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obstetrics > drugs, meds, immunization > Flashcards

drugs, meds, immunization Flashcards

1
Q

mild sedative used for trt of nausea in pregnancy w/c can cause phocomelia

A

thalidomide

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2
Q

thalidomide is still used for trt of?

A

leprosy

multiple myeloma

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3
Q

physiologic changes w/c affects drug mechanism

A 
dec GI motility, inc gastric pH
inc plasma vol
dec serum albumin, inc alpha-1 acid glycogen
inc renal BF
inc hepatic microenzyme
hyperventilation, inc TV & pulmo BV
inc aqueous and fatty tissue spaces
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4
Q

properties of drug that easily cross placenta

A

highly lipid soluble
non-ionized
LMW
minimally protein bound

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5
Q

fetal pharmacokinetics affecting drugs

A

protein binding capacity of fetal plasma is lower than maternal
fetal plasma & amniotic fluid are slightly more acidic
metabolizing capacity of fetal liver enzyme is much less
fetal glomerular filtration is markedly reduce

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6
Q

timing and effect of drugs during pregnancy

20 days

A

all or nothing; fetus is highly resistant to birth defects

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7
Q

timing and effect of drugs during pregnancy

3-8 wks

A 
possibly no effect
miscarriage
obvious birth defect
inc risk of childhood cancer
organogenesis
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8
Q

timing and effect of drugs during pregnancy

2nd & 3rd trim

A

changes in growth & fx of normally formed organs & tissue
unlikely to cause obvious birth defect
unknown long-term effect

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9
Q

FDA drug categories

A

A - adequate, well-controlled studies no risk of fetal abnormality
B - no risk in animal, no adequate studies in human; risk in animal, no risk in human
C - risk in animal, no adequate studies in human; no adequate studies in animal & human
D - benefit > risk
X - absolute contraindication

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10
Q

Category C

A

Corticosteroids, Fluconazole, Methylene Blue, Minoxidil

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11
Q

Category D

A

ACE inhibitors, Aminocaproic acid, ARBs, Aminoglycosides, Atenolol, Carbamazepine, Methimazole, Mifepristone, RU-486, Penicillamine, Potassium iodine, Diatrizoate, Tetracycline, Valproic acid, Antineoplastics (Alkylating agents), Aspirin, Benzodiazepines, Bromides, Colchicine, Phenytoin, Lithium, Mysoline, Phenobarbital or methylphenobarbital, Megesterol, Norethindrone, Tamoxifen

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12
Q

Category X

A

Antineoplastics (antimetabolites): Methotrexate, Cytaribine, Chlorambucil, Cycolphosphamide Flurazepam, Triazolam, DES, Finasteride, Misoprostol, Raloxifene, Statins, Acetohydroxamin acid, Androrgens (ex. Danazol), Benzodiazepines, Temazepam, Ergotamine, Progestins, Retinoic acid, Isotretinoin (Accutane), Acitretin (Soriatane), Etretinate, Topical tazarotene, Thalidomide, Warfarin

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13
Q

benzodiazepine (DX)

A

bradypnea or withdrawal symptoms if given late in pregnancy

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14
Q

aminoglycoside (D)

A

ototoxicity

nephrotoxicity

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15
Q

chloramphenicol (X)

A

gray baby syndrome

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16
Q

fluoroquinolone

A

bone & joint abnormalities esp. in 1st trim

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17
Q

nitrofurantoin (B)

A

hemolytic anemia at term
2-fold risk of cleft lip at 1st trim
contraindicated in G6PD def

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18
Q

TMP-SMX (D)

A

TMP: interfere w/ folic acid metab
SMX: jaundice & hemolytic anemia

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19
Q

warfarin (X)

A

schizencephaly, microcephaly, hydrocephalus, blindness, mental disability, fteal hemorrhage

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20
Q

fluconazole (C)

A

in animals, fetotoxicity, teratogenicity

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21
Q

spironolactone

A

anti-androgenic

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22
Q

ACE inhibitors (D)

A

last trim, fetal kidney damage, oligohydramnios, facial, limb & lung defect, fetal hypotension

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23
Q

what anti-hypertensive drugs can be given safely?

A

nifedipine

methyldopa

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24
Q

beta-blocker (D)

A

dec HR & fetal growth restriction

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25
Q

calcium channel blocker

A

1st trim, birth defect of fingers & toes

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26
Q

haloperidol

A

1st trim, limb defect

3rd trim, extrapyramidal symptoms, restlessness, shaking, dob

27
Q

phenytoin (D)

A

inc risk cleft palate & heart defect

28
Q

valproate (D)

A

heart, face, skull, limb, and neural tube defect

29
Q

methotrexate (X)

A

early, abortion

micrognathia, cleft palate, spinal abnormalities, ear defects, club foot

30
Q

danazol (X)

A

early, masculinization

31
Q

isotretinoin (X)

A

abortion, heart defect, small ears, hydrocephalus

32
Q

radioactive iodine (D)

A

fetal hypothyroidism, mental retardation, inc risk of malignancy

33
Q

safest & best drug for PPROM

A

ampicillin

34
Q

drug for PPROM with complication

A

clindamycin

35
Q

cephalosporin is generally safe. T or F?

A

true

36
Q

co-amox is associated w/ birth defect if given in 1st trim. T or F?

A

false

37
Q

tetracycline (D)

A

2nd or 3rd trim, dental staining

38
Q

metronidazole (B)

A

carcinogenic in rats but no AE in human pregnancy

39
Q

diphenhydramine & meclizine (B)

A

not recommended in the last 2 wks d/t risk of retrolental fibroplasia

40
Q

metoclopramide (B)

A

inc rate of gastric emptying

high doses: extrapyramidal symptoms

41
Q

ondansetron (B)

A

used in postchemo N/V

42
Q

first line for N/V

A

emetrol

43
Q

drugs for heartburn & GERD

A

antacids (B: Al & Mg; C: Ca)
H2-R blocker (B)
PPI (C): avoided in 1st trim

44
Q

drugs for constipation

A

bisacodyl
senna
psyllium

45
Q

drugs for diarrhea

A

kaolin & pectin

loperamide

46
Q

paracetamol (B)

A

first choice

high dose: embryotoxicity

47
Q

NSAID (C 30 wks; D >30 wks)

A

potential orofacial cleft (naproxen) & structural cardiac defect
risk of premature closure of DA if given in 3rd trimester

48
Q

opiods (C)

A

chronic use may lead to dependence & withdrawal symptoms

slightly greater risk of spina bifida, gastroschisis, cardiac abnormalities

49
Q

magnesium sulfate (D)

A

prevent & treat seizure in preeclampsia
fetal neuroprotection (<32 wks)
short term prolongation of pregnancy (up to 48 hrs)
AE: bone demineralization

50
Q

nifedipine (C)

A

SM relaxation

anti-hypertensive & tocolytic

51
Q

methyldopa (B)

A

first line anti-hypertensive
alpha adrenergic agonist centrally
not diminish uterin BF
caution in depression

52
Q

hydralazine (C)

A

SM relaxation (vasodilator)
lowers BP rapidly
AE: neonatal thrombocytopenia & lupus

53
Q

isoxsuprine/terbutaline

A

beta 2 agonist (vasodilator)
uterine muscle relaxation
AE: maternal pulmo edema

54
Q

recommendation for Hepa A & B vax

A

A: if needed
B: if high risk

55
Q

recommendation for TdaP

A

1 dose >20 wks preferrably 27-36 wks

56
Q

recommendation for meningococcal vax

A

given if needed

57
Q

recommendation for pneumococcal vax

A

given if needed

58
Q

recommendation for HPV vax

A

not given during pregnancy

59
Q

recommendation for MMR vax

A

contraindicated

avoid pregnancy <3 months post-MMR vax

60
Q

recommendation for varicella vax

A

contraindicated

61
Q

recommendation for zoster vax

A

contraindicated

62
Q

recommendation for dengue vax

A

contraindicated

63
Q

recommendation for rabies vax

A

given if needed

obstetrics (11 decks)

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