Question

1. Identify four basic considerations of drug therapy during pregnancy.
2. Discuss the physiologic changes that occur during pregnancy and their effect on drug disposition and dosing.
3. Discuss placental drug transfer, focusing on the importance of clinicians assuming that any drug taken during pregnancy will reach the fetus.
4. Discuss adverse reactions during pregnancy, focusing on the effects of drugs on the fetus and neonate.
5. Discuss the term teratogenesis as it relates to drug therapy during pregnancy and the stages of fetal development.
6. Identify teratogens and measures that can be taken to minimize their risks.
7. Discuss the appropriate steps in determining exposure to teratogens.
8. Discuss drug therapy during breast-feeding and the potential risks to the breast-feeding neonate or infant of a mother who is taking drugs. Consider the health and well-being of both the mother and the fetus.

9. Distinguish among the categories established by the U.S. Food and Drug Administration to classify potential drug risks to the fetus (A, B, C, D, X). Comment on the meaning of each category with regard to potential fetal risks, the reasons medications are categorized as they are, and the evidence upon which each drug is assigned to a classification.

Answer 1

1.The important consideration in drug therapy for pregnant women is the potential adverse effects on the developing fetus. A clear clinical indication for drug therapy must exist before a drug is prescribed. Some health problems can occursecondarily to pregnancy and require drug therapy. If the fetus has a health problem, drugs are administered to the pregnant women with the intent if treating the fetus as the drug passes through the placenta. If the patient has an existing disease condition that requires drug therapy, the health care providers must consider whether the prescribed drug therapy will have afverse effects on the fetus. Any adverse effects the pregnancy may have on the mother health must be identified because they may require changes in drug therapy   

2.

In cardiovascular system circulating blood volume increases, and total red blood cell volume increases. Oxygen consumption increases by approx 15% tob20%Nsusea and vomiting may occur as a result of the secretion of hcg, it subsides by the third month. Frequency of urination increases in the first and third trimester because of increased bladder sensitivity and pressure of the enlarging uterus on the bladder. Basal metabolic rate increases and metabolic function increases

3.All drugs can cross the placenta. But some can cross more easily than others especially lipid soluble. Protein bound drugs have more difficulty crossing.

4.Drugs can adversely affect both pregnant patients and fetus. Some unique effects are Heparin causes osteoporosis, prostaglandins stimulate uterine contractions. Certain pain relievers used during delivery can depress respiration in the neonate.

5 Teratogenesis is the process by which congenital malformation are produced in an embryo or fetus.

Development occurs in three stages. Conception through week 2,embryonic period ,weeks3 to 8.

Gross malformation produced by teratogens. Fetal period week 9 through delivery. Functions disrupted with teratogen exposure.

6.Measures which can be taken to reduce the risk for teratogenesis are

• Pregnant patients should avoid unnecessary drug use.
• Responding to teratogen exposure such as identifying details of exposure and ultrasound scans.