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NAPLEX 25 > Chapter 48: Drug Use In Pregnancy & Lactation > Flashcards

Chapter 48: Drug Use In Pregnancy & Lactation Flashcards

(57 cards)

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1
Q

How is pregnancy confirmed?

A

High levels of human chorionic gonadotropin (hCG) in urine or blood

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2
Q

During which trimester is the baby most susceptible to birth defects?

A

First trimester (0 - 12 weeks)

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3
Q

What are teratogens?

A

Agents that can cause birth defects during pregnancy

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4
Q

For a drug to be teratogenic, what must it do?

A

Cross the placenta into fetal circulation

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5
Q

When should teratogenic drugs ideally be discontinued?

A

Prior to pregnancy, if possible

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6
Q

What is a safe and sometimes effective strategy for prenatal smoking cessation?

A

Behavioral intervention

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7
Q

What can folate deficiency cause during pregnancy?

A

Birth defects of the brain and spinal cord (neural tube defects)

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8
Q

What is the recommended daily intake of dietary folate equivalents (DFE) for adults?

A

400 mcg DFE per day

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9
Q

What is the increased daily intake of folate required during pregnancy?

A

600 mcg DFE/day

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10
Q

What are some food sources of folate?

A
  • Fortified flour and cereals
  • Dried beans
  • Green leafy vegetables
  • Orange juice
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11
Q

What are the calcium and vitamin D requirements for pregnant women aged 19-50?

A
  • 1,000 mg/day of calcium
  • 15 mcg/day (600 IU/day) of vitamin D
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12
Q

What is the reason for the transition to the new pregnancy and lactation labeling format?

A

To provide more detailed benefit/risk data on prescription drugs

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13
Q

What does Pregnancy Category X indicate?

A

Contraindicated in pregnancy; cannot be used for any reason

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14
Q

What does Category A indicate?

A

Controlled studies in animals & women show no risk in the first trimester

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15
Q

What does Category B indicate?

A

Animal studies have not demonstrated fetal risk, but no well-controlled studies are available in pregnant women

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16
Q

What does Category C indicate?

A

Animal studies have shown harm to the fetus; use only if potential benefit outweighs the risk

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17
Q

What does Category D indicate?

A

Positive evidence of risk to the human fetus; benefits may outweigh risks with serious diseases

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18
Q

What is included in the pregnancy risk summary for all medications?

A
  • Risk of adverse developmental outcomes
  • Dose adjustments
  • Maternal/fetal adverse reactions
  • Disease risks
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19
Q

What should pregnant women be encouraged to participate in?

A

Pregnancy exposure registries

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20
Q

What does the lactation section in package inserts include?

A
  • Presence of drug/metabolites in human milk
  • Effects on the breastfed infant
  • Effects on milk production
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21
Q

What does the section for females and males of reproductive potential include?

A
  • Effects on fertility
  • Requirements for pregnancy testing and contraception
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22
Q

What should be used to treat medical conditions in pregnant women if possible?

A

Lifestyle measures

Lifestyle measures should be prioritized before considering drug treatments.

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23
Q

What should be done with teratogenic drugs prior to pregnancy?

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A

Discontinued, if possible

Many pregnancies are unplanned, making this challenging.

24
Q

Where are medications with boxed warnings and contraindications for teratogenicity noted?

Study These Flashcards
A

In the drug tables of the UWorld RxPrep course book

These tables summarize risks associated with various drugs.

25
What may some drugs with significant teratogenic risk have due to potential fetal harm?
REMS requirements ## Footnote REMS stands for Risk Evaluation and Mitigation Strategy.
26
According to NIOSH, what are teratogens classified as?
Hazardous drugs ## Footnote Special handling is required to avoid risk to healthcare workers.
27
What is a risk associated with the use of lamotrigine in pregnancy?
Congenital malformations ## Footnote Seizures in pregnant women can also harm both mother and child.
28
What should be checked when prescribing/dispensing to pregnant women?
Reputable, up-to-date resources ## Footnote Briggs' Drugs in Pregnancy and Lactation is a recommended resource.
29
Teratogenic acne meds
Isotretinoin, topical retinoids
30
Teratogenic antibiotics
Quinolones & tetracyclines
31
Which anticoagulant is teratogenic
Warfarin
32
Which cardio meds are teratogenic?
Statins, RAAS inhibitor
33
Which hormones are teratogenic?
Estradiol, progesterone, raloxifene, Duavee, testosterone,contraceptives
34
Teratogenic migraine meds
Dihydroergotamine, ergotamine
35
What is preeclampsia?
Elevated blood pressure during pregnancy that indicates organ damages (i.e.; kidneys or liver)
36
What is the recommendation to prevent preeclampsia?
Low dose aspirin at the end of the first trimester
37
What is the preferred management during pregnancy for motion sickness, nausea, vomiting?
Lifestyle changes first (avoid empty stomach, smaller meals, more meals, plenty of water…) Pyridoxine (Vit B6) +/- Doxylamine
38
What is the preferred management during pregnancy for GERD/heartburn?
Lifestyle changes first (smaller meals, more meals, avoid trigger foods, elevating head while sleeping…) Tums
39
What is the preferred management during pregnancy for farting?
Simethicone (GasX or Mylicon)
40
What is the preferred management during pregnancy for constipation?
Lifestyle changes first (more fluids, more fiber, more activity) Fiber (Psyllium, Calcium Polycarbophil) “Bulk Laxative”
41
What is the preferred management during pregnancy for cough, cold, allergies?
Cromolyn first line 2nd gen antihistamine (chlorpheniramine) second line [Loratidine or Cetirizine too] Nasal Steroids (budesonide) if needed
42
What is the preferred management during pregnancy for pain?
Tylenol first line AVOID NSAIDs and Aspirin
43
What is the preferred management during pregnancy for asthma?
Maintenance: Budesonide Rescue: ICS-Fomoterol or Albuterol
44
What is the preferred management during pregnancy for Iron deficiency anemia?
Iron or Prenatal vitamins with Iron
45
What is the preferred management during pregnancy for hypertension?
Labetalol, Nifedipine ER, Methyldopa ACEs, ARBs, ARNIs are contraindicated
46
What is the preferred management during pregnancy for Diabetes?
Insulin when not controlled with lifestyle changes Low dose aspirin is recommended with preeclampsia in both T1 & T2 DM
47
What is the preferred management during pregnancy for vaginal fungal infections?
Topical Antifungals for 7 days
48
What is the preferred management during pregnancy for Urinary Tract Infections?
Cephalexin 500mg PO Q6H for 7 days Amoxicillin 500 mg PO Q8H for 7 days Nitrofurantoin, Bactrim are alternatives
49
What is the preferred management during pregnancy for VTE?
LMWH (Enoxaparin)
50
What is the preferred management during pregnancy for Hypothyroidism?
Levothyroxine (needs a 30 - 50% increase dose)
51
What is the preferred management during pregnancy for hyperthyroidism?
Mild cases no treatment If need drugs PTU during first trimester & methimazole for second & third trimester
52
Babies receiving breast milk partially or exclusively should receive ___ IU of vitamin D daily
400
53
Breastfed babies require __ mg/kg/day of iron during months __-__
1 4-6
54
Which pain meds should not be used by breastfeeding mothers due to risk of excessive sleepiness, breathing difficulty and/or death in the infant?
Codeine and tramadol
55
Breastfed infants have died from being breastfed, especially in mothers taking certain pain meds who were _____ metabolizers
2D6 ultra-rapid
56
T/F: a mother who is HIV positive can safely breastfeed
False - not recommended
57
Which medications should be avoided during lactation?
Amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital, and statins

NAPLEX 25 (63 decks)

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