Fundamentals of Clinical Pharmacology With Application for Pregnant Women

Print Publication Year: May 12, 2017

Series: 1542-2011

Published Online: May 12, 2017

eISBN: na

DOI: 10.1111/jmwh.12621

Career: May 12, 2017

Specialty: 1542-2011

Item type: May 12, 2017

ISBN: na

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.