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Endocrinology > pregnancy > Flashcards

pregnancy Flashcards

1
Q

pregnancy: nasal congestion

A

avoid guaifenesin

decongestants are per MD only

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2
Q

pregnancy: diarrhea

A

avoid bismuth

loperamide is per MD only

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3
Q

pregnancy: constipation

A

avoid senna

bulk, bisacodyl, docusate OK

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4
Q

pregnancy: pain

A

avoid aspirin 3rd tri
NSAIDs are ok 1st try
generally avoid/use APAP minimally

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5
Q

pregnancy: nausea, mild

A

can use ginger, pyridoxine, cyclizine

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6
Q

pregnancy: nausea, moderate

A

can use doxylamine, reglan, zofran

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7
Q

pregnancy: anti-infectives

A

prefer penicillins, cephalosporins, macrolides

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8
Q

pregnancy: hypertension

A

avoid: ACEi, ARB

options are labetalol, nifedipine, methyldopa, hydralazine

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9
Q

pregnancy: anticoagulation

A

UFH/LMWH safe

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10
Q

pregnancy: antidepressants

A

sertraline, citalopram OK

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11
Q

pregnancy: CNS agents

A

amphetamines can cause withdrawal

benzos rarely used, floppy baby syndrome

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12
Q

postpartum: contraception

A

avoid CHC until 3-6 weeks postpartum

at any time, options are progestin only implant or pill, IUD

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13
Q

physiologic changes in pregnancy: blood volume

A

blood volume increased, expands Vd

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14
Q

physiologic changes in pregnancy: RBC

A

increased RBC– depletes iron stores & requires supplements

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15
Q

physiologic changes in pregnancy: HR, BP

A

decreased blood pressure
increased cardiac output/HR

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16
Q

physiologic changes in pregnancy: hepatic perfusion

A

increased hepatic perfusion with some CYP enzymes being more active

17
Q

physiologic changes in pregnancy: GFR

A

increased GFR= enhanced drug removal

18
Q

physiologic changes in pregnancy: albumin

A

reduced albumin= less drug binding= more free drug concentrations

19
Q

physiologic changes in pregnancy: antithrombin

A

decreased antithrombin, increased risk VTE

20
Q

physiologic changes in pregnancy: weight

A

average weight gain is 25-30 pounds

21
Q

generalizations for PK in pregnancy

A

absorption generally unaffected
distribution: more free drug, higher Vd
clearance is higher

almost all drugs cross placenta

22
Q

definition of teratogen

A

produces permanent alteration in form/function in offspring

23
Q

true or false: a drug is clearly either a teratogen or not

A

false
need to consider other factors, exposure, dose

24
Q

definition of a congenital malformation

A

prenatal structural abnormalities present at birth that interfere with viability or physical well-being
ex cleft lip, club foot, spina bifida

25
Q

true or false: drugs are 1% of the causes of congenital malformations

A

true

26
Q

teratogenicity depends upon

A

genetic constitution of mother and fetus– there can be genetic mutations or polymorphisms in drug metabolism genes

27
Q

8 principles of teratology

A
  1. 1 teratogen can cause many different malformations
  2. many teratogens cause the same malformations
  3. teratogens don’t have to be hazardous to mother
  4. teratogens must be present at a critical period
  5. teratogens can act directly or indirectly
  6. dose-relationship presumed, rarely defined
  7. genetic susceptibility of infant to toxic metabolites may be unifying pathway to injury
  8. malformation may be animal species/strain specific
28
Q

what is the mechanism by which drugs cross the placenta

A

mostly simple diffusion, concentration driven

29
Q

drugs in category X

A

valproate
methotrexate
ribavirin
triazolam
bosentan
aliskiren
emergency contraception
griseofulvin
isotretinoin

30
Q

most common congenital abnormality

A

neural tube defects
all women take 0.4 folic acid daily

31
Q

which drugs are associated with risk of neural tube defects

A

classic anti-epileptic agents such as valproic acid

32
Q

cardiovascular drugs of concern for pregnancy

A

warfarin
ACEi/ARB
beta blockers without ISA

33
Q

CNS drugs of concern for pregnancy

A

SSRIs, lithium

34
Q

other drugs of concern for pregnancy

A

misoprostol, tetracyclines, androgens, estrogens, fluconazole, chemotherapy, mycophenolate, NSAIDs

35
Q

implications of alcohol use during pregnancy

A

fetal alcohol syndrome

36
Q

implications of nicotine use during pregnancy

A

premature rupture of membranes
abruptio placentae
low birthweight
preterm birth
stillbirth
SIDS

37
Q

implications of cannabis use during pregnancy

A

unsafe, low birth weight, premature birth, NICU care

Endocrinology (10 decks)

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