CLIN PHARM [LAB] GROUP 3 - PREGNANCY AND LACTATION pt. 2

• DRUG USE DURING LACTATION:

  • Medications enter breast milk via ___ ___ of non ionized and non-protein-bound medication

  passive diffusion
• DRUG USE DURING LACTATION:

  • Drugs with ___,___ ___ ___, and ___ ___ ___ = LESS LIKELY TO CROSS (slower transfer/in smaller amounts)

  HMW, lower lipid solubility, higher protein binding
• DRUG USE DURING LACTATION:

  • ___ maternal serum drug conc. = HIGHER conc. in breast milk

  HIGHER
• DRUG USE DURING LACTATION:

  • ___ drug half-life = maintain HIGHER levels in breast milk

  LONGER
• DRUG USE DURING LACTATION:

  • ___ and ___ of feedings and amount of milk ingested are also important

  Timing, frequency
• DRUG USE DURING LACTATION:

  • RELACTATION: ___ 10 mg TID for 7-14 days only if non drug therapy is ineffective

  metoclopramide
• NON-PHARMACOLOGIC APPROACH IN LACTATION

  • ___ (Moringa oleifera capsule)

  Natalac
• NON-PHARMACOLOGIC APPROACH IN LACTATION

  • the FIRST and ONLY clinically proven lactation enhancer in the Philippines. It is a natural health supplement for nursing mothers especially those with inadequate lactation

  Natalac (Moringa oleifera capsule)
• PREGNANCY-INFLUENCED ISSUES

  Gestational DM:

  • 1st-line is non-pharmacologic approaches, including: ___, ___ ___, ___ ___ for obese women

  exercise, dietary modifications, caloric restrictions
• PREGNANCY-INFLUENCED ISSUES

  Gestational DM:

  • DOC when lifestyle interventions fail: ___ ___ (does not cross the placenta)

  HUMAN INSULIN
• PREGNANCY-INFLUENCED ISSUES

  Gestational DM:

  • ALTERNATIVES: ___, ___

  Glyburide, metformin
• PREGNANCY-INFLUENCED ISSUES

  Gestational DM:

  • limited long-term safety data

  Glyburide, metformin
• PREGNANCY-INFLUENCED ISSUES

  Hypertensive Disorders:

  • Hypertensive disorders of pregnancy include: (4) PCCG

  1. preeclampsia-eclampsia
  2. chronic HTN
  3. chronic HTN with superimposed preeclampsia
  4. gestational HTN
• PREGNANCY-INFLUENCED ISSUES

  Hypertensive Disorders:

  • for women at risk for preeclampsia

  Aspirin
• PREGNANCY-INFLUENCED ISSUES

  Hypertensive Disorders:

  • decreases relative risk of HTN and pre eclampsia

  Calcium
• PREGNANCY-INFLUENCED ISSUES

  Hypertensive Disorders:

  • decreases risk of progression of preeclampsia to eclampsia; also treats eclamptic seizures

  Magnesium sulfate
• PREGNANCY-INFLUENCED ISSUES

  Thyroid Abnormalities

  • has lower rate of placental transfer and less severe PTU-caused teratogenicity

  propylthiouracil (PTU)
• PREGNANCY-INFLUENCED ISSUES

  Thyroid Abnormalities

  • Overt hyperthyroidism: ___

  propylthiouracil (PTU)
• PREGNANCY-INFLUENCED ISSUES

  Thyroid Abnormalities:

  • AVOID: ___/___ (teratogen: aplasia cutis)

  Methimazole/Carbimazole
• PREGNANCY-INFLUENCED ISSUES

  Thyroid Abnormalities:

  • Overt hypothyroidism: Thyroid replacement therapy
  • (ie, ___)

  levothyroxine
• PREGNANCY-INFLUENCED ISSUES

  Venous Thromboembolism (VTE):

  • WHAT TO AVOID: ___ (teratogen: nasal hypoplasia)

  Warfarin
• PREGNANCY-INFLUENCED ISSUES

  Venous Thromboembolism (VTE):

  • WHAT TO USE: ___ ___

  LMW Heparin
• CHRONIC ILLNESSES IN PREGNANCY

  Epilepsy:

  • WHAT TO AVOID: ___ ___ (teratogen: NTD), ___ (teratogen: cleft palates), ___ (teratogen: fetal hydantoin syndrome)

  Valproic acid, Phenobarbital, Phenytoin
• CHRONIC ILLNESSES IN PREGNANCY

  Epilepsy:

  • Drug therapy should be optimized prior to conception; ___ monotherapy is recommended when possible

  AED
• CHRONIC ILLNESSES IN PREGNANCY

  Epilepsy:

  • All women taking anti-epileptic drugs should take ___ (4-5 mg daily)

  folic acid
• CHRONIC ILLNESSES IN PREGNANCY

  Hypertension:

  • WHAT TO USE: MiNaHaL
  • PO: ___, ___
  • IV: ___, ___

  Methyldopa, Nifedipine

  Hydralazine, Labetalol
• CHRONIC ILLNESSES IN PREGNANCY

  Hypertension:

  • WHAT TO AVOID: ___ ___ (teratogen: renal dysgenesis)

  ACE inhibitors
• CHRONIC ILLNESSES IN PREGNANCY

  Hypertension:

  • Refractory HTN: ___, ___, ___

  Nitroprusside, diazoxide, NTG
• CHRONIC ILLNESSES IN PREGNANCY

  Depression:

  • SSRIs - not considered major teratogens except ___.

  paroxetine
• CHRONIC ILLNESSES IN PREGNANCY

  Depression:

  • Use of ___ and ___ in the latter part of pregnancy is associated with persistent pulmonary HTN of the newborn and prenatal antidepressant exposure syndrome

  SSRIs, SNRIs
• CHRONIC ILLNESSES IN PREGNANCY

  Depression:

  • ___ ___ - not considered major teratogens but have been associated with neonatal withdrawal syndrome in late pregnancy

  Tricyclic antidepressants
• CLINICAL PRACTICE GUIDELINES for Pregnancy and Lactation

  The Clinical Practice Guideline for Care in Pregnancy and Puerperium
• PREGNANCY-INFLUENCED ISSUES

  Gestational DM

  • DOC when lifestyle interventions fail: ___ ___ (does not cross the placenta)

  HUMAN INSULIN