Perinatal, Pediatric, And Geriatric Pharm Block 4

Front 1

Drug Use in Pregnancy

Back 1

Most drugs can cross the placenta.
-Can be therapeutic effects for fetus
-But can be adverse effects for fetus including toxic effects, teratogenicity.
-Must counsel pregnant mothers on what they can and cannot take

Front 2

Teratogenicity

Back 2

Ability of drug to cause birth defects or fetal malformations

Front 3

Potential therapeutic effects in fetus from mother taking a drug

Back 3

- corticosteroids to Increase fetal lung maturation in certain situations
- antiretroviral drugs to prevent HIV infection in fetus

Front 4

ACE Inhibitors taken by mother leads to

Back 4

Renal damage in fetus
-all trimesters, esp 2 and 3

Front 5

Cyclophosphamide taken by mother leads to

Back 5

Various congenital malformations in fetus
-1st trimester

Front 6

Ethanol taken by mother leads to

Back 6

Fetal alcohol syndrome in fetus
-All trimesters

Front 7

Heroin taken by mother leads to

Back 7

Chronic use --> neonatal dependence
-All trimesters

Front 8

Isotretinon (Accutane) taken by mother leads to

Back 8

Extremely high risk of birth defects in fetus
-All trimesters

Front 9

Mycophenolate mofetil taken by mother leads to

Back 9

Major malformations face, limbs, other in fetus
-1st trimester

Front 10

Tetracycline taken by mother leads to

Back 10

Discolor/defects in teeth, altered bone growth in fetus
-All trimesters

Front 11

Thalidomide taken by mother leads to

Back 11

Shortened or absent long bones of limbs in fetus.
-first trimester

Front 12

Warfarin

Back 12

-1st tri - hypoplastic nasal bridge
-2nd tri - CNS malformations
-3rd tri - risk of bleeding

Front 13

List some physiological differences between infants and older individuals that can result in pharmacokinetic differences

Back 13

1. Increased or decreased oral bioavailability related to differences in GI function

2. Differences in distribution related to differences in body water (higher body water in neonates as % of body weight), protein binding

3. Slower elimination of many drugs in neonates due to lower activities of P450 enzymes and conjugating enzymes in neonate.

4. Lower renal clearance of some drugs in neonates - lower GFR

Front 14

Indomethacin

Back 14

-NSAID that inhibits prostaglandin synthesis.
-Given to premature infants to close patent ductus arteriosus

Front 15

Prostaglandin E1

Back 15

-Used to maintain (keep open) patent ductus arteriosus in certain neonates with congenital heart defects

Front 16

Exposure of nursing infant to drugs taken by mother

Back 16

-Excretion of drugs in breast milk.
-Examples of drugs that can produce significant effects in infants:
-Chloral hydrate - possible drowsiness if fed at peak concentration in milk

-Chloramphenicol - possible bone marrow suppression (don't take while nursing)

-Diazepam - sedation in infant

-Heroin - can prolong neonate dependence

Front 17

What Physiological changes with aging (in the elderly) can result in pharmacokinetic differences in the elderly?

Back 17

Decrease in various physiological functions with age in some individuals.
1. Increase in half-life of some drugs. (related to decrease in creatinine clearance in about 2/3 of individuals)

2. Decrease hepatic clearance of some drugs (related to decreased rate of hepatic metabolism - change in phase I drugs (cytochrome P450) is greater than phase II reactions)

3. Altered distribution of some drugs - decreased total body water and increased body fat (as % of body mass); possible protein changes

Front 18

Acetylcholinesterase Inhibitors (Denepezil)

Back 18

Drug used in management of Alzheimer's Dz
-disease may be due to deficiency of cholinergic neurotransmission so give this drug which blocks acetylcholine reuptake/break down

Front 19

NMDA receptor antagonist (Memantine)

Back 19

Drug used in the management of Alzheimer's dz
-persistant activation of CNS NMDA receptors by excitatory amino acid glutamate has been hypothesized to contribute to the symptoms of alzheimer's dz - so give antagonist.

Front 20

Ranibizumab

Back 20

-Used in management of neovascular (wet) age-related macular degeneration
-monoclonal antibody fragment that binds VEGF
-intravitreal injection

Front 21

Pegaptanib

Back 21

-Used in management of neovascular (wet) age-related macular degeneration
-pegylated oligonucleotide that binds VEGF
-intravitreal injection