What drug characteristics affect the determination of drug safety in pregnancy?
A. Low molecular weight and low protein binding
B. Low molecular weight and pH
C. High molecular weight and low protein binding
D. High molecular weight and high protein binding
A. Low molecular weight and low protein binding. To transport across the placenta trophoblastic barrier (PTB) drugs need to be small so low molecular weight and unbound so low protein binding to plasma proteins.
B. Low molecular weight and pH – while pH will impact transport from maternal blood to breast milk, it does not impact transport from maternal blood to fetal blood across the PTB;
C.High molecular weight and low protein binding large molecules will not cross the PTB.
D. High molecular weight and high protein binding Large molecules or drugs bound to plasma proteins will not cross the PTB
Which of the following drugs is not teratogenic during the first trimester?
C. Lisinopril, ACE inhibitor, are primarily teratogenic when administered during the second or third trimester causing congential hypocalvaria, renal anomalies, perinatal renal failure, growth restriction, prematurity or neonatal hypotension.
A. Lamotrigine B. Bupropion and D. Isotretinoin are all known to be teratogenic when given during the first trimester. Often associated with significant malformations.
Which of the following drugs is considered potentially teratogenic throughout pregnancy?
C. Chlorpromazine – it is antipsychotic medication and potentially teratogenic throughout pregnancy. While no increase in malformations, neonates may experience transient hypotension and extrapyramidal tract symptoms.
A. Thalidomide; B. Isotretinoin; and D. Valproic acid exert teratogenic effects primarily when administered during the first trimester.
Which of the following is a true statement regarding drug safety during breast feeding?
A. Drugs that have low systemic level in mom will have low levels in milk
B. Drugs that are highly protein bound are generally readily available to pass into the milk compartment