Peripartum/Pregnancy

Question 1

The 2 objectives of Healthy People 2020 for pregnant women include: 1) Reduce pre-term births and low birth weight and 2)

Answer 1

Abstinence from tobacco/drugs/alcohol

Question 2

Teratogen risk is highest in weeks __ to __ of pregnancy

Answer 2

3-8 weeks

Question 3

____ psychotropic meds cross the placenta and are excreted in breast milk

Answer 3

ALL

Question 4

**The foundation of decision making process for use of meds during pregnancy is:

Answer 4

weighing the risk of untreated mental illness vs. risk of medication effects on baby

Question 5

**What does the latest research recommend in regard to med dosages vs. adjunct meds during pregnancy?

Answer 5

Maximize dosage of drugs BEFORE adding adjunct med

Question 6

Dose reductions in psychotropic meds due to concerns about harming baby can lead to:

Answer 6

subtherapeutic treatment in mom which increases risks for both mother and baby

Question 7

The introduction of this new system in 2015 requires all medications to include reproductive and lactation information in their package insert, including any effects a medication could have on males reproductive health.

Answer 7

Pregnancy and Lactation Labeling Rule (by FDA)

Question 8

This depression screening tool is specific to pregnant women

Answer 8

Edinburgh Pregnancy Depression Scale (EPDS)

Question 9

This is the 1st-line treatment for perinatal depression

Answer 9

SSRIs

Question 10

These 4 SSRIs are considered to be the safest to use during pregnancy:

Answer 10

sertraline
fluoxetine
escitalopram
citalopram

Question 11

This class of drugs have been associated with low birth weight, pre-term birth, postpartum hemorrhage and PERSISTENT PULMONARY HYPERTENSION (PPH) in the newborn

Answer 11

SSRIs

Question 12

This antidepressant is associated with congenital heart defects in the newborn (VSD, ASD)

Answer 12

paroxetine

Question 13

This antidepressant may be helpful for both depression and HYPEREMESIS GRAVIDARUM (severe N/V associated with pregnancy)

Answer 13

mirtazapine

Question 14

For rapid symptom relief (suicidality), psychotic agitation, minimal response to meds, this may be indicated according to APA and ACOG

Answer 14

ECT

Question 15

This treatment for perinatal depression increases risk for pre-term labor, placental abruption (placenta separating from uterus), and SPONTANEOUS ABORTION

Answer 15

ECT

Question 16

Non-pharm TXs such as CBT, IPT and ___ ___ ____ may be effective for perinatal depression

Answer 16

Bright Light Therapy (BLT)

Question 17

Fetal risks for this psychiatric disorder include pre-term birth, low birth weight, PLACENTA PREVIA (placenta partially or completely covers mother’s cervix), PRE-ECLAMPSIA (severe HTN leading to potential organ damage)

Answer 17

Perinatal Bipolar Disorder

Question 18

This rare congenital heart defect is associated with perinatal use of lithium

Answer 18

Ebstein’s anomaly

Question 19

When using atypical antipsychotics during pregnancy, should stick to:

Answer 19

Older, more widely-researched agents

Question 20

The most serious risk associated with bipolar disorder for mothers during pregnancy is:

Answer 20

suicide

Question 21

What are some administration and monitoring considerations for lithium in pregnant women? (2 answers)

Answer 21

BID instead of QD dosing

Monitor renal fx (creatinine)

Question 22

Some institutes recommend avoiding the use of this drug for any women of childbearing age unless they have had a tubal ligation or hysterectomy

Answer 22

Depakote

Question 23

The 1st-line tx of mild-moderate anxiety in pregnancy is

Answer 23

CBT

Question 24

The 2nd-line tx for anxiety disorders in pregnancy is:

Answer 24

CBT + SSRI

Question 25

What did a meta-analysis by NICE show in regard to risk of fetal malformations related to benzodiazepine use?

Answer 25

No increase in risk for fetal malformations.

Question 26

Benzo use during pregnancy can result in these 2 issues in the baby

Answer 26

Withdrawal syndrome | Floppy baby

Question 27

Perinatal _____ can increase risk for hyperemesis gravidarum (HG) and immunosuppression

Answer 27

Anxiety

Question 28

Taking an antihistamine on same day as a _____ can increase the risk of _____

Answer 28

benzo | increased risk of stillbirth

Question 29

There is very little research on this anxiolytic so it is best avoided during pregnancy

Answer 29

buspirone

Question 30

These 2 antidepressants and this 1 hypnotic are reasonably safe options to help with sleep issues during pregnancy

Answer 30

trazodone and mirtazapine | zolpidem (Ambien)

Question 31

Gestational diabetes, preeclampsia, placental abruption, preterm birth, small for gestational age (SGA), LGA (especially with ATYPICALS), cardiac abnormalities (RISPERIDONE), and neglect are all risks for women with this condition

Answer 31

Perinatal Schizophrenia

Question 32

Both FGA and atypicals may increase risk for this complication in the newborn

Answer 32

over-sedation (sometimes requiring mechanical ventilation)

Question 33

This ADHD med is associated with cardiac malformations when taken during the first trimester of pregnancy

Answer 33

methylphenidate

Question 34

This is the preferred stimulant to use during breastfeeding due to lower levels of transmission in breast milk

Answer 34

methylphenidate (as compared to amphetamine)

Question 35

What is the research on safety in regard to the use of guanfacine, clonidine and atomoxetine during pregnancy?

Answer 35

Limited data (should be avoided)

Question 36

This drug is considered relatively safe during pregnancy and can be used off-label for ADHD

Answer 36

bupropion

Question 37

These 2 antipsychotics have lower transmission in breast milk:

Answer 37

olanzapine | quetiapine

Question 38

This benzo has a short half life and low transmission through breast milk

Answer 38

lorazepam

Question 39

This antipsychotic can DECREASE prolactin levels and so can decrease breast milk production. Also, this other class of drugs can decrease milk production

Answer 39

aripiprazole | anticholinergics/antihistamines