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Endocrinology > Maternal Health & Drugs in Pregnancy > Flashcards

Maternal Health & Drugs in Pregnancy Flashcards

1
Q

What are the cardiac changes in pregnancy and what do they lead?

A
  • Increased blood volume 45% - expand volume of distribution
  • Increased RBC - deplete iron stores (require supplementation)
  • Increased cardiac output/HR - decreased BP
  • Reduced albumin - less protein binding, more “free drug concentrations” (higher clearance of drugs)
  • Decreased antithrombin III, factor S - increased risk of VTE
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2
Q

What are some other physiologic changes in pregnancy?

A
  • Elevation of diaphragm - SOB
  • Increased hepatic perfusion with increased cytochrome P450, 3A4, 2C9, 2D6; decreased IA2 activity
  • Average weight gain 25-30 pounds
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3
Q

What happens during days 0-14 in fetal development?

A
  • Focus on maternal exposure BUT also paternal influence
  • Fertilization and implantation
  • All or nothing
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4
Q

What happensduring days 14-56 in fetal development?

A
  • Organogenesis (structure)
  • Face, ear, eye, CNS, hand, heart
  • GU system and limbs (up to > week 10)
  • If medication is going to influence here–> it is called a structural influence
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5
Q

What happens during days 57-term in fetal development?

A
  • Fetal period: Growth, Function, and Structure
  • More growth and function than structure
  • An influence in this period could result in stunted growth, change of function, intellect/emotional development, and change in structure
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6
Q

What are the most common congenital anomalies in the US?

A
  • Most common–> cleft lip/palate
  • Poly/syndactaly
  • Clubfoot
  • Genitalia
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7
Q

What are the factors that allow drug to pass through the placenta?

A
  • Surface area of the placenta
  • Lipid soluble drugs
  • Lighter the weight, the more permeable to the placenta
  • Un-ionized form
  • Low protein binding
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8
Q

Accutane

A
  • Category X
  • Can cause structural abnormality, miscarriage, retardations
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9
Q

Fetal Hyandtoin Syndrome (Fetal Anti-Epileptic Syndrome)

A
  • DPH, Pbarb, Valproate, Tegretol, Topamax
  • 1st trimester effects
  • Valproate is HIGH RISK, Days 31-44 for neural tube defects (Spina bifida-folate deficiency)
  • BUT uncontrolled epilepsy is also teratogen
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10
Q

Neural Tube Defects

A
  • Early 1st phase of pregnancies
  • Most common major congenital abnormalities
  • ALL women take folic acid 0.4 mg daily beginning 1 month pre-conception
  • Increase to 4 mg/day if previous NTD pregnancy
  • Prenatal ultrasound detection
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11
Q

Warfarin

A

Fetal Warfarin Syndrome

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12
Q

ACE Inhibitors/ARBs

A

-2nd/3rd trimester
-Oligohydramnios
-Anuria
-Renal anomalies
-Renal failure
-Growth restriction
-Hypotension

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13
Q

Beta-blockers without ISA

A

-2nd/3rd
-Severe IUGR

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14
Q

SSRIs

A

-Cardiac malformation
-Neurobehavioral sx
-Neonatal withdrawal

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15
Q

Lithium

A

Ebstein’s anomaly (cardiac)

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16
Q

Misoprostal

A

Limb and neural tube defects

17
Q

Tetracyclines

A

-Weakened fetal bones
-Tooth enamel dysplasia
-Tooth discoloration
-2nd and 3rd trimester
-hepatic injury

18
Q

Androgens, estrogens

A
  • 8 weeks to term
  • Masculinization, feminization
19
Q

Fluconazole

A

-1st trimester
-Cardiac, skeletal, and craniofacial
-NOT recommended for VVC when topical agents preferred

20
Q

Mycophenolate

A

-1st trimester
-Abortion
-Ear/facial
-Limbs

21
Q

NSAIDs

A

-1st trimester, after 32 weeks
-Abortion
-Premature PDA closure
-AVOID in 3rd trimester due to risks of bleeding, prolonging gestation/labor, renal dysfunction, PDA, decreased amniotic fluid

22
Q

What nasal congestion treatments should pregnant patients avoid?

A

-Expectorant: Guaifenesin
-Decongestants: Use sparingly and avoid especially when HTN, DM, risk of premature labor

23
Q

What diarrheal medication should pregnant patient avoid?

A

Bismuth salicylate

24
Q

What constipation medication should pregnant patient avoid?

A

Senna

25
Q

Sulfonamides

A

-3rd trimester

26
Q

Aminoglycosides

A

Risks of congenital deafness

27
Q

Quinolones

A

NOT recommended for routine use as in UTIs due to fetal/neonatal animal data

28
Q

What are some pharmacological treatments for hypertension in pregnant patients?

A

-Methyldopa
-Nifedipine
-Labetalol
-Hydralazine

29
Q

What antihypertensive medications should pregnant patients avoid?

A

ARBs, ACEI, some beta-blockers, diuretics

30
Q

What anticoagulation medication is best for pregnant patients?

A

UFH or LMWH are safest

31
Q

Amphetamines

A

-Drug withdrawal (3rd trimester)
-Later behavioral difficulties

32
Q

Benzodiazepines

A

-Premature births
-Neonatal withdrawal
-“floppy infant” esp as prolonged lorazepam elimination in infant post-delivery

Endocrinology (10 decks)

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