Placental transfer of medications​
1. Factors promoting transfer​:
- ❌
​- ❌ molecular weight (250-500)​

2. Factors reducing transfer​
- Highly ❌​
- ❌ binding​
- ❌ Molecular weight (>500-1000)​

Known specific teratogens​ - match to effect:
❌ - first trimester phocomelia​
❌ - late first trimester nasal hypoplasia, third trimester fetal anticoagulation and intracranial bleeding​
❌ - first trimester spontaneous abortion, second and third trimester renal hypoplasia​
❌ - first trimester-cardiac and NTD​ (neural tube defects)
❌ - NTDs and facial hypoplasia​

Opiod dependence:
Cessation during pregnancy can result in fetal ❌ and fetal death​
Usual course of action is ❌ maintenance​
Detoxification by tapering can be performed in carefully selected patients with fetal ❌​

Congenital Adrenal Hyperplasia​ is an ❌ genetic condition causing increased androgen production in a female fetus. Maternal administration of ❌ suppresses the ❌ adrenal glands​. Must be initiated ❌ in pregnancy​.

Uterine stimulants for labour induction, PPH:
❌​
Ergot alkaloids​ (May cause hypertensive crisis in hypertensives or when administered by the ❌ route​)
Prostaglandins (Categories ❌ are potent uterine stimulants​)

Uterine relaxants/Tocolytics​:
Beta 2 agonists​ (ritodrine, terbutaline and salbutamol, no effect on delaying ❌)
Calcium channel blockers​ (Nifedipine​, ❌ for preterm)
Oxytocin receptor antagonists​ (Atosiban​. Doesn't work though - ❌ just as good)
Nitrates​ (Nitroglycerin and isosorbide dinitrate, ❌ mediated relaxation of smooth muscle​. Good for twins or C section)
Prostaglandin synthetase inhibitors​ (blocks synthesis of prostaglandins via COX, limited use <❌h)

Contraceptives:
- Estrogen component inhibits ❌ through suppression of ❌
- Progesterone: Inhibits ovulation by suppressing the LH surge, thick cervical ❌ barrier​, ovum transport is altered​, implantation is hampered by ❌ changes​

Physiologic bladder contraction is mediated by acetlycholine at post-ganglionic ❌ receptors (M3)​. Treatment of abnormal contraction (❌ bladder or detrusor overactivity) is therefor mainly ❌ agents​ like atropine, propanetheline, solifenacin. Common side effects: dry mouth and eyes, blurred vision, tachycardia, pruritis, sedation, headache, constipation​. Contraindication in narrow angle ❌ and urinary retention.

Incontinence due to reduced outlet resistance​ is usually treated surgically​. ❌ receptors contract the urinary sphincter​. Ephedrine and pseudoephedrine minimally effective (only ❌ cases)​. ❌ (SNRI) contracts the sphincter during filling with no effect on relaxation with voiding​.