drug therapy across lifespan- pharm

Essentially all drugs can cross the placenta and the

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Unformatted text preview: size, protein binding, and blood flow to the placenta. • Essentially all drugs can cross the placenta and the nurse should assume that any drug taken during pregnancy will reach the fetus. (nicotine, pot, narcotics) 7 Pharmacodynamics Physical changes occur: 1) by 32 weeks gestation cardiac output is increased by 50% and 2) from the second trimester on arterial blood pressure is decreased. The above changes necessitate careful assessment of the drug’s pharmacodynamics. 8 Pharmacodynamics Teratogen---any compound capable of interfering with embryonic and/or fetal development. 1. Must cause a characteristic set of malformations. 2. Act only during a specific period of time during gestation. 3. Incidence of malformations should increase with increasing dosage and duration of exposure. 4. Incidence and causes of congenital anomalies. • Less than 1% of all birth defects caused by Less drugs drugs 1. Identification of teratogens very difficult. 2. Greatest risk is 15-60 days after conception. (2 Greatest weeks to a month after female gets pregnant) weeks 9 Teratogenesis and Teratogenesis Stage of Development Stage Development occurs in three stages: • Conception through week 2 • Embryonic period – weeks 3 to 8 Embryonic Gross malformations produced by teratogens • Fetal period – week 9 to term Fetal Functions disrupted with teratogen exposure 10 Fig. 9-1. Effects of teratogens at various stages of development of the fetus. 11 FDA 12 Drugs Associated with Neonatal Withdrawal Symptoms • • • • • • Alcohol Cocaine Antihistamines- benadryl Barbiturates Benzodiazepines Opiates 13 Drugs and Breast Feeding • Majority of drugs are secreted into breast milk---but very few instances in which the drug needs to be discontinued. • If drug concentrations in the breast milk rise enough a pharmacological effect can occur in the infant. • Difficult to accurately predict the amount of maternal drug transfer but range is approximately 1%-3%. • Drugs present in breast milk may cause adverse effects i...
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