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reposystem -- pregna

drug therapy in pregnancy and pediatrics

Kernicterus competition between drugs and bilirubin with plasma protein binding sites
Tetracycline effects teeth
amphetamine and methylphenidate growth retardation
aspirin in children reyes syndrome
Routes oral and rectal. Avoid parenteral
why do you avoid parenteral admin phase II metabolism is slower to develop
Drug Dosage dose= adult dose X (kg/150)
preferred method of drug dosage surface area
when is adult renal fucntion attained 1 year
pediatric absorption variations in peripheral blood flow makes unpredictable absorption of parenteral drugs. Gastric pH and emptying time vary during development
Distribution differences in amount of body water, fat and plasma protein results in Vd differences from adult
Metabolism phase I metabolism more developed than Phase II in neotates. Phase I activates, phase II conjugates
teratogenesis defined as induction of alterations of somatic cells of a developing organism causing defects in organ systems
Factors determining placental drug transfer placental blood flow, molecular size of drug, lipid solubility of drug, pKa of drug, fetal pH
basic drugs and fetus increased ion trapping on fetal side
acidic drugs and fetus increased ion trapping on fetal side
fetal pH slightly less than maternal pH resulting in increased ion trapping of basic drugs on fetal side
protein binding in fetus fetus has lower total plasma protein
fetal distribution significant amount of umbilical venous blood flow enters fetal liver before reaching general circulation
metabolism drug metabolizing systems present and functional early n gestation. Phae I reactions generally more developed than Phase II
fetal excretion via placenta (early) and kidneys (late)
factors which control susceptiblity of teratogenesis cell proliferation, organogenesis, growth and functional maturation, most organs have a period of particular susceptiblitiy, dose dependant
drug classifications (risk factors) A, B, C, D, X
Class A vitamins
Category B no demonstrated fetal risk but are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect
Category C have revealed adverse effects on the fetus but potential benefit justifies the potential risk to fetus
Category D beneftis from use in pregnant women may be acceptable despite the risk. Used in a life threatening situation. There is positive evidence of human fetal risk
Category X studies in animals or human beings have demonstrated fetal abnormaliteiis or there is evidence of fetal risk based on human experience or both. Use of drug in pregnant woemen clarly outweighs any possible benefit
Analgesia during pregnancy APAP best choice. NSAIDs increase risk of miscarriage
Anemia during pregnancy prevention – oral ferrous suphate – tx, oral ferrous sulphate x3 dayliy and folic acid 5 mg daily
nausea and vomiting PremesisRx
Preeclampsia (early) treat with bed rest and sedate with phoneobarbital. ASA effects on platelets decrease clotting and increase placental perfusion
Eclampsia bed rest magnesium sulfate and hydralizine
folic acid prevention of neural tube defects
depression SSRIs
Diethylstilbestrol vaginal adenosis, clear cell vaginal adenocarcinoma
Ethanol risk of fetal alcohol syndrome and alcohol-related neurodevelopmental defects
methotrexate multiple congenital malformations
phenytoin fetal hydantoin syndrome
thalidomide phocomelia (absent long bones)
warfarin first triemester hypoplastic nsal bridge, chondrodysplasia
warfarin second trimester CNS malformations
Warfarin third trimester risk of bleeding. Discontinue use 1 month before delivery
Created by: Todd Jamrose Todd Jamrose