By Sue Jordan; Kate Isherwood, RGN.; Fiona Murphy; Vicky Whittaker
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Extra resources for Pharmacology for midwives : the evidence base for safe practice
Sample text
To prevent this, pregnant women are advised to take any iron tablets with vitamin C, for example with orange or tomato juice. Any iron taken with antacid preparations will not be absorbed. The decline in gastro-intestinal motility associated with pregnancy (due to increased progesterone and decreased motilin) delays the absorption of certain drugs from the gastro-intestinal tract. This may reduce the efficacy of antiepileptics (see Chapter 19). During pregnancy, the peripheral circulation is dilated which may enhance the absorption of drugs given by subcutaneous or intramuscular injections.
Some fetal abnormalities, including cardiac anomalies and neural tube defects, can be detected in utero by screening with high resolution ultrasound. 1 lists some common medications which may adversely affect the fetus. A further list is included in Chapter 14, antimicrobial agents. For many drugs and herbal remedies, the manufacturers advise against use in pregnancy on the grounds that there are insufficient human data to demonstrate safety. No drugs have been subjected to randomized controlled clinical trials in human pregnancy.
Examples include: insulin receptors, opioid receptors, dopamine receptors, histamine receptors. Many drugs imitate the actions of the body’s own ligands. Some drugs are direct replacements, for example insulin and epinephrine (adrenaline). Others provide an artificial boost to certain receptors, for example opioids. Each receptor shows a high degree of specificity for its own ligand, so that histamine receptors are bound only by histamine, and not by insulin and vice versa. This idea of specificity, based on the three-dimensional shape or structure of ligand and receptor, is referred to as the ‘Lock and Key Hypothesis’ (Clark, 1933) (see Fig.
