pharm chapter 9

risk-benefit analysis (pregnancy)

• a clinical decision-making approach that compares risk to the fetus vs. risk of not treating the mother

teratogenic effects

drug effects that cause physical malformations in the developing fetus

neonatal / perinatal effects

drug effects that occur around the time of birth, such as withdrawal symptoms and low birth weight

behavioral teratogenesis

long-term effects on the child’s IQ, learning, and behavior

→ due to drug exposure during pregnancy

placenta not a barrier

concept that psychotropic drugs can cross the placenta and affect the fetus

first trimester vulnerability

the period of highest risk (weeks 2=8) for developmental abnormalities

maternal toxicity vs fetal toxicity

toxic effects in the mother do not reliably predict effects in the fetus

FDA pregnancy categories

A → no risk (controlled studies)

B → no evidence of risk in humans

C → risk unknown (most SSRIs)

D → evidence of risk

X → contraindicated (do not use)

untreated maternal depression

depression during pregnancy that is not treated, which can cause hormonal changes (high cortisol), developmental delays, poor prenatal care

postpartum depression (‘baby blues’)

depression occurring after childbirth, often within the first few weeks

brexanolone

a medication for postpartum depression that modulates GABA-A receptors and is given as an infusion

mood stabilizers in pregnancy

• valproate = WORST

  • neural tube defects

  • autism

• carbamazepine = BAD

• lithium = risk (heart defects)

• lamotrigine = safer

ethnopyschopharmacology

• culture + genetics influence drug response

genetic polymorphisms

• affect drug levels, response, and side effects

CYP450 enzymes

• liver enzymes that control drug metabolism

• leads to:

  • poor metabolizers → increase side effects

  • rapid metabolizers → decrease effectiveness

race & ethnicity

• no sharp genetic boundaries

• both are social constructs

• not biological categories