Drugs in Pregnancy, An Issue of Obstetrics and Gynecology Clinics, E-Book (eBook)
240 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-93990-4 (ISBN)
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Contains 17 practice-oriented topics including obstetrical pharmacology; over-the-counter medications in pregnancy; antibiotic use in pregnancy; opioids in pregnancy; mood disorder medications in pregnancy; and more.
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Provides in-depth clinical reviews on drugs in pregnancy, offering actionable insights for clinical practice.
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Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
In this issue of Obstetrics and Gynecology Clinics of North America, guest editor Dr. Catherine Stika brings her considerable expertise to the topic of Drugs in Pregnancy. The use of medications during pregnancy can be difficult to manage because not only is research lagging in this area, but typically drugs are not studied for use in pregnant women. In this issue, key experts provide a state-of-the-art review on clinical pharmacology in pregnancy, with a look at commonly prescribed medications as well as over-the-counter medications. Contains 17 practice-oriented topics including obstetrical pharmacology; over-the-counter medications in pregnancy; antibiotic use in pregnancy; opioids in pregnancy; mood disorder medications in pregnancy; and more. Provides in-depth clinical reviews on drugs in pregnancy, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
Principles of Obstetric Pharmacology
Maternal Physiologic and Hepatic Metabolism Changes
∗ Corresponding author.
email address: c-stika@northwestern.edu
Since the recognition of pregnancy as a special pharmacokinetic population in the late 1990s, investigations have expanded our understanding of obstetric pharmacology. Many of the basic physiologic changes that occur during pregnancy impact on drug absorption, distribution, or clearance. Activities of hepatic metabolizing enzymes are variably altered by pregnancy, resulting in concentrations sufficiently different for some drugs that efficacy or toxicity may be affected. Understanding these unique pharmacologic changes will better inform our use of medications for our pregnant patients.
Keywords
Key points
- • Pregnancy is a pharmacologic special population, where changes in absorption, distribution, metabolism, and elimination of drugs can impact concentrations sufficiently that different dosing may be required.
- • Normal physiologic changes in pregnancy (increases in plasma volume, total body water, glomerular filtration rate, and renal secretion and decreases in plasma proteins) can impact drug concentrations and clearance.
- • Hormonal changes in pregnancy alter drug-metabolizing enzymes; activities of cytochrome P450 (CYP) 2D6, CYP2C9, CYP3A4, and uridine 5′-diphosphate glucuronosyltransferase (UGT) 1A1 and UGT1A4 increase, whereas CYP1A2 and CYP2C19 decrease.
Impact of physiologic changes in pregnancy on pharmacology
Case #1
Increase in blood volume and total body water
Table 1
PK Parameter | Early First T | Late First T | Early Second T | Late Second T | Early Third T | Late Third T | <8 wk PP | >12 wk PP |
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Renal: CrCL | ↑ | ↑↑ | ↑↑ | ↑↑↑ | ↑↑↑ | ↑↑ | ↑ | = |
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Plasma volume/TBW | ↑ | ↑ | ↑↑ | ↑↑ | ↑↑↑ | ↑↑↑ | ↑ | = |
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Albumin | ↓ | ↓ | ↓↓ | ↓↓ | ↓↓↓ | ↓↓↓ | ? | = |
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α1-acid glycoprotein | ↓ | ↓ | ↓↓ | ↓↓ | ↓↓↓ | ↓↓ | = | = |
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Hepatic arterial blood flow | ? | = | = | = | = | = | ? | = |
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Hepatic portal blood flow | ? | ↑ | ↑ | ↑ | ↑↑ | ↑↑ | ? | = |
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UGT1A1 | ? | ↑ | ↑↑ | ↑↑ | ↑↑↑ | ↑↑↑ | ? | = |
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UGT1A4 | ↑ | ↑ | ↑↑ | ↑↑↑ | ↑↑↑↑ | ↑↑↑↑ | = | = |
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CYP1A2 | ? | ↓ | ↓↓ | ↓↓ | ↓↓ | ↓↓↓ | ↓ | = |
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CYP2B6 | ? | ? | ? | = | = | = | ? | = |
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CYP2C9 | ? | ↑ | ↑ | ↑ | ↑↑ | ↑↑ | ? | = |
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CYP2C19 EM/RM/UM | ? | ? | ? | ? | ↓↓↓ | ↓↓↓ | ? | = |
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CYP2D6 EM/RM | ? | ? | ↑ | ↑↑ | ↑↑↑ | ↑↑↑ | ? | = |
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CYP3A4/5 | ? | ↑↑↑ | ↑↑↑ | ↑↑↑ | ↑↑↑ | ↑↑↑ | ↑↑↑ | ? | = |
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Abbreviations: =, no different from nonpregnant state; ?, parameter change is unknown; CrCL, creatinine, clearance; CYP, cytochrome P450; EM, extensive metabolizer; PK, pharmacokinetic; PP, postpartum; RM, rapid metabolizer; T, trimester; TBW, total body water; UGT, uridine 5’-diphosphate glucuronosyltransferase; UM, ultrarapid metabolizer.
Decreased protein binding
Erscheint lt. Verlag | 25.2.2023 |
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Sprache | englisch |
Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Gynäkologie / Geburtshilfe |
Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie | |
ISBN-10 | 0-323-93990-2 / 0323939902 |
ISBN-13 | 978-0-323-93990-4 / 9780323939904 |
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