Lecture 5 - Pregnancy

Question 1

The should pt take preg test to be accurate?

Answer 1

1 week after missed period
morning
follow up with PCP to confirm

Question 2

Gravida

Answer 2

number of times person pregnant, regardless of outcome

Question 3

PARA

Answer 3

number of births carried to viability (20 weeks)

Question 4

TPAL

Answer 4

T = number of term deliveries
P = number of preterm deliveries
A = number of abortions/miscarriages/ectopic pregnancies
L = number of living children

Question 5

Trimester

Answer 5

1st = 1-13
2nd = 14-26
3rd = 27-40

Question 6

Duration of pregnancy

Answer 6

9.5 months, ~ 40 weeks

add 7 days to last day of period for conception and ~ 9months for due date

Question 7

Passive diffusion drug properties?

Answer 7

Mw < 500
High lipid solubility
Low Degree of ionization
Low protein binding

Question 8

Ways to prevent neural tube defects

Answer 8

Folic acid (B9) supplement
Smoking cessation
Avoid/limit caffeine intake
vaccination

Question 9

Folic Acid dosing for neural tube defect prevention

Answer 9

400mcg = daily non preg
600-800mcg/day if preg

4mg/day if have a NTD, prev preg had NTD, type 1 DM, on anti-seizure meds

Question 10

Smoking cessation that can be used during preg?

Answer 10

Patches or gum can be used, replacement therapy less harmful than smoking cigs

Question 11

Vaccines during preg

Answer 11

Flu
Tdap = after 20weeks, ideally 27-36
Covid-19

Question 12

Vaccines before pregnancy

Answer 12

ideally up to date

give any live req vaccines before preg

Question 13

Vaccines after pregnancy

Answer 13

Tdap if didn’t get
MMR/Varicella if not already immune

Question 14

Non-pharm morning sickness treatments

Answer 14

Slowly rise from bed
Eat small snack in bed before getting up
Ginger (up to 1g/day)
Eat multiple, small meals/snacks throughout the day

Question 15

Pharm Treatments morning sickness

Answer 15

Pyridoxine (B6) +/- doxylmine

Unisom = OTC
Diclegis = RX
Boniest = RX

Metoclopramide
Prochlorperazine

Question 16

Diclegis info

Answer 16

10mg Doxylamine/pyridoxine

Day 1/2 = 2 tab QHS
Day 3 = tab AM and 2 QHS if still have symptoms
Day 4+ = 1 QAM/QPM/ 2QHS (4QD Max)

$$$$

Question 17

Bonjest info

Answer 17

20mg Doxylamine/pyridoxime…its ER

Day 1 = 1 QHS
Day 2 = 1QAM/QHS

Question 18

Antihistamines safe for allergies

Answer 18

1st gen = chlorpheniramine/diphenhydramine
2nd gen = loratadine/cetirizine
Intranasal = fluticasone furoate, mometasone, budesonide

Caution: oral and nasal decongestant such as phenylephrine

Question 19

non-pharm constipation treatments

Answer 19

Inc dietary fiber
inc fluid intake
Exercise
Sits bath for hemorrhoids

Question 20

Pharm treatment options for constipation

Answer 20

Bulk forming lax = psyllium or methyl cellulose = 1st line

Stool softeners = docusate

Stimulant lax = Senna (pref) or bisacodyl =use if dont respond to others

Osmotic lax = Poly gly or lactulose = only use short term if nothing else work

Lubricant lax = mineral/castor oil = AVOID

Question 21

Non-pharm back pain options

Answer 21

Heating pad/ice
Massage/chiropractor
Acupuncture
Exercise
Elevate when sit

Question 22

Tips for prevention of preg back pain

Answer 22

wear low heeled shoes
maintain good posture
sleep on side with pillow between legs
squat when picking up

Question 23

Pharm treatment for backpain

Answer 23

Tylenol = go to all trimesters

NSAIDS = avoid after weeks 20

Can use topical analgesics such as Lido patch or capsaicin cream

Question 24

Non-pharm heartburn/indigestion treatment

Answer 24

Multiple small meals/snacks
Avoid caffeine
no food prior to bed
raise head of bed
traffic light diet

Question 25

Pharm Heartburn/indigestion treatment

Answer 25

Ca/Mg/AL antacids...avoid taking within 2hrs of iron or folic acid supplement Mod-Severe symptoms = H2RA or PPI Avoid sodium bicarb

Question 26

Nonpharm Cold/cough treatments

Answer 26

Rest inc fluid intake elevate head while sleep humidifier throat lozenge gargle with salt

Question 27

Pharm Cold/cough Treatments

Answer 27

avoid combo, often have alc in them fever/pain = tylenol Runny nose = anti hist Cough = guaifenesin/dextromethorphan safe Congestion = avoid Sudafed 1st trimester, phenylephrine in preg

Question 28

Screening for DM in pregnancy

Answer 28

OGTT does between weeks 24-28 indicated for those with BMI > 25 and 1 additional risk factor for DM

Question 29

Nonpharm DM in preg management

Answer 29

Diet modifications light or moderate exercise weight management

Question 30

Pharm management for DM in preg

Answer 30

Insulin = drug of choice Metformin Glyburide = cross placenta, fallen out of favor

Question 31

Gestation HTN

Answer 31

HTN during preg after 20th week without pre-eclampsia no proteinuria can develop into pre-eclampsia

Question 32

Pre-eclampsia is...

Answer 32

new onset of hypertension after 20 weeks of gestation in previously normotensive patient

Question 33

Criteria for Pre-eclampsia

Answer 33

SBP > 140 or DBP > 90 on 2 occasions atleast 6hrs apart OR SBP > 160/ DBP > 110 plus.... Proteinuria platelets < 100K LFTs 2X ULN Renal dysfunction ( Scr > 1.1 or dble previous) Pulmonary edema Cerebral or visual disturbances

Question 34

Who is at risk for Pre-eclampsia

Answer 34

1st preg obese family or personal history < 20 or 35-40yrs old Gestational DM Multiple gestation = twin or triplets HTN, Kidney disease, Lupus, DM prior to preg

Question 35

Risk reduction for at risk for Pre-eclampsia

Answer 35

Low dose aspiring from weeks 12-36

Question 36

Pharm HTN management

Answer 36

Labetalol = caution asthma Hydralazine = Lookout for lupus like symptoms Nifedipine = Use ER, IR associated with hypotension Methyldopa = safe, not really used HCTZ = look out for orthostatic hypotension

Question 37

Pharm HTN agents to avoid pregnancy

Answer 37

ACEi ARBs Spironolactone

Question 38

What to do if pt has pre-eclampsia

Answer 38

Delivery is only cure Consider betamethasone if 24-34 weeks Treat HTN acutely (IV labetalol or hydralazine) prevent seizures w/ IV mag

Question 39

Hyperemesis Gravidarum

Answer 39

severe nausea and vomiting Dif from morning sickness by.... Dehydration Electrolyte/metabolic disturbances Nutritional deficiency Weight loss > 5%

Question 40

Hyperemesis Gravidarum treatment

Answer 40

IV fluids Nutrition via tube Antiemetics Vitamin and electrolyte repletion

Question 41

VTE in pregnancy

Answer 41

inc throughout preg, highest 6 weeks post party

Question 42

VTE Management in pregnancy

Answer 42

Heparin Enoxaparin = 1mg/kg BID Dalteparin 100unit/kg BID generally avoid warfarin and direct acting anticoagulants Duration = remainder of therapy and + 6 weeks post part (minimum duration 3 month)