Drug Therapy During Pregnancy and Breastfeeding

Question 1

By the third trimester, renal blood flow is _______, causing a large increase in the glomerular filtration rate

Answer 1

doubled

To compensate for accelerated excretion, dosage must be increased

Question 2

Hepatic metabolism ______ during pregnancy

Answer 2

increases

Question 3

Tone and motility of bowel______ in pregnancy, causing intestinal transit time to ____________

Answer 3

decrease

increase

Question 4

Due to prolonged transit time, there is more time for drugs to be absorbed. This could _______ levels of drugs whose absorption is usually poor. A reduction in dosage might be needed.

Answer 4

increase

Question 5

Drugs that are ___________ cross the placenta easily

Answer 5

lipid soluble

Question 6

Drugs that are ______, __________, or ________ cross the placenta with difficulty

Answer 6

ionized, highly polar, or protein bound

Question 7

The provider should….

Answer 7

assume that any drug taken during pregnancy will reach the fetus

Question 8

Pregnant patients who take heparin are at risk of

Answer 8

osteoporosis which can cause compression fractures of the spine

Question 9

Withdrawal syndrome will ensue if…

Answer 9

regular use of dependence producing drugs (heroin, barbiturates, alcohol) during pregnancy and the drug dependent infant is not supported with the drugs

Question 10

Drug effect of greatest concern that produces congenital anomalies

Answer 10

teratogenesis

Question 11

Causes of congenital anomalies

Answer 11

genetic predisposition, environmental chemicals, and drugs

Question 12

____________are produced by exposure to teratogens during embryonic period

Answer 12

gross malformations

Question 13

Teratogen exposure during fetal period usually disrupts _____ rather than gross anatomy.

Answer 13

function

Question 14

In the fetal period, growth and development of the brain are especially important. Disruptions of brain development can result in___________

Answer 14

learning deficits and behavior abnormalities

Question 15

Preimplantation/presomite period, teratogens act in an

Answer 15

all or nothing fashion

Question 16

To prove a drug is a teratogen, 3 criteria must be met:

Answer 16

• cause a characteristic set of malformations
• act only during a specific window of vulnerability
• incidence of malformations should increase with increasing dosage and duration of exposure

Question 17

Fast acting teratogen, a single dose exposure

Answer 17

thalidomide

Question 18

Must be taken repeatedly in high doses for gross malformation to result

Answer 18

alcohol

Question 19

Teratogens that affect ____ may be nearly impossible to identify

Answer 19

behavior

Question 20

Teratogens that produce delayed effects are hardest to identify

Answer 20

diethylstilbestrol

Question 21

____________ taken late in pregnancy may cause hypoglycemia and respiratory complications along with a hypotonic state that is commonly called floppy infant syndrome

Answer 21

benzodiazepines

Question 22

causes congenital deafness

Answer 22

aminoglycoside streptomycin

Question 23

fetal hemorrhage is associated with

Answer 23

warfarin

Question 24

spontaneous abortion can be caused by

Answer 24

misoprostol

Question 25

How do you minimize drug risk during pregnancy?

Answer 25

develop a comprehensive list of current drugs used including prescriptions, OTC, nutritional supplements, and recreation drugs

Question 26

Vitamin___ can cause craniofacial anomalies and CNS, cardiac, and thymus abnormalities

Answer 26

A

Question 27

Some diseases like _____ pose a greater risk to fetal health than the drugs used for treatment

Answer 27

epilepsy, asthma, diabetes

Question 28

When a pregnant patient has been exposed to a known teratogen, the first step is to

Answer 28

determine exactly when the drug was taken and exactly when the pregnancy began

Question 29

If drug exposure was NOT during the period of organogenesis, the patient should be reassured that the risk of drug-induced malformation is

Answer 29

minimal

Question 30

What should be done if the exposure did occur during organogenesis?

Answer 30

- references should be consulted to determine the type of malformation - at least 2 ultrasound scans should be tone to assess the extent of injury - if sever, termination of pregnancy should be considered

Question 31

Drugs that are _______ enter breast milk readily

Answer 31

lipid soluble

Question 32

Drugs that are ____, ____, or ____ tend to be excluded from breast milk

Answer 32

ionized, highly polar, or protein bound

Question 33

Drug classes that are contraindicated during breastfeeding

Answer 33

controlled substances, anticancer, immunosuppressants, others

Question 34

______________are associated with irritability or sedation and may decrease milk supply

Answer 34

first generation antihistamines

Question 35

Most drugs detected in milk are in concentrations that

Answer 35

are too low to cause harm

Question 36

When drugs must be used, steps taken to minimize risk

Answer 36

- dosing immediately after breastfeeding - avid drugs with long half-life - avoid sustained release formulations - choose drugs that tend to be excluded from milk - choose drugs that are least likely to affect the infant - avoid drugs that are known to be hazardous - use the lowest effected dosage for the shortest time possible - abandon plans to breastfeed if necessary

Question 37

Teratogenic effects during weeks 4-5 of gestation

Answer 37

Amelia/meromelia

Question 38

Teratogenic effects during weeks 3-6 of gestation

Answer 38

TA, ASD, VSD, neural tube defects

Question 39

Teratogenic effects during weeks 5-6 of gestation

Answer 39

cleft lip

Question 40

Teratogenic effects during weeks 4-9 of gestation

Answer 40

low-set malformed ears, deafness, microphthalmia, cataracts, glaucoma

Question 41

Teratogenic effects during weeks 6-16 of gestation

Answer 41

intellectual disorders

Question 42

Teratogenic effects during weeks 6-8 of gestation

Answer 42

heart, upper and lower limbs, cleft palate

Question 43

Teratogenic effects during weeks 16-38 of gestation

Answer 43

less sensitive: CNS, ears, eyes, teeth, palate, external genitalia