Drug Therapy During Pregnancy and Breastfeeding Flashcards Preview

Pharmacotherapeutics for the Advanced Practice Nurse > Drug Therapy During Pregnancy and Breastfeeding > Flashcards

Flashcards in Drug Therapy During Pregnancy and Breastfeeding Deck (43)
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1
Q

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

A

doubled

To compensate for accelerated excretion, dosage must be increased

2
Q

Hepatic metabolism ______ during pregnancy

A

increases

3
Q

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

A

decrease

increase

4
Q

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.

A

increase

5
Q

Drugs that are ___________ cross the placenta easily

A

lipid soluble

6
Q

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

A

ionized, highly polar, or protein bound

7
Q

The provider should….

A

assume that any drug taken during pregnancy will reach the fetus

8
Q

Pregnant patients who take heparin are at risk of

A

osteoporosis which can cause compression fractures of the spine

9
Q

Withdrawal syndrome will ensue if…

A

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

10
Q

Drug effect of greatest concern that produces congenital anomalies

A

teratogenesis

11
Q

Causes of congenital anomalies

A

genetic predisposition, environmental chemicals, and drugs

12
Q

____________are produced by exposure to teratogens during embryonic period

A

gross malformations

13
Q

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

A

function

14
Q

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

A

learning deficits and behavior abnormalities

15
Q

Preimplantation/presomite period, teratogens act in an

A

all or nothing fashion

16
Q

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

A
  • 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
17
Q

Fast acting teratogen, a single dose exposure

A

thalidomide

18
Q

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

A

alcohol

19
Q

Teratogens that affect ____ may be nearly impossible to identify

A

behavior

20
Q

Teratogens that produce delayed effects are hardest to identify

A

diethylstilbestrol

21
Q

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

A

benzodiazepines

22
Q

causes congenital deafness

A

aminoglycoside streptomycin

23
Q

fetal hemorrhage is associated with

A

warfarin

24
Q

spontaneous abortion can be caused by

A

misoprostol

25
Q

How do you minimize drug risk during pregnancy?

A

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

26
Q

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

A

A

27
Q

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

A

epilepsy, asthma, diabetes

28
Q

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

A

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

29
Q

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

A

minimal

30
Q

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

A
  • 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
31
Q

Drugs that are _______ enter breast milk readily

A

lipid soluble

32
Q

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

A

ionized, highly polar, or protein bound

33
Q

Drug classes that are contraindicated during breastfeeding

A

controlled substances, anticancer, immunosuppressants, others

34
Q

______________are associated with irritability or sedation and may decrease milk supply

A

first generation antihistamines

35
Q

Most drugs detected in milk are in concentrations that

A

are too low to cause harm

36
Q

When drugs must be used, steps taken to minimize risk

A
  • 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
37
Q

Teratogenic effects during weeks 4-5 of gestation

A

Amelia/meromelia

38
Q

Teratogenic effects during weeks 3-6 of gestation

A

TA, ASD, VSD, neural tube defects

39
Q

Teratogenic effects during weeks 5-6 of gestation

A

cleft lip

40
Q

Teratogenic effects during weeks 4-9 of gestation

A

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

41
Q

Teratogenic effects during weeks 6-16 of gestation

A

intellectual disorders

42
Q

Teratogenic effects during weeks 6-8 of gestation

A

heart, upper and lower limbs, cleft palate

43
Q

Teratogenic effects during weeks 16-38 of gestation

A

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