New Era University

COLLEGE OF MIDWIFERY
Room 215, Professional Schools Building
No. 9 Central Avenue, New Era, Quezon City 1107 Philippines
Email: [email protected]  Mobile: +63 923 610 6866
Link to Virtual Office: https://meet.google.com/jah-diue-ufr

ASYNCHRONOUS ACTIVITY
Clinical Practicum

PHARMACOLOGY FOR MIDWIFERY

Course Description:
This course deals with the risk of conditions requiring drug therapy and helps with
medical decision-making during pregnancy and lactation.

Course Objectives:
At the end of the course, the student should be able to:

• Explain the effect of pregnancy on pharmacokinetics and pharmacodynamics.

• Apply knowledge of commonly prescribed drug groups in midwifery practice
(pharmacotherapy) for the childbearing woman, fetus, and neonate.
• Identify and critically analyze medication management of the pregnant woman
using evidence-based practice.
• Identify and critically analyze ethical and legal issues in medication
management to improve clinical practice.

Pharmacology: It is a Latin word meaning drug knowledge.

- Pharmacou = drug.
- Ology = science or knowledge.

Principles of Pharmacology:

Pharmacokinetics and pharmacodynamics are two related sciences that study the
effects of drugs. Pharmacokinetics studies how the body absorbs, distributes,
metabolizes, and excretes a drug, while pharmacodynamics studies the mechanism
of action and effect on an organism.

The three basic concepts of pharmacology:

1. Pharmacokinetics - the absorption, distribution, metabolism, and excretion of

drugs by the body

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2. Pharmacodynamics - the biochemical and physical effects of drugs and the
mechanisms of drug actions

3. Pharmacotherapeutics - the use of drugs to prevent and treat diseases.

Drug Classifications
Drugs are classified by how they affect body systems, therapeutic use, or chemical
characteristics, such as beta-blockers.

Drug Names
Midwives must know both the trade name of a drug, which is assigned by the
pharmaceutical company, and the generic name, which is not protected by
trademark.

Drug Nomenclature
Every drug has (at least) three names:
1. Chemical Name - a scientific name that precisely describes the drug’s atomic and
molecular structure.
2. Generic Name - an abbreviation of the chemical name and it refers to a common
established name regardless of its manufacturer. There is only one generic name for
a drug.
3. Brand Name - it is selected by the drug company selling the product. Trade
names are protected by copyright. The symbol ® after a trade name indicates that
the name is registered by and restricted to the drug manufacturer.

Drugs Derivation

Drugs and biologic products are derived from 4 main sources:

1. Plants: examples of which are digitalis

2. Animals and humans: from which drugs such as insulin, and epinephrine are
obtained

3. Minerals or mineral products: examples such as iodine and iron

4. Chemicals: made in laboratories

Sources of drugs:

Drugs and biologic products are derived from 4 main sources:

Plants: Examples of which are digitalis.

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Animals and humans: From which drugs such as insulin, and epinephrine are
obtained.

Minerals or mineral products: Examples such as iodine and iron.

Chemicals Made in laboratories. They are pure drugs and some of them are simple
such as sodium bicarbonate whereas others are 3 complex synthesis such as
sulfonomides and adrenocorticosteroids.

Route of Drug Administration

The various routes of administration are classified into local routes and systemic
routes. The local route is the simplest mode of administration of a drug at the site
where the desired action is required. When the systemic absorption of a drug is
desired, medications are usually administered by two main routes: the enteral route
and the parenteral route.

1. Local Route:
Applied to a localized area of the body or to the surface of a body part regardless of
the location of the effect.
• Drugs are applied to the skin or mucous membrane of the eye, ear, nose,
mouth, vagina, etc., mainly for local action.
• It provides a high local concentration of the drug without affecting the general
circulation.
• Drugs that are absorbed into the circulation after local administration may
then have systemic effects.

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 • Drugs for topical applications are usually available as creams, ointment,
liniment, and drops.

2. Enteral Routes: any administration that makes use of the GIT to administer the
drug.

Oral - Oral drug administration is the most common route for administering drugs, as
it involves placing them in the mouth and swallowing them.

Rectal - Rectal medication can be administered in suppository or liquid form and can
be administered as a retention enema.

Sublingual/Buccal - The drug is placed under the tongue or between the gums and
the inner lining of the cheek and allowed to dissolve, avoiding swallowing. It is
quickly absorbed through the mucosa into circulation, bypassing portal circulation
and first-pass metabolism in the liver.

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2. Parenteral Routes: any administration that avoids the used of the GIT to
administer the drug.

Parental Routes

Subcutaneous (SC) - Subdermal or hypodermal administration of a substance

beneath the skin.
Intramuscular (IM) - Administration within a muscle.
Intradermal (ID) - Administration within the dermis.
Intravenous (IV) - Administration within or into a vein or veins.
Intra-arterial (IA) - Administration within an artery or arteries.
Intrathecal (IT) - Administration within the cerebrospinal fluid, including injection into
the cerebral ventricles.
Intraperitoneal (IP) - Administration within the peritoneal cavity.
Intravitreal - Administration within the vitreous body of the eye.
Transdermal - •Commonly referred to as “the patch”, drugs administered must be
highly lipophilic.
Inhalation - Drugs can be inhaled as gases and enter the bloodstream through the
alveolar membrane, which is a common route for both local and systemic actions.

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3. Injection Sites (Ruiz and Montoto. 2018)

The Evidence-Based for Pharmacologic Intervention

All treatments and their effects are multidimensional. When assessing the
contribution made by drugs to health care, we could consider the available evidence
under the headings:

• Magical/ Placebo and Nocebo Effects

• Empirical Evidence
• Rational / Scientific Evidence

4. Drug Therapy

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The interactions between the drug and the person receiving it can be divided into
four stages:
• Getting the drug into the body – pharmaceuticals
• Getting the drug around, about, and out of the body – pharmacokinetics
• Actions of the drug on the body – pharmacodynamics
• Effects of the drug on the person – therapeutics

Pharmaceuticals: getting the drug into the body

Two issues are considered here:

a) Compliance

Compliance or concordance with medication is the extent to which clients adhere to

prescribed regimens and the associated professional advice.
Factors associated with non-compliance include:
✓ Women in pregnancy who consider themselves to be healthy
✓ Fear of harming the unborn child
✓ Living alone
✓ Taking more than three drugs
✓ More than two drug administrations per day
✓ Reduced esophageal motility, for example, dehydration

b) Drug Formulation
The storage requirements of each preparation depend on the formulation. Therefore,
the data sheet for each product and brand should be consulted for instructions on
storage.

Pharmacokinetics: how the body handles the drug This section addresses the
questions:

• Is the drug getting to the desired site of action? (Absorption and distribution)
• Is the drug getting out of the body? (elimination)
• Is there a risk of accumulation and toxicity?

Therapeutic Range
Drugs have a therapeutic range or desirable range for their concentration in plasma.
Above this range, toxic effects may appear. Below this range, the drug does not
have the desired effect. For some drugs, this range is very narrow, and the
therapeutic concentration is close to the concentration at which adverse effects
appear. Pregnancy can affect the body's handling of drugs.

Absorption 1.

The absorption of a drug depends on the route of administration, formulation, and

the way the drug molecules move across cell membranes. Barriers to drug

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absorption and distribution include the gut wall, capillary walls, cell membranes, the
blood/brain barrier, the placenta, and the blood/milk barrier.

Distribution 2.

Distribution is the movement of the drug around the body. It is affected by:
a) plasma protein binding.
b) the lipid solubility of the drug (that is whether it dissolves in fatty tissues)
c) the binding properties of the drug
d) blood flows to the organs and the state of the circulation.
e) stage of the life cycle, for example, pregnancy, infancy.
f) disease state, for example, pre-eclampsia or heart failure

Elimination or Clearance 3.

Elimination of drugs varies depending on the individual drug. Most drugs are excrete
d via the kidneys, although bile is also an important route. Alcohol is unusual in that
5-10% is eliminated unchanged via the lungs, sweat, and urine. Elimination involves
metabolism in the liver plus excretion by the kidneys.

Pharmacodynamics: actions of the drug on the body

Drugs work by interacting with the patient's/recipient's molecules, which can lead to
changes in the behavior of tissues, organs, and systems. Drugs modify the existing
functions of the body but cannot introduce new functions. Most drugs act on more
than one type of cell and have multiple effects on the body.

.5. Pharmacokinetics vs. Pharmacodynamics

Most drug molecules work via:

• Protein receptors in cell membranes or within cells

• Many drugs work by acting on specific receptor proteins. These are
components of the cell membrane which normally respond to the body’s
hormones and neurotransmitters – the endogenous ligands. Examples include
insulin receptors, opioid receptors, dopamine receptors, and 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.

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Figure 6. Drug-Plasma Protein Binding (Sparreboom et al., 2001)
Ion channels in cell membranes
Ion channels bind to certain drugs, such as calcium antagonists and local
anesthetics, but their side effects can affect several body systems, such as nerves
and muscles. Examples include nifedipine and lignocaine.
Enzymes in cells or extracellular fluid
Enzymes are present in all cells, catalyzing their biochemical reactions. Drugs, such
as NSAIDs and MAOIs, bind to enzymes and inhibit their actions. These drugs are
likely able to interact with enzymes due to their shape and structure, similar to the
drug-receptor interaction.

Non-specific actions
Antacids, such as sodium bicarbonate and aluminum hydroxide, neutralize gastric
secretions without acting on the cells of the body. These drugs are presumed to act
by virtue of their physiochemical properties.

Therapeutics: The effects of the drug on the person.

This section addresses the question: has the drug produced any effect on the
recipient? If so, is the result therapeutic or toxic?

Changes in the Physiology of Cells, Tissues, and Organs

Even if a drug is working on the body’s cells, there may be no noticeable response.
For example, due to individual differences, an oxytocic or a tocolytic may be
ineffective.

Clinical Effects

The clinical response to oxytocin infusions can be unpredictable and idiosyncratic.

For example, some women are sensitive to oxytocin and require a low dose. Clinical
effects also depend on age, gender, pregnancy, disease state, drug interactions,
weight, height, and genetic makeup. Women generally require lower doses of drugs
than men, even when body weight is taken into consideration.

Side Effects

Side effects are adverse drug reactions that occur within the normal range of
therapeutic doses. Most drugs have potential side effects. These can be grouped
under the headings:

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Related to the Drug’s Main Actions

The main side effects of a drug are usually related to the dose administered, so
monitoring systems must be in place. Anti-coagulants and insulin can cause bleeding
and hypoglycemia, while other drugs require more understanding of physiology.

Related to Subsidiary Actions

Drugs act on more than one type of cell receptor, resulting in diverse side effects.
For example, oxytocin acts on the oxytocic receptors of the uterus, but also on the
anti-diuretic (ADH) receptors in the nephrons, triggering water retention and fluid
overload. In pregnancy, the subsidiary actions of drugs on the uterus assume great
importance, and any drugs which stimulate uterine contractility should be avoided,
such as stimulant laxatives, misoprostol, and all drugs related to ergotamine.

Hypersensitivity Responses

A hypersensitivity response is possible with almost all drugs, especially

antimicrobials. Individuals with a history of atopic disorders are particularly
vulnerable. Most drugs or their metabolites can combine with carrier proteins in the
circulation to form immunogens, which can affect any organ. The severity of the
response is variable, ranging from a temporary skin rash to life-threatening aplastic
anemia.

Cell Damage

Drugs can cause direct damage to cells, such as paracetamol (acetaminophen) in

large doses, or alter DNA regulating oncogenes. Drug-induced teratogenesis is a
result of cell damage, and the risks of fetal damage depend on several factors as
well as the chemical composition of the drug.

• The stage of pregnancy

• The amount of drug ingested

• The number of doses – a single dose may be less damaging than repeated
exposure

• Other agents to which mother and fetus are exposed

• The mother’s nutritional status

• The genetic makeup of the mother and fetus.

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http://site.iugaza.edu.ps/naselnoor/files/2013/09/Pharmacology-For-Midwives.pdf

https://www.studocu.com/ph/document/st-paul-university-manila/midwifery-
pharmacology/module-1-midwifery-pharmacology/10448673

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