Exam 1 - Drug Use in PG Flashcards
(82 cards)
1
Q
What is the term for “Due Date?”
A
GESTATION
2
Q
Define gestation.
A
267 days from conception OR 280 days (40 weeks) from last menstrual period
3
Q
How many trimesters are there in pregnancy?
A
3
4
Q
How many weeks does each trimester last?
A
13 weeks
5
Q
How long is a term in pregnancy?
A
37-42 weeks gestation
6
Q
What is the term for the number of times a woman has been pregnant?
A
GRAVIDITY
7
Q
What is the term for the number of a woman’s pregnancies which exceed 20 weeks gestation?
A
PARITY
8
Q
What is a term for the number of babies a woman has had past 20 weeks gestation?
A
PARITY
9
Q
Name some physiologic changes in PG?
A
Increased cardiac output Increased renal perfusion and function Increased blood volume Decreased GI motility Increased weight gain
10
Q
How many pounds can a woman expect to gain in PG?
A
20-30 lbs
11
Q
Name the physiologic changes in PG that require an increased demand.
A
Increased demand for:
- Calories
- Protein
- Calcium
- Folic acid
- Iron
12
Q
How many additional calories do pregnant women need?
A
300/day
13
Q
How many additional proteins do pregnant women need?
A
10 g/day
14
Q
How much additional calcium do pregnant women need?
A
1200 mg/day
15
Q
How much additional folic acid do pregnant women need?
A
400 mcg/day
16
Q
What does folic acid help with?
A
Neural tube
17
Q
How much additional iron do pregnant women need?
A
30 g/day from 2nd trimester on
18
Q
T/F: PG women have shorter t 1/2 of renally eliminated drugs.
A
TRUE
-Perfusing kidneys really well because of extra blood volume
19
Q
T/F: PG women have larger apparent Vd for lipophobic drugs.
A
TRUE
-More fat and volume for drugs to go into
20
Q
In preconception planning, how much folic acid would low risk women take for neural tube defects?
A
Low risk 0.4 mg/day
21
Q
In preconception planning, how much folic acid would high risk women take for neural tube defects?
A
High risk 0.4 mg/day
22
Q
What can smoking lead to in PG?
A
Low birth weight
Premature birth
23
Q
Which immunizations should women in preconception planning have?
A
Rubella and Hepatitis B
Influenza vaccine
24
Q
What is the term for something that is capable of producing congenital abnormalities?
A
TERATOGEN
25
What can teratogens cause?
Organ teratogenicity
Perinatal complications
Neurobehavioral complications
26
In exposure to teratogens, what is meant by timing of exposure?
Conception to 14 days results in "all or none" effects
27
When exposed to a teratogen, when is the greatest risk of organogenesis?
Second through eighth week
28
Which trimesters are less risky in exposure to teratogens?
Second and third trimesters
29
What factors effect placental transfer?
- Low protein binding
- High lipophilicity
- Low molecular weight (<600 daltons)
- Unionized state
- Placental barrier (thins as PG progresses)
- Uterine blood flow (increases with gestation)
30
T/F: Drugs that want to bind to protein won't cross placenta because the fetus has less protein.
TRUE
31
T/F: A drug that is highly lipophilic won't cross the placenta because mom has more fat.
TRUE
32
T/F: Vancomycin, Insulin, and LMWH won't cross because their molecular weight is too big.
TRUE
33
T/F: Unionized drugs won't cross the placenta.
TRUE
34
What is the brand name for Retinoic Acid?
Accutane
35
What is the generic name for Accutane?
Retinoic Acid
36
What happens when pregnant pts take Accutane?
Embryopathy
- CNS craniofacial and Cardiac defects
- Microtia
37
Name the important human teratogens.
- ACE-inhibitors
- Carbamazepine
- Phenytoin
- Valproic acid
- Alcohol
- Lithium
- Misoprostol
- Retinoids (systemic use)
- Tetracyclines
- Thalidomide
- Warfarin
38
What abnormality do ACE-inhibitors cause in PG?
Renal failure/agenesis
39
What abnormality does Carbamazepine cause in PG?
Neural tube defects
40
What abnormality does Phenytoin cause in PG?
Fetal hydantoin syndrome
41
What abnormality does Valproic acid cause in PG?
Neural tube defects
42
What abnormality does Alcohol cause in PG?
Fetal alcohol syndrome
43
What abnormality does Lithium cause in PG?
Ebstein's anomaly
44
What abnormality does Misoprostol cause in PG?
Mobius syndrome
45
What abnormality do Retinoids (systemic use) cause in PG?
Retinoid embryopathy
46
What abnormality do Tetracyclines cause in PG?
Discoloration of teeth
47
What abnormality does Thalidomide cause in PG?
Phocomelia
48
What abnormality does Warfarin cause in PG?
Fetal warfarin syndrome
49
Name the additional teratogens.
- Androgens
- Antineoplastics
- Cocaine
- Diethylstibestrol
- Etretinate
- Iodides (radioactive)
- Live vaccines (MMR, Varicella)
- Methimazole
- Penicillamine
- Vitamin A (>18,000-25,000 IU/day)
50
What are the signs of Fetal Alcohol Syndrome?
- Small head circumference
- Low nasal bridge
- Thin reddish upper lip
- Epicanthic folds
- Short nose
- Small midface
51
What does Dilantin (Phenytoin) do to the fetus?
- Growth retardation
- Profuse scalp hair
- Short upturned nose
- Long philtrum
- Ear anomalies
- Wide space between eyes
- Short nose
- Digital hypoplasia
52
What was Thalidomide used for?
Hyperemesis
53
Name the suspected teratogens.
- ACE inhibitors
- Benzodiazepines
- Estrogens
- Progesterones
- Quinolones
54
Name the drugs that have nonteratogenic adverse effects.
- Antithyroid drugs
- Aminoglycosides
- Aspirin and NSAIDs
- Barbiturates - chronic use
- Benzodiazepines
- Beta-blockers
- Caffeine
- Chloramphenicol
- Cocaine
- Diuretics
- Isoniazid
- Narcotic analgesics - chronic use
- Nicotine
- Oral hypoglycemic agents
- PTU
- Sulfonamides
55
Why do you want to avoid beta-blockers in diabetes?
B/C it masks the s/s of hypoglycemia
56
Name the agents considered safe while pregnant.
- Acetaminophen
- Cephalosporins
- Corticosteroids
- Docusate sodium
- Erythromycin
- Multiple vitamins
- Narcotic analgesics
- Penicillins
- Phenothiazines
- Thyroid hormones
- Tricyclic antidepressants
57
"PC CANT TEMP" = Safe agents
P - Peninicillins
C - Cephalosporins
C - Corticosteroids
A - Acetaminophen
N - Narcotic analgesics
T - Thyroid hormones
T - TCAs
E - Erythromycin
M - Multiple vitamins
P - Phenothiazines
58
What is the term for a severe form of morning sickness that may lead to dehydration, electrolyte disturbances, and acid-base imbalances?
Hyperemesis gravidarium
59
What is the nonpharmacologic treatment for morning sickness?
- Small, frequent meals high in carbs
- Limit spicy foods
- Avoid nausea producing situations, smells, etc.
- Cracker at bedside
- Acupuncture/pressure points
60
What is the pharmacologic treatment for morning sickness?
- First line agents = Pyridoxine (Vit B6), Diclegis/Bonjesta, Antihistamines (Doxylamine, Meclizine), Promethazine
- 2nd Line = Metoclopramide
- Ondansetron
- Cyanocobalamin (Vit B12)
- Dimehydrinate
- Ginger
61
What is the first line treatment for morning sickness?
- Pyridoxine (Vit B6)
- Diclegis/Bonjesta
- Antihistamines (Doxylamine, Meclizine)
- Promethazine
62
What is the 2nd line treatment for morning sickness?
Metoclopramide
63
When is constipation common in PG?
2nd and 3rd trimester
64
_____ may be a side effect of iron, calcium supplementation.
CONSTIPATION may be a side effect of iron, calcium supplementation.
65
What are the treatments for constipation in PG?
- Fluids
- Physical exercise
- High fiber foods
- Bulk-forming laxatives
- Stool softeners
- Osmotic laxatives
66
T/F: No enemas or strong stimulant laxatives.
TRUE
| -Can cause contractions
67
Which types of laxatives should be avoided?
- Bisacodyl - short term
- Senna
- Castor and mineral oil
68
When is heartburn (GERD) most common?
Late in 2nd or 3rd trimester
69
What is the treatment for heartburn (GERD) in PG?
- Small, frequent meals, no late night meals
- Decreased caffeine, nicotine, chocolate, etc.
- Increased HOB or sleep on 2 pillows
- Antacids for mild to moderate (H2RA, PPIs, Reglan for severe, Sucralfate); avoid magnesium and aluminum
NO sodium bicarbonate
70
T/F: All anticonvulsants are considered teratogenic in PG.
TRUE
71
How much folic acid supplementation in epilepsy?
4-5 mg qd
72
How much vitamin K supplementation in epilepsy?
10 mg po qd in the LAST month
73
T/F: Treat status epilepticus as usual without regard to PG.
TRUE
74
What are the risks when a pg woman has bacterial vaginosis?
- Pre-term labor
- Premature ROM
- Spontaneous abortion
- Postpartum endometritis
75
What bacteria causes bacterial vaginosis?
- Usually anaerobic
- Mycoplasmas
- Gardnerella vaginalis
76
What is the treatment for bacterial vaginosis?
- Metronidazole 500 mg BID x 7 days
| - Clindamycin 300 mg po BID x 7 days
77
T/F: Avoid ACE inhibitors and ARBs in pg.
TRUE
78
What do you try first in HA in pregnancy?
Non-pharmacologic treatment
79
What pharmacologic treatments are okay to take for HA in pregnancy?
- APAP, caution with codeine, narcotics (Fioricet)
- NSAIDs and ASA - contraindicated in late PG; IBU, Naproxen
- Sumatriptan - drug of choice
- Propranolol, then amitriptyline/nortriptyline
80
What drugs are contraindicated in HA in pregnancy?
Ergotamine and Dihydroergotamine
81
T/F: Never use Naloxone in a mother or infant.
TRUE
82
What immunizations for pg women?
- Pertusis (Tdap, Td); each pregnancy, 3rd trimester
- Influenza
- After delivery = MMR, Varicella; b/c they are live vaccines and only if not up to date
