do not cause fetal abnormalities

Category B drugs

Animal reproduction studies have not shown a fetal risk or adverse effect.

Risks have not been confirmed in controlled studies in women.

Category C drugs

Either studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women or studies in women and animals are not available

Category X

Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.

Thalidomide

used for nausea

very teratogenic = phocomelia

Fetal Alcohol syndrome characteristics

small head

low nasal bridge

flat mid face

smooth philtrum

Predictable toxic drug actions on the fetus from nicotine and cocaine

low birth weight

--- stimulate fetal lung maturation

corticosteroids

--- induces fetal hepatic enzymes

phenobarbital

---- induce fetal cardiac arrhythmias

digoxin, felcainade, verapamil

---- decrease / eliminate viral transmission to fetus

anti virals

What are the significant teratogenic / adverse effects on the fetus

- ACE Inhibitors

renal damage

True / False: most drugs taken by the lactating women are detectable in breast milk

true

It takes about ---- minutes for drugs to reach equilibrium

20

Breastmilk has --- pH compared to plasma, therefore weak --- are more likely to accumulate in breast milk

lower

weak bases

If a nursing mother needs to take medications and the the drug is relatively safe, the medication should be taken ---- minutes after ---

30 - 60 minutes after nursing

--- concentrations in breast milk are at 70% maternal serum concentrations

tetracycline

Isoniazid reached equilibrium rapidly, causing --- deficiency

pyridoxine

True / False: sedatives / hypnotics can sedate the nursing infant

true

True / False: nicotine concentrations in breast milk are low and produce minimal effects

true

Oral contraceptives can ---- lactation

suppress

Propylthiouracil may suppress ---- function

thyroid

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