Drug Use During Pregnancy and Thalidomide Tragedy

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Questions and Answers

Which of the following drugs is associated with fetal hydantoin syndrome?

Carbamazepine

Phenobarbitone

Captopril

Valproic acid (correct)

What condition is indicated by exposure to warfarin during pregnancy?

Isoniazid syndrome

Fetal alcohol syndrome

Warfarin syndrome (correct)

Fetal hydantoin syndrome

Which of the following drugs is classified as an embryotoxic agent?

Ticarcillin

Cimethidine

Mefenamic acid (correct)

Dypiridamol

What is a key reason to discourage self-medication during pregnancy?

Effects of medications differ between the pregnant mother and fetus. Signup and view all the answers

Which of the following conditions may result from aminoglycoside exposure during pregnancy?

Ototoxicity and nephrotoxicity Signup and view all the answers

Which of these drugs is deemed appropriate for use during pregnancy?

Acetaminophen Signup and view all the answers

What was the primary use of Thalidomide in the late 1950s and early 1960s?

To alleviate nausea in pregnant women Signup and view all the answers

Which drug is specifically noted for its potential late abnormalities if taken during pregnancy?

Diethylstilbestrol (DES) Signup and view all the answers

Which of the following changes is NOT a maternal pharmacokinetic change during pregnancy?

Decreased plasma volume Signup and view all the answers

What should be assessed when evaluating drug use during lactation?

Presence of drugs in breast milk Signup and view all the answers

What factor does NOT influence transplacental drug transfer?

Duration of drug exposure Signup and view all the answers

How much does medication exposure account for in terms of all birth defects?

Less than 1% Signup and view all the answers

What is an example of a predictable drug effect on the unborn?

Masculinization of the female fetus by androgenic hormones Signup and view all the answers

What physiological change occurs during pregnancy that affects drug absorption?

Increased nausea and vomiting Signup and view all the answers

Which of the following is NOT a potential complication affecting drug selection during pregnancy?

Genetic predisposition of the fetus Signup and view all the answers

Which aspect of maternal metabolism increases during pregnancy?

Hepatic perfusion Signup and view all the answers

Study Notes

Thalidomide Tragedy (1961-1962)

Thalidomide, used for nausea in pregnant women, caused birth defects.

Reasons for Drug Use During Pregnancy

Treatment of acute illness.
Management of chronic diseases.
Pregnancy complications.
Managing physiological changes during pregnancy.
Addressing complications during labor.

Maternal Pharmacokinetic Changes During Pregnancy: Absorption

Delayed gastric emptying.
Increased nausea and vomiting.
Elevated gastric pH.

Maternal Pharmacokinetic Changes During Pregnancy: Distribution

Increased maternal plasma volume.
Increased body fat.
Decreased plasma albumin concentration.
Competition for protein binding sites by steroids and hormones.

Maternal Pharmacokinetic Changes During Pregnancy: Metabolism

Increased hepatic perfusion.
Altered activity of metabolic enzymes and drug transporters.

Maternal Pharmacokinetic Changes During Pregnancy: Excretion

Increased renal blood flow.
Increased glomerular filtration rate (GFR) by 30-50%.

Transplacental Drug Transfer

Drugs cross the placenta via diffusion.
Transfer rate depends on lipid solubility, charge, molecular weight, and protein binding.

Drug Effects on the Unborn: Predictable vs. Unpredictable

Predictable: Based on known pharmacological properties (e.g., androgenic hormones causing masculinization).
Unpredictable: Effects specifically impacting the developing organism, not predictable from known properties.

Drug Selection During Pregnancy

Medication exposure accounts for <1% of birth defects.
Stage of pregnancy, route of administration, and dose affect outcomes.

Sensitivity of Specific Organs to Teratogenic Agents

Critical stages of human embryogenesis are particularly vulnerable.

Drugs and Fetal Anomalies

Anticonvulsants: Fetal hydantoin syndrome.
Anticoagulants (Warfarin): Warfarin syndrome.
Mefenamic acid: Embryotoxic.
Aminoglycosides: Ototoxic, nephrotoxic, affect Factor VIII.
Alcohol: Fetal alcohol syndrome.
DES (Diethylstilbestrol): Late abnormalities.

Relatively Safe Drugs During Pregnancy

Paracetamol, penicillin, isoniazid, folic acid.

Drugs Requiring Careful Consideration During Pregnancy

Phenothiazines, narcotic analgesics, NSAIDs, antiarrhythmics, diuretics.

Pregnancy Drug Categories (Based on Animal Studies)

B1: No evidence of fetal harm in animal studies. Examples: cimetidine, dipyridamole, spectinomycin.
B2: Incomplete animal data, no evidence of fetal harm in humans. Examples: ticarcillin, amphotericin, dopamine, acetylcysteine, belladonna alkaloids.
B3: Evidence of fetal harm in animals, potential risk in humans. Examples: carbamazepine, pyrimethamine, griseofulvin, trimethoprime, mebendazole.

Drugs Requiring Special Caution During Pregnancy

Phenytoin, phenobarbital, valproic acid, clonazepam, quinine, captopril, cytostatic agents, anticoagulants, androgens, steroid anabolics, isotretinoin, and diethylstilbestrol.

General Principles of Drug Use During Pregnancy

Use drugs only when absolutely necessary.
Ensure correct benefits outweigh risks.
Choose appropriate drugs.
Adjust medication doses as needed.
Discourage self-medication.
Fetal effects may differ from maternal effects.

Drugs Commonly Used During Pregnancy

Analgesics/antipyretics.
Antibiotics.
Antiemetics/antihistamines.
Antihypertensives.
Antidiabetics.
Antithyroid drugs.
Hypnotics/sedatives/psychotropics.
Drugs used in asthma.

Drug Use During Lactation

Drugs in maternal circulation can be excreted in breast milk.
Risk evaluation is crucial.
Weaning may be necessary if there is significant risk to the infant.

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Description

Explore the historical context and significance of the Thalidomide tragedy, along with the pharmacokinetic changes that affect drug use during pregnancy. This quiz covers the reasons for drug usage, maternal absorption, distribution, metabolism, and excretion during pregnancy. Understand the complexities and implications of medication management in expectant mothers.