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Endocrinology > Drugs in Pregnancy and Lactation > Flashcards

Drugs in Pregnancy and Lactation Flashcards

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1
Q

Biogenesis

A

the first 15-21 days after fertilization
-germ layer formation

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2
Q

how many weeks approx is pregnancy?

A

40 weeks.

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3
Q

Organogenesis

A

weeks: 2 to 8
-development of major organs
-typically when congenital defects occur (down syndrome, cleft palate, septal defect)

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4
Q

Fetal period

A

week 9
embryo becomes fetus

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5
Q

which trimester is usually the highest risk with drug exposure?

A

1st trimester
(embryo period of weeks 2-8)

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6
Q

Which period is most critical in pregnancy?

A

weeks 2 to 8 aka 14 to 56 days

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7
Q

Which period is the LEAST critical period?

A

weeks 1 to 2

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8
Q

what happens if an embryotoxic drug is given in the embryonic period ?

A

Can result in termination of pregnancy as it overlaps with the organogenesis stage (weeks 2-8) , can cause irreparable damage

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9
Q

How many NEGATIVE pregnancy tests are required before starting isotretinoin?

A

two

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10
Q

A patient is taking isotretinoin (Epuris) and wants to become pregnant. How would you counsel her on planning for pregnancy?

A

Stop drug. Wait 1 month.

Acetretin - wait 3 years to conceive

Tetracycline - wait 1 week after last dose

Spironolactone - wait 5 days after last dose

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11
Q

What is the recommended time interval between stopping methotrexate for either partner + pregnancy?

A

between 3 to 12 months (Varies)

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12
Q

What are the PK factors related to drugs affected the rate and extent (AUC) of placental transfer?

A

polarity
lipid solubility
specific carrier proteins (like Pgp binding)
Molecular weight (higher weight = cant cross placenta)
pH
Drug distribution

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13
Q

what happens to progestin levels in pregnancy?

A

it stays high. keeps corpus luteum intact for 3 months. placental progestin increases til end of pregnancy

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14
Q

hcG levels?

A

high in first 3 months

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15
Q

what causes the nausea and vomiting in first trimester?

A

high hCG levels

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16
Q

What is a Category X drug?

A

positive evidence of risk to fetus in clinical controlled studies

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17
Q

What is Category C vs. D ?

A

C - animal studies show risk, but human data N/A
D - demonstrated risk to fetus

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18
Q

Warfarin causes Fetal Warfarin Syndrome in which trimester?

A

1st

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19
Q

Isotretinoin, acitretin category?

A

Cat. X

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20
Q

which drugs can cause genital tract malformation?

A

hormonal contraceptive, estrogen, androgen

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21
Q

Which drugs should be avoided if pt has HTN or dyslipidemia?

A

ACE, ARBs, Statins

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22
Q

Which drugs are considered an abortifacient?

A

misoprostol
mifepristone

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23
Q

what happens if a woman drinks alcohol while pregnant?

A

growth abnormalities
cardiac and skeletal development abnormalities
fetal alcohol syndrome

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24
Q

which drug can cause dental discoloration and affect development of the tooth enamel?

A

tetracycline

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25
Which drugs can cause athropathies (cartilage erosion) in pregnancy?
Fluoroquinolones (oral) , but systemic products like eye drops are acceptable due to low bioavailability
26
Which drug that was previously used as antiemetics caused birth defects?
thalidomide
27
Which anti-seizure medications are contraindicated in the first trimester?
Valproic acid and sodium valproate (neural tube defect) phenytoin (cleft-palate, spina bifida)
28
Which drugs can be absorbed from the skin and should be avoided when dispensing if pregnant or planning for pregnancy?
finasteride and dutasteride. -finasteride: cause abnormalities in male genital
29
drug options to treat HTN in pregnancy?
labetalol nifedipine methyldopa if severe: IV options - labetalol, nifedipine, hydralazine
30
what is the treatment for HTN emergency in pregnancy?
IV hydralazine or IV labetalol
31
what is the correct tallman lettering for hydralazine and hydroxyzine?
hydrALAzine and hydrOXYzine
32
what is considered a HTN crisis?
BP > 180/110 --> can lead to stroke
33
what drug should be avoided in uti ?
nitrofurantoin - avoid near term, risk of inducing hemolytic anemia in fetus
34
which antibiotics should be avoided for UTI ?
trimethoprim and Sulfa/trimethoprim (Septra) - antifolate teratogenecity and avoid sulfamethoxazole in last 6 weeks --> neonatal hyperbilirubinemia nitrofurantoin - avoid in last 4-6 wks of pregnancy (but ok in first 2 trimesters) avoid FQs, tetracycline, doxycycline
35
if a 13-week pregnant woman has CrCl of 28 and sulfa allergy, what is the best treatment to choose?
amoxicillin or amoxi/clav *avoid nitrofurantoin if CrCl < 30, avoid Septra in sulfa allergy
36
APPROPRIATE drug options for uti in pregnancy?
amoxicillin (if susceptible), amoxi/clav, cephalexin fosfomycin (if suscptible) nitrofurantoin (trimester 1 and 2, not near end term)
37
in patients who take antiseizure meds + pregnant, what supplements should be taken?
daily multivitamin with 1 mg folic acid (start 3 months before conception, continue until 12 weeks gestational age) this reduces the teratogenic effects of ASMs
38
Appropriate drug options for seizure in pregnancy?
L-O-L lamotrigine oxcarbazepinee levetiracetam (+ folic acid 5 mg/wk)
39
which antiepileptic drug increases the risk of leukopenia?
carbamazepine
40
after using lamotrigine for a long period of time, what are the common side effects?
dizziness ataxia drowsy diplopia (double vision) blurred vision
41
treatment for mild nausea/vomiting?
ginger root, acupressure, pyridoxine
42
treatment for moderate nausea/vomiting?
without dehydration = prochlorperazine, metoclopramide, methylprednisone, diclectin (lack of evidence)
43
treatment for severe nausea/vomiting or dehydration?
ondansetron iv or po if resistant: methylprednisone iv or po
44
first and 2nd line for constipation in pregnancy?
bulk laxative like psyllium 2nd line: PEG, lactulose
45
if a pregnant pt has migraine, which drugs to avoid?
triptans and NSAIDs (in 3rd trimester)
46
Target Fasting BG in pregnancy?
< 5.3 mmol/L
47
target post-prandial BG in pregnancy?
< 6.7 mmol/L
48
first line drug option for diabetes in pregnancy?
insulin 2nd line - metformin (if insulin not tolerated) or sulfonylureas
49
1st line treatment of HYPERthyroidism in pregnancy?
PTU for first 3 months, then switch to methimazole after 3 months
50
1st line for peptic ulcer + pregnancy?
P.A.C PPI, amoxi + clarithomycin
51
1st line for bipolar disorders and pregnancy?
lamotrigine quetiapine
52
1st line - asymptomatic bacteriuria?
amox amoxi/clav cephalexin
53
1st line - UTI cystitis?
SMX/TMP trimethoprim nitrofurantoin (avoid near term) fosfomycin
54
1st line - gonorrhea/chlamydia?
ceftriaxone OR cefixime + azithromycin
55
1st line- vaginal candidiasis?
cotrimazole or miconazole *avoid fluconazole
56
1st line - BV?
clindamycin 2nd line is metronidazole
57
1st line-- trichomonas?
metronidazole
58
1st line for lyme disease
amoxicillin
59
1st line for acne?
benzoyl peroxide erythromycin or clindamycin topicals glycolic acid azelaic acid
60
1st line for headlice
permethrin (nix)
61
if a patient is taking enoxaparin for dvt, what should be monitored to avoid bleeding risk?
Antifactor Xa
62
What are the factors that affect drug secretion into breast milk?
1. lipid solubility 2. membrane permeation 3. low MW 4. basic drugs (high excretion into breast milk bc breast milk is a weak acid --> causes ionization --> increased excretion) 5. protein binding affinity
63
which drugs are contraindicated in breastfeeding?
opioids vareniclin COCs (but can use progestin only) cannabis
64
Which antibiotics for UTI are compatible with breastfeeding?
FQs Nitrofurantoin SMX/TMP amox, cephalosporins
65
If a mother is told to take metronidazole while she is breastfeeding, what is a key counselling point?
Pause breastfeeding for 12-24 hrs after dose
66
For a travelling family, can the breastfeeding mother take Dukoral? what about a 2 yr old child?
mother- yes child- no; dukoral not recommended in ages less than 2

Endocrinology (6 decks)

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