在妊娠哺乳期用药.pptxVIP

There are two major considerations regarding drug use in pregnant women:Effect of pregnancy on : drugs (pharmacokinetics) Effect of drugs on : pregnancy (fetus)第二页，共四十九页。 Drugs in pregnancy第三页，共四十九页。 IntroductionAbout 40% of pregnant women take drugs (at least 1drug)6% take drugs during 1st trimester (exclude folic, iron, vitamins)The most common drugs are analgesics, antibacterial, antacids.What about new drugs?3第四页，共四十九页。 I. Effect of pregnancy on drugs(Pharmacokinetics) Absorption:The rate may be reduced because of delayed gastric emptyingThe extent may not be absorbedVomiting is common. Effect?Reduced bioavailability4第五页，共四十九页。 Effect of pregnancy on drugsB) Distribution: 1. Maternal plasma volume ECF ▲ 50% (3rd trimester) 2. Total body water ▲ 20% total body fat 3. What is the effect on Vd steady state concentration? 4. Serum albumin ▼ by about 20% (in pre-eclampsia 35%) 5. Alpha1-acid glycoprotein ▲By about 40% (in pre-eclampsia 100%) 6. The free fraction of acidic drugs ▲ 7. The free fraction of basic drugs ▼ 8. E.G. Diazepam, phenytoin, valproate. What?What is the effect on t ? of the drug? E.g. phenytoin5第六页，共四十九页。 Drug metabolism:▲Hepatic microsomal mixed function oxidaseIncreased during pregnancy (2nd, 3rd)Explain why he rate of clearance of phenytoin, valproate, carbamazepine is increased during pregnancyThere is no change in hepatic blood flow. Effect? Drugs of first pass effect . Examples propranolol6Effect of pregnancy on drugs第七页，共四十九页。 B. Excretion: Effective renal plasma flow ▲ (doubles) GFR ▲by 70% Clearance rate increases e.g. ampicillin. Solve? What about dose in UTI? Explain why the dosages of digoxin and lithium, are increased during pregnancy?Do you think that pregnancy can also affect drug pharmaco-dyamics? ▲B. blockers7Effect of pregnancy on drugs第八页，共四十九页。 II. Effect of drugs on fetusDrugs can influence fetal development at 3 separate stages: Fertilization