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Clinical Pharmacology During Pregnancy - 1st Edition - ISBN: 9780123860071, 9780123860088

Clinical Pharmacology During Pregnancy

1st Edition

eBook ISBN: 9780123860088
Hardcover ISBN: 9780123860071
Imprint: Academic Press
Published Date: 22nd November 2012
Page Count: 488
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Clinical Pharmacology During Pregnancy is written for clinicians, physicians, midwives, nurses, pharmacists and other medical professionals directly involved in the care of women during pregnancy. This book focuses on the impact of pregnancy on drug disposition and also includes coverage of treatments for diseases of specific body systems as well as essential content on dosing and efficacy.

The broad range of this book encompasses analgesics, antiasthmatics, antidepressants, heart and circulatory drugs, vitamins and herbal supplements, and more. Topics in chemotherapy and substance abuse are covered, as are research issues, including clinical trial design and ethical considerations.

Key Features

  • Uses an evidence-based approach for therapeutics during pregnancy
  • Includes a summary of specific medications by indication with up-to-date information on dosing and efficacy in pregnancy for the given indication


This book will be of value to anyone who is actively involved in the care of pregnant women, including obstetricians, residents in obstetrics, fellows in fetal maternal medicine, internists, general and family practitioners who provide care for women of reproductive age, pharmacists, midwives, nurse practitioners and physician assistants.

Table of Contents


1. Introduction


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


3. Impact of Pregnancy on Maternal Pharmacokinetics of Medications

3.1 Introduction

3.2 Effects of pregnancy on pharmacokinetic parameters

3.3 Summary


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


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



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



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


8. Ethics of Clinical Pharmacology Research in Pregnancy


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


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


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



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



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


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


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



16. Diabetes in Pregnancy

16.1 Introduction

16.2 Epidemiology

16.3 Classification

16.4 Gestational diabetes

16.5 Diabetes management in pregnancy



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


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


19. Uterine Contraction Agents and Tocolytics

19.1 Introduction

19.2 Uterine contraction agents (uterotonics)

19.3 Uterine relaxation agents (tocolytics)


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


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)


22. Vitamins, Minerals, Trace Elements, and Dietary Supplements

22.1 Introduction

22.2 First trimester

22.3 Second trimester

22.4 Third trimester


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

23.7 Acupuncture and acupressure therapy in pregnancy

23.8 Meditation and hypnosis in pregnancy


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



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

Liver diseases in pregnancy

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




No. of pages:
© Academic Press 2012
22nd November 2012
Academic Press
eBook ISBN:
Hardcover ISBN:


"This medications references is intended for medical and health professionals involved in the care of pregnant women…A companion website features case studies, slides, bulleted summaries, and questions."--Reference and Research Book News, August 2013

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