52-53: medications in preg and lactation NOT DONE Flashcards

1
Q

inc what in prenatal diet

A

-300-400 calories
-folate and folic acid
-calcium intake
-vitamin D
-protein

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2
Q

dec what in prenatal diet

A

-artificial sweeteners
-unpasteurized foods
-alcohol
-unwashed fruits and veggies
-herabl teas
-undercooked meat
-caffeine

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3
Q

Caffeine intake during pregnancy

A

-takes longer to be metabolized
-less than 200 mg/day

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4
Q

Benefits of prenatal supplements

A

-help w fetal development
-prevent fetal and maternal complications

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5
Q

Timing of prenatal supplements

A

-ideally start 3 months before conception
-folic acid at least one month before getting preg

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6
Q

Prenatal vitamins and minerals

A

-calcium
-iron
-iodine
-choline
-Vit A, B6, B12, C, D
-folic acid

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7
Q

Vaccine recommendations for pregnant women

A

-inactivated influenza
-Tdap during each pregnancy
-RSV weeks 32-36
-covid-19

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8
Q

Vaccines to AVOID in pregnant women

A

-HPV
-MMR
-LIVE influenza
-Varicella
-yellow fever
-typhoid fever

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9
Q

Fetal alcohol syndrome

A

-CNS abnormalities
-growth defects
-facial dysmorphia

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10
Q

Fetal alcohol syndrome birth defects

A

-growth deformities
-facial abnoramlities
-CNS impairment
-behavior disorders
-impaired intellectual development

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11
Q

Tobacco use during pregnancy

A

-preterm birth
-low birth weight
-birth defects
-sudden infant death syndrome

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12
Q

Marijuana use during pregnancy

A

-low birth weight
-brain development disruption
-decreased attention span
-behavioral problems
-marijuana use in child by 14

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13
Q

Opioid use during pregnancy

A

-maternal death
-poor fetal growth
-preterm birth
-still birth
-neonatal withdrawal

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14
Q

medication for substance abuse

A

-methadone
-buprenorphine

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15
Q

Neonatal Opioid Withdrawal Syndrome

A

-72 hours after birth
-tremors
-sleep problems
-reflexes
-seizures
-poor feeding
-shit and vomit

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16
Q

Neonatal opioid withdrawal syndrome treatment

A

-buprenorphine, morphine, methadone
-IV fluids
-higher calorie formula

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17
Q

Absorption in pregnancy

A

-slower GI
-inc extent of absorption
-dec rate of absorption

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18
Q

Distribution in pregnancy

A

-inc Vd of hydrophillic drugs
-dec protein binding

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19
Q

Metabolism in pregnancy

A

-inc CYP3A4 activity
-dec CYP2C19 activity

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20
Q

Excretion in pregnancy

A

-inc renal hepatic blood flow
-inc CrCl

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21
Q

Teratogen

A

-drug or environmental agent with potential to cause abnormal fetal growth and development
-hazardous medication and require special handling

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22
Q

Common teratogens

A
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23
Q

Short-term complications in pregnancy

A

-nausea
-heartburn
-constipation
-pain, fever, headache
-cough and cold
-UTI

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24
Q

Nausea and vomiting risk factors in pregnancy

A

-h/o motion sickness
-GERD
-high fat diet
-younger patients

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25
Q

Hyperemesis gravidarum

A

-severe formm of nausea and vomiting
-weight loss, electrolyte imbalances, dehydration

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26
Q

Nausea and vomiting treatment

A

1st nonpharmacologic
2nd pharmacologic

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27
Q

Non-pharmacologic treatment of vomiting

A

-avoid triggers
-drink throughout the day
-eat smaller, freq, dry meals
-eat dry toast or crackers before getting out of bed
-avoid spicy foods
-keep stomach from being empty

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28
Q

Pharmacological treatment

A
  1. Pyridoxine (Vit B6)
  2. Doxylamine and Pyridoxine
  3. Meclizine, Dimenhydrinate, diphenhydramine
  4. ondansetron, metoclopramide
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29
Q

GERD/Heartburn in pregnancy

A

-usually 3rd trimester
-hormone changes
-esophageal sphincter relaxing
-uterus enlarging

30
Q

Non-pharmacological treatment of GERD

A

-smaller freq meals
-eat slowly
-avoid food and drinks 3 hours before bed
-elevate head of bed
-avoid smoking and alcohol

31
Q

GERD pharmacological treatment

A
  1. antacids
  2. sucralfate (not absorbed in GI tract)
  3. Histamine- 2 receptor antagonists, proton pump inhibitors
32
Q

Constipation non-pharmacological treatment

A

-eat 25-30g fiber
-inc fluid intake
-exercise

33
Q

constipation pharmacological treatment

A

-fiber
-osmotic lax
-stool softeners
-avoid castor oil or mineral oil

34
Q

Pain fever headache non-pharma treatment

A

-cool compress
-manage stress
-inc relaxation techniques
-get at least 8 hours of sleep each night

35
Q

pain, fever, headache pharmacological treatment

A

-acetaminophen
-AVOID NSAIDs and aspirin

36
Q

Cough, cold, allergy treatment

A

-ensure appropriate vax
1. cromolyn
2. chlorpheniramine, diphenhydramine

-loratadine and cetirizine during 2nd and 3rd trimester
-oral decongestants should be avoided during 1st trimester

37
Q

UTI and adverse pregnancy outcomes

A

-preterm delivery
-low birth weight
-sepsis

38
Q

UTI prevention

A

-hydration
-proper wiping and voiding before and after sex
-wear cotton undies
-avoid tight clothes

39
Q

UTI recommended treatment

A

-cephalexin
-nitrofurantoin and sulfa with trimethoprim
-amoxicillin
-fosfomycin and nitrofurantoin

40
Q

What to avoid in UTI treatment

A

-fluoroquinolones
-tetracyclines
-sulfamethoxazole with trimethoprim

41
Q

chronic disease states during pregnancy

A

-depression and anxiety
-gestation diabetes
-HYPO/HYPERthyroidism
-thromboembolism
-preeclampsia and eclampsia
-epilepsy
-group B strep

42
Q

Depression and anxiety treatment in pregnancy

A

-treat w psychotherapy, antidepressants or both
-SSRIs do not inc risks of birth defects

43
Q

Gestational Diabetes

A

-24-28 weeks for first time in pregnancy

44
Q

Gestational diabetes treatment

A

-diet and exercise
-regular self-monitoring of blood glucose
-monitoring baby
-insulin
-metformin and sulfonylureas

45
Q

Hypothyroidism

A

-tiredness
-weight gain
-intolerance to cold temps
-dry, course hair

46
Q

Hypothyroidism treatment

A

-levothyroxine
-inc dose when pregnant

47
Q

Hyperthyroidism treatment

A

-propylthiouracil preferred during the first trimester
-consideration should be given to switching to methimazole after 1st trimester

48
Q

Thromboembolism

A

-4-5x risk of blood clots
-can happen due to status of blood flow, endothelial injury, or hypercoagulability

49
Q

Thromboembolism nonpharmacological treatment

A

-inferior vena cava IVC filter
-compression stockings

50
Q

Pharmacologic treatment of thromboembolism

A

-LMWH during pregnancy does not cross placenta or have teratogenic effects
-at least 2 months and until 3 weeks postpartum
AVOID warfarin

51
Q

Preeclampsia

A

-a sudden spike in BP plus proteinuria
-usually 3rd trimester
-may develop after delivery of baby

52
Q

preeclampsia symptoms

A

-thrombocytopenia
-LFT elevation
-headaches
-vision changes
-SOB
-N/V

53
Q

preeclampsia complications

A

-maternal complications
-placental abruption
-fetal or newborn death
-eclampsia

54
Q

Preeclampsia prevention

A

-aspirin 60-80mg in late 1st trimester
-calcium supplementation
-exercise
-early delivery is often recommended

55
Q

Preeclampsia treatment

A

-hydralazine (IV or IM)
-labetalol
-Nitroprusside
-Nifedipine
-avoid ACE/ARBs

56
Q

Eclamsia

A

-seizures that occur in pts with preeclampsia
-can lead to stroke or death

57
Q

Eclasmia treatment

A

-magnesium sulfate 4-6g bolus
-relaxes blood vessels in cerebrum
-alternatives: phenytoin, benzodia

58
Q

Group B strep

A

-baby infection from vagina

59
Q

Group B strep treatment

A
  1. penicillin G or ampicillin IV once labor has started
    -Cefazolin if mild PCN allergy
    -Clindamycin and vancomycin if severe PCN allergy
60
Q

Preterm labor

A

-before 37 weeks

61
Q

Medications for preterm labor

A

-Progesterone 200mg vag suppository if NO history
-250 mg IM if history

62
Q

Premature membrane rupture treatment in under 34 weeks

A

-corticosteroids to develop lungs
-antibiotics to prevent infection
-Tocolytics to stop labor
-magnesium sulfate to help fetus brain

63
Q

Deliver baby after

A

37 weeks premature membrane rupture

64
Q

Stages of Labor

A
  1. early and active labor
  2. birth of baby
  3. delivery of the placenta
65
Q

Labor Dystocia

A

-below minimal normal rate of change or descent

66
Q

Labor Dystocia complications

A

-fetal distress
-infection risk
-postpartum hemorrhage
-uterine rupture
-inc risk of trauma

67
Q

Prevention of labor dystocia

A

-avoid admission during latent stages of labor
-inc access to labor to labor support
-consider induction of labor at or beyond term
-an upright or walking position
-use cervical ripening agents

68
Q

Treatment of labor dystocia

A

-oxytocin
-cesarean section

69
Q

When to induce labor

A

-over 41-42 weeks
-preeclampsia
-infection
-fetal compromise
-diabetes, renal disease, pulmonary disease, HTN

70
Q

Risk of induction

A

-low fetal HR
-failed induction
-