Clinical Pharmacology During Pregnancy

Front Cover
Clinical Pharmacology During Pregnancy
Copyright
Contents
Contributors
1 - Introduction
	References
2 - Physiologic Changes During Pregnancy
	2.1
Physiologic changes during pregnancy
	2.2
Cardiovascular system
	2.3
Respiratory system
	2.4
Renal system
	2.5
Gastrointestinal system
	2.6
Hematologic and coagulation systems
	2.7
Endocrine system
	2.8
Summary
	References
3 - Impact of Pregnancy on Maternal Pharmacokinetics of Medications
	3.1
Introduction
	3.2
Effects of pregnancy on pharmacokinetic parameters
	3.3
Summary
	References
4 - Medications and the Breastfeeding Mother
	4.1
Medication use by the breastfeeding mother
	4.2
Clinical pharmacology of drug transfer into breast milk
	4.3
During delivery
	4.4
General anesthesia
	4.5
Epidural anesthesia
	4.6
Galactogogues
	4.7
Immediate postpartum period
	4.8
Pain
	4.9
Methadone
	4.10
Resumption of pre-pregnancy medications
	4.11
Psycho- and neurotropic drugs
	4.12
Drugs not to give to the nursing mother postpartum
	4.13
Oral contraceptives (OCPs)
	4.14
Summary
	4.15
Where to find information
	References
5 - Fetal Drug Therapy
	5.1
Introduction
	5.2
Indications for fetal therapy
	5.3
Strategies to achieve fetal drug therapy
	5.4
Special considerations
	Acknowledgments
	References
6 - Treating the Placenta: an Evolving Therapeutic Concept
	6.1
Introduction
	6.2
The placenta as the therapeutic target: the past
	6.3
The placenta: therapeutic targets
	6.4
The placenta as a therapeutic target today
	6.5
The placenta as a therapeutic target in the future
	Conclusions
	References
7 - What is Sufficient Evidence to Justify a Multicenter Phase 3 Randomized Controlled Trial in Obstetrics?
	7.1
Introduction
	7.2
Evidence, equipoise, and the ethical considerations in deciding whether to conduct a trial
	7.3
Why are failure rates so high for pregnancy drug trials compared to other therapeutic areas?
	7.4
Role of phase 2 trials
	7.5
How to improve success rates
	7.6
Learning from experience – the example of antioxidants and preeclampsia
	Conclusions and recommendations
	References
8 - Ethics of Clinical Pharmacology Research in Pregnancy
	References
	Questions for further discussion
9 - Pharmacogenomics in Pregnancy
	9.1
Pharmacogenomics
	9.2
Genetics and polymorphisms
	9.3
Genes that influence pharmacokinetic variability
	9.4
The current state of pharmacogenetic testing
	9.5
Potential therapeutic areas for pharmacogenomics in pregnancy
	9.6
Study designs and approaches to pharmacogenetics trials
	References
10 - Analgesics and Anti-Inflammatory, General and Local Anesthetics and Muscle Relaxants
	10.1
Introduction
	10.2
General anesthesia
	10.3
Inhalational anesthetics
	10.4
Intravenous anesthetics
	10.5
Neuromuscular blocking agents
	10.6
Regional anesthesia
	10.7
Summary
	References
11 - The Management of Asthma During Pregnancy
	11.1
Introduction
	11.2
Effect of pregnancy on the course of asthma
	11.3
Effect of asthma on pregnancy
	11.4
Asthma management
	11.5
Pharmacologic therapy
	Conclusion
	References
12 - Updated Guidelines for the Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum
	12.1
Introduction
	12.2
Hyperemesis gravidarum
	12.3
Etiology and risk factors
	12.4
Differential diagnosis
	12.5
Management of NVP and HG
	Conclusion
	References
13 - Clinical Pharmacology of Anti-Infectives During Pregnancy
	13.1
Antibacterial therapy
	13.2
Antifungal therapy
	13.3
Malaria
	13.4
Tuberculosis
	13.5
HIV
	13.6
Antivirals
	13.7
Parasitic infections
	References
14 - Chemotherapy in Pregnancy
	14.1
Introduction
	14.2
Overview of chemotherapeutic agents
	14.3
Alkylating agents
	14.4
Anthracyclines
	14.5
Plant alkaloids
	14.6
Targeted therapies
	14.7
Other agents
	14.8
Treatment of specific cancers
	14.9
Breast cancer
	14.10
Lymphoma
	14.11
Leukemia
	14.12
Ovarian cancer
	14.13
Future fertility
	14.14
Pharmacokinetics in pregnancy
	References
15 - Substance Use Disorders
	15.1
Introduction
	15.2
Substance use disorders defined
	15.3
Addiction defined as a disease of the brain
	15.4
The good news: the brain can recover
	15.5
Pregnancy enhances recovery
	15.6
Addiction in women and pregnancy
	15.7
Psychiatric co-morbidity
	15.8
Substances used
	15.9
Screening and detection
	15.10
The role of urine and meconium testing
	15.11
Brief office screening strategies
	15.12
Brief office interventions
	15.13
Long-term care and maintenance
	Conclusion
	References
16 - Diabetes in Pregnancy
	16.1
Introduction
	16.2
Epidemiology
	16.3
Classification
	16.4
Gestational diabetes
	16.5
Diabetes management in pregnancy
	Conclusion
	References
17 - Cardiovascular Medications in Pregnancy
	17.1
Introduction
	17.2
Cardiovascular changes in pregnancy
	17.3
Cardiovascular diseases in pregnancy
	17.4
Pharmacodynamics of hemodynamically active drugs in pregnancy
	17.5
Fetal pharmacodynamic response to hemodynamically active drugs
	17.6
Direct fetal effects of hemodynamically active drugs
	17.7
Pharmacokinetic changes in hemodynamically active drugs in pregnancy
	Key points
	References
18 - Antidepressants in Pregnancy
	18.1
Introduction
	18.2
Effects of untreated perinatal depression on women and children
	18.3
Approach to treatment
	18.4
Potential risks of selective serotonin reuptake inhibitor (SSRI) use during pregnancy
	18.5
Potential risks of non-SSRI antidepressant use during pregnancy
	18.6
Potential risks of older antidepressant use during pregnancy
	18.7
Anxiety
	18.8
Summary
	References
19 - Uterine Contraction Agents and Tocolytics
	19.1
Introduction
	19.2
Uterine contraction agents (uterotonics)
	19.3
Uterine relaxation agents (tocolytics)
	References
20 - Antenatal Thyroid Disease and Pharmacotherapy in Pregnancy
	20.1
Thyroid function and physiology in pregnancy
	20.2
Hyperthyroidism in pregnancy
	20.3
Pharmacotherapy with thionamides in pregnancy
	20.4
Hypothyroidism in pregnancy
	20.5
Pharmacotherapy with levothyroxine in pregnancy
	20.6
Summary
	References
21 - Dermatological Medications and Local Therapeutics
	21.1
Introduction
	21.2
Acne
	21.3
Psoriasis
	21.4
Bacterial infections
	21.5
Viral infections
	21.6
Fungal infections
	21.7
Parasitic infections
	21.8
Antipruritics
	21.9
Glucocorticosteroids
	21.10
Immunomodulators/immunosuppressive therapy
	21.11
Analgesics
	21.12
Antiseptics (disinfectants)
	References
22 - Vitamins, Minerals, Trace Elements, and Dietary Supplements
	22.1
Introduction
	22.2
First trimester
	22.3
Second trimester
	22.4
Third trimester
	References
23 - Herbs and Alternative Remedies
	23.1
Herbal teas frequently used during pregnancy
	23.2
Essential oils used as aromatherapy during pregnancy
	23.3
Herbs used as capsules or dried extracts
	23.4
Herbal topical preparations used in pregnancy
	23.5
Non-herbal supplements used in pregnancy
	23.6
Herbs used to induce labor
	23.7Acupuncture and acupressure therapy in pregnancy
	23.8
Meditation and hypnosis in pregnancy
	References
24 - Envenomations and Antivenoms During Pregnancy
	24.1
General principles about envenomation
	24.2
Snake bites
	24.3
Spider bites
	24.4
Scorpion stings
	24.5
Hymenoptera
	24.6
Jellyfish
	24.7
Antivenom use during pregnancy
	Conclusions
	References
25 - Gastrointestinal Disorders
	25.1
Gastroesophageal reflux disease
	25.2
Peptic ulcer disease
	25.3
Constipation
	25.4
Diarrhea
	25.5
Abdominal pain
	25.6
Gastrointestinal infections
	25.7
Inflammatory bowel disease
	25.8
Hepatitis B
	25.9
Hepatitis C
	25.10
Wilson’s disease
	25.11
Autoimmune hepatitis
	25.12
Intrahepatic cholestasis of pregnancy
	25.13
Primary biliary cirrhosis and primary sclerosing cholangitis
	References
Index