Changes in pregnancy Increased plasma volume →dilution Increased hormones bind to plasma-protein binding sites
Decreased albumin Drugs widely distributed Fat-soluble drugs stored longer and slow release
When is the maternal-fetal circulation established Maternal-placental-fetal circulation is c...
decreased albumin drugs widely distributed fat sol
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NUR 323 Test 1 Questions and Correct
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Changes in pregnancy ✅Increased plasma volume →dilution
Increased hormones bind to plasma-protein binding sites
Decreased albumin
Drugs widely distributed
Fat-soluble drugs stored longer and slow release
When is the maternal-fetal circulation established ✅Maternal-placental-fetal circulation
is complete ≈third week after conception.
What does transfer of the circulation established ✅Transfer begins about the 5th week
after conception
How do drugs get to the fetus ✅Drugs cross into fetal circulation via placenta, where
relatively large amounts are pharmacologically active.
What are drug effects on fetus through circulation ✅Metabolized slowly in immature
fetal liver
Enter fetal brain easily
Excretion slow and inefficient due to immature fetal kidneys
50% drug containing blood returns to maternal circulation
What happens to the remaining blood when it comes back to the fetus after a drug is
taken ✅Mother metabolizes the returning drug- containing blood
Drug effects on the fetus are mainly determined by ✅Type, amount of drugs
Duration of exposure
Level of fetal growth and development when exposed to medications
How much of a drug is in a babys blood after a mom takes a regular drug ✅Maternal
medications taken on regular scale result in fetal blood containing 50% to 100% of drug
amount in maternal blood.
What determines what substances are readily absorbed in the fetal ciruclation
✅Molecular size, wt and lipid solubility determine which substances are readily
absorbed into the fetal circulation
When are birth defects most likely to happen ✅Most likely to occur during first trimester
of pregnancy 3-8wks
,Second an third trimester drugs effects on baby ✅Second/third trimester drugs
manifest adverse effects in the neonate or infant.
(Growth retardation, respiratory problems, infection, bleeding)
When is brain development effected in pregnancy ✅Brain development and function
affected by drugs at any stage during pregnancy and infancy
Category A drug ✅Category A Human study, safe in 1st trimester
Ex of category A drug ✅Example drugs or substances: levothyroxine, folic acid,
liothyronine, magnesium sulfate
Category B drugs ✅Category B Animal studies, safe in pregnancy
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are
no adequate and well-controlled studies in pregnant women.
Ex of category B drug ✅Example drugs: metformin, hydrochlorothiazide,
cyclobenzaprine, amoxicillin, pantoprazole
Category C drug ✅Animal reproduction studies have shown an adverse effect on the
fetus and there are no adequate and well-controlled studies in humans, but potential
benefits may warrant use of the drug in pregnant women despite potential risks.
Animal studies show adverse effects but potential benefits may warrant use of the drug
in pregnant women despite potential risks.
Ex of category C drug ✅Example drugs: tramadol, gabapentin, amlodipine, trazodone
Ex of category D drug ✅Example drugs: lisinopril, alprazolam, losartan, clonazepam,
lorazepam
Category D drug ✅There is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience or studies in humans, but
potential benefits may warrant use of the drug in pregnant women despite potential
risks.
Category X drug ✅Studies in animals or humans have demonstrated fetal
abnormalities and/or there is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience, and the risks involved in use
of the drug in pregnant women clearly outweigh potential benefits.
Ex of category x drug ✅Example drugs: atorvastatin, simvastatin, warfarin,
methotrexate, finasteride
Risk benefit asmt of drug therapy in pregnancy ✅Maternal and Fetal assessment
, Risk to fetus compared to maternal benefit
Consequences of treatment vs non-treatment
Principles of drug therapy in pregnancy ✅Include mother and family in discussion
Ideally, pregnancy should be drug free
If medications taken during pregnancy, most are safe
Lowest dose possible
Client education
Commonly used meds in pregnancy ✅1. Folic acid- 400-800 mcg daily
2. Prenatal vitamin i tab daily
3. Iron (Ferrous sulfate) 27mg po daily (usually in PNV)
Iron should be taken with ✅Take with Vit C. Avoid coffee and Calcium
Vaccines that are approved in pregnancy ✅1. Hep b
2. Inactivated flu
3. Tdap 27-36 wks
4. Rabies
Vaccines to avoid in pregnancy ✅MMR - rubella postpartum
Flu nasal spray
Varicella
Meds to continue with pregnancy ✅Seizures
HTN
Asthma
Depression - happy mother is a happy pregnancy
Meds to discontinue in pregnancy ✅Herbal Supplements - because they aren't
regulated
OTC drugs - some are safe, but stop
"Natural" Remedies - whats "natural"? They arent regulated
Always discuss with HCP
Chronic htn ✅Chronic HTN - 140/90 before 20wks and lasting >12wks PP
Gestational htn ✅Gestational HTN - 140/90 after 20wks, no proteinuria
Preeclampsia ✅Preeclampsia - 140/90 + proteinuria after 20wks
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