RX523 Pharmacokinetics in Pregnant & Lactating Persons

How does body composition change during pregnancy?

- Increased total body water

- Increased body fat

How does the cardiovascular system change during pregnancy?

- Increased cardiac output and stroke volume

- Increased heart rate

- Increased blood volume

- May lead to dilutional anemia (hemodilution)

How does the GI tract change during pregnancy?

- Decreased gastric acid secretion

- Heartburn, nausea, and vomiting

- Prolonged gastric emptying time

- Decreased intestinal motility

- Altered expression of P-gp

How does the renal system change during pregnancy?

- Increased renal blood flow

- Decreased serum creatinine

- Increased creatinine clearance and GFR

- Altered expression of renal transporters

How does the hepatic system change during pregnancy?

- Increased CYP3A4 and CYP2D6 activity

- Decreased CYP1A2 activity

- Increased UGT1A1 and UGT1A4 activity

How does absorption change during pregnancy?

Reduced rate of oral absorption

How does increased total body water impact distribution during pregnancy?

- Increased Vd, particularly for hydrophilic drugs

- Decreased Cmax

- Loading dose adjustments may be needed

How does increased fat tissue impact distribution during pregnancy?

- Increased Vd for lipophilic drugs

- Dosing interval adjustments may be needed

How does altered protein binding impact distribution during pregnancy?

- Reduced albumin and alpha-1 acid glycoprotein

- Decreased protein binding

- Increased fu

- Potential toxicity and reaching elimination organs more quickly

How does metabolism change during pregnancy?

- Increased blood flow increases clearance for high ER drugs

- Metabolism may be increased or decreased depending on enzymes

How does excretion change during pregnancy?

- Increased renal clearance

- Dose adjustment may be needed to prevent subtherapeutic concentrations

What are the key points of drug movement across the placenta?

- Passive diffusion

- Low molecular weight drugs

- Rate determined by concentration gradient

- Protein-bound drugs do not cross

What are the key points of drug movement into breast milk?

- Rate determined by concentration gradient

- Passive diffusion or active transport

- Weak bases, lipid-soluble, poorly protein-bound

Match the drug physicochemical characteristic with the optimal quantifier that would facilitate drug movement across the placenta.

Drug weight

Low

Match the drug physicochemical characteristic with the optimal quantifier that would facilitate drug movement across the placenta.

Lipid solubility

High

Match the drug physicochemical characteristic with the optimal quantifier that would facilitate drug movement across the placenta.

Percent ionization

Low

Match the drug physicochemical characteristic with the optimal quantifier that would facilitate drug movement across the placenta.

Percent protein binding

Low

The pregnant person's blood supply and fetal blood supply directly mix together to facilitate the functions of the placenta.

False

Which statement accurately describes a commonly occurring physiological change that may impact oral drug absorption in a pregnant person?

Increased stomach pH

Match the physiological alteration commonly observed in pregnancy with the predicted impact on pharmacokinetic processes or parameters.

Nausea and vomiting

Decreased F

Match the physiological alteration commonly observed in pregnancy with the predicted impact on pharmacokinetic processes or parameters.

Decreased albumin concentrations

Increased Vd

Match the physiological alteration commonly observed in pregnancy with the predicted impact on pharmacokinetic processes or parameters.

Increased total body water

Decreased Cpeak

Match the physiological alteration commonly observed in pregnancy with the predicted impact on pharmacokinetic processes or parameters.

Increased renal blood flow

Increased Clr

Which statement accurately describes a commonly occurring physiological change that may impact drug distribution in a pregnant person?

Increased total body water