Term
|
Definition
Barbie’S Car Goes Real Phast
– Barbiturates
– St. John’s Wort
– Carbamazepine
– Griseofulvin (antifungal agent)
– Rifampin
– Phenytoin
Richard’s Black Car Goes Putt Putt and
Smokes
– Rifampin
– Barbiturates
– Carbamazepine
– Griseofulvin
– Phenytoin
– Phenobarbital
– Smoke (cigarette) or St. John’s Wort |
|
|
Term
Major CYP450 Inducers
CRAP GPS |
|
Definition
CRAP GPS
– Carbamazepine
– Rifampin
– Alcohol (chronic)
– Phenytoin
– Griseofulvin
– Phenobarbital
– Sulfonylureas |
|
|
Term
Major CYP450 Inducers
Richard’s Black Car Goes Putt Putt and
Smokes |
|
Definition
– Rifampin
– Barbiturates
– Carbamazepine
– Griseofulvin
– Phenytoin
– Phenobarbital
– Smoke (cigarette) or St. John’s Wort |
|
|
Term
Major CYP450 Inducers
Barbie’S Car Goes Real Phast |
|
Definition
– Barbiturates
– St. John’s Wort
– Carbamazepine
– Griseofulvin (antifungal agent)
– Rifampin
– Phenytoin |
|
|
Term
|
Definition
Clearly Cool Ken’s Vehicle Is Equally Quick
– Clarithromycin or Chloramphenicol
– Cimetidine or Ciprofloxacin
– Ketoconazole (and all of the other ‐azole antifungal
agents)
– Valproic Acid
– Isoniazid
– Erythromycin
– Quinidine, Quinine, Quinupristine/Dalfopristine
• Also Grapefruit Juice, Protease Inhibitors,
Omeprazole |
|
|
Term
| Factors affecting placental drug transfer and toxicity include |
|
Definition
Physiochemical properties of drug
Amount of drug
Stage of pregnancy
Duration of exposure to drug
Most drugs move from maternal circulation to fetal circulation by simple diffusion across placenta |
|
|
Term
| Drug properties placental drug transfer |
|
Definition
Lipid solubility
High lipid solubility higher conc in placenta
Degree of ionization
Low ionzation higher conc in placenta
Protein binding
Unbound drug higher conc in placenta
Molecular weight
< 500 Da cross placenta easily
pH of maternal blood
Affects degree of ionization
Fetal pH is more acidic than maternal pH
Placental barrier
Placental & fetal metabolism |
|
|
Term
|
Definition
Nausea & vomiting
Delayed gastric emptying
Increased gastric pH |
|
|
Term
| Distribution in pregnancy |
|
Definition
Maternal plasma volume increases
Body fat increases increase in volume of distribution of fat-soluble drugs
Decreased maternal plasma albumin conc increases volume of distribution of highly bound drugs |
|
|
Term
|
Definition
| High levels of estrogen and progesterone affect liver enzymes increased accumulation of some drugs (increased excretion of others) |
|
|
Term
|
Definition
GFR increases increased renal excretion
Excretion of unbound drugs increases
High levels of estrogen and progesterone affect liver enzymes increased elimination of some drugs (increased accumulation of others) |
|
|
Term
| Factors affecting breast milk drug transfer and toxicity include |
|
Definition
Most drugs transfer into milk by passive diffusion
Drug factors affecting transfer:
pKa of drug – high (basic pH)
Protein binding – low
Lipophilicity – high
Molecular weight – < 300 Da
Ionization – non-ionized
Half life of drug – longer
Maternal plasma levels – higher
Oral bioavailability
Many drugs simply not absorbed by infant’s GI tract
Nursing time |
|
|
Term
| Infant factors affecting drug concentration in milk |
|
Definition
Age
Quantity of breast milk consumed
Nursing time |
|
|
Term
| Minimizing infant exposure |
|
Definition
Avoid/delay products not medically necessary
Avoid extended/sustained release products
Administer once daily drugs just before infant’s longest sleep interval
Pump before taking drugs, saving fresh milk for later feedings
Use lowest effective dose for shortest duration possible
Choose an alternate route of administration |
|
|
