Fundamentals of Clinical Pharmacology With Application for Pregnant Women

Abstract

Medication use is common in pregnancy, yet for most medications the optimal formulation and dosage have not been described specifically for pregnant women. Often, adverse effects are only discovered anecdotally or after extensive off-label use occurs. Since pharmacologic research that includes pregnant women is sparse and animal studies are often not applicable to the human fetus, providers must use knowledge of drug behavior and normal physiologic changes of pregnancy to personalize treatment for pregnant women. In this review, we present an overview of the basic concepts of clinical pharmacology: pharmacokinetics, pharmacodynamics, and pharmacogenomics. The normal physiologic changes of pregnancy are presented as a framework to understand alterations in drug behavior. A clinical vignette that addresses 4 pregnancy scenarios involving medications-preterm birth, vaccination, herpes simplex virus infection, and codeine toxicity-is provided to illustrate application of core clinical pharmacologic concepts. Discussion of relevant literature illustrates the challenges of offering individualized pharmacologic therapy in pregnancy.

The Unique Microbiome and Innate Immunity During Pregnancy

“…It is acknowledged that to prevent maternal infection and adverse neonatal outcomes during pregnancy, clinical medication is commonly used, although the optimal formulation and dosage of most drugs have not been described specifically for pregnant women (121). For Group A streptococci infection or other Galanz-positive bacteria, clindamycin has more advantages compared to penicillin because of a longer post-antibiotic effect and less side effects (122).…”

Global versus local: A regional core embryology syllabus for medical students

“…Embryology plays an important role on understanding gross and topographic anatomy, identifying abnormal organization of the body, and to comprehend clinical and surgical treatments of congenital anomalies. Embryology intersects with obstetrics, pediatrics, and genetics (Das et al, 2018; Moxham et al, 2016), assisted reproduction (Harper et al, 2013), and pharmacology (Patil et al, 2017). Such considerations justify that human embryology is approached for health courses in a clinical orientation, with great emphasis on congenital malformations (Scott et al, 2013).…”

Foetal Tachyarrhythmias: A Modern State of the Problem

“…Следует отметить, что проведенные работы продемонстрировали хорошее проникновение дигоксина и флекаинида через плаценту в отличие от амиодарона. [1,2,11,16,17]. Однако при низком уровне перфузии трансплацентарная передача дигоксина снижается.…”