pregnancy

Question 1

pregnancy: nasal congestion

Answer 1

avoid guaifenesin

decongestants are per MD only

Question 2

pregnancy: diarrhea

Answer 2

avoid bismuth

loperamide is per MD only

Question 3

pregnancy: constipation

Answer 3

avoid senna

bulk, bisacodyl, docusate OK

Question 4

pregnancy: pain

Answer 4

avoid aspirin 3rd tri
NSAIDs are ok 1st try
generally avoid/use APAP minimally

Question 5

pregnancy: nausea, mild

Answer 5

can use ginger, pyridoxine, cyclizine

Question 6

pregnancy: nausea, moderate

Answer 6

can use doxylamine, reglan, zofran

Question 7

pregnancy: anti-infectives

Answer 7

prefer penicillins, cephalosporins, macrolides

Question 8

pregnancy: hypertension

Answer 8

avoid: ACEi, ARB

options are labetalol, nifedipine, methyldopa, hydralazine

Question 9

pregnancy: anticoagulation

Answer 9

UFH/LMWH safe

Question 10

pregnancy: antidepressants

Answer 10

sertraline, citalopram OK

Question 11

pregnancy: CNS agents

Answer 11

amphetamines can cause withdrawal

benzos rarely used, floppy baby syndrome

Question 12

postpartum: contraception

Answer 12

avoid CHC until 3-6 weeks postpartum

at any time, options are progestin only implant or pill, IUD

Question 13

physiologic changes in pregnancy: blood volume

Answer 13

blood volume increased, expands Vd

Question 14

physiologic changes in pregnancy: RBC

Answer 14

increased RBC– depletes iron stores & requires supplements

Question 15

physiologic changes in pregnancy: HR, BP

Answer 15

decreased blood pressure
increased cardiac output/HR

Question 16

physiologic changes in pregnancy: hepatic perfusion

Answer 16

increased hepatic perfusion with some CYP enzymes being more active

Question 17

physiologic changes in pregnancy: GFR

Answer 17

increased GFR= enhanced drug removal

Question 18

physiologic changes in pregnancy: albumin

Answer 18

reduced albumin= less drug binding= more free drug concentrations

Question 19

physiologic changes in pregnancy: antithrombin

Answer 19

decreased antithrombin, increased risk VTE

Question 20

physiologic changes in pregnancy: weight

Answer 20

average weight gain is 25-30 pounds

Question 21

generalizations for PK in pregnancy

Answer 21

absorption generally unaffected
distribution: more free drug, higher Vd
clearance is higher

almost all drugs cross placenta

Question 22

definition of teratogen

Answer 22

produces permanent alteration in form/function in offspring

Question 23

true or false: a drug is clearly either a teratogen or not

Answer 23

false
need to consider other factors, exposure, dose

Question 24

definition of a congenital malformation

Answer 24

prenatal structural abnormalities present at birth that interfere with viability or physical well-being
ex cleft lip, club foot, spina bifida

Question 25

true or false: drugs are 1% of the causes of congenital malformations

Answer 25

true

Question 26

teratogenicity depends upon

Answer 26

genetic constitution of mother and fetus-- there can be genetic mutations or polymorphisms in drug metabolism genes

Question 27

8 principles of teratology

Answer 27

1. 1 teratogen can cause many different malformations 2. many teratogens cause the same malformations 3. teratogens don't have to be hazardous to mother 4. teratogens must be present at a critical period 5. teratogens can act directly or indirectly 6. dose-relationship presumed, rarely defined 7. genetic susceptibility of infant to toxic metabolites may be unifying pathway to injury 8. malformation may be animal species/strain specific

Question 28

what is the mechanism by which drugs cross the placenta

Answer 28

mostly simple diffusion, concentration driven

Question 29

drugs in category X

Answer 29

valproate methotrexate ribavirin triazolam bosentan aliskiren emergency contraception griseofulvin isotretinoin

Question 30

most common congenital abnormality

Answer 30

neural tube defects all women take 0.4 folic acid daily

Question 31

which drugs are associated with risk of neural tube defects

Answer 31

classic anti-epileptic agents such as valproic acid

Question 32

cardiovascular drugs of concern for pregnancy

Answer 32

warfarin ACEi/ARB beta blockers without ISA

Question 33

CNS drugs of concern for pregnancy

Answer 33

SSRIs, lithium

Question 34

other drugs of concern for pregnancy

Answer 34

misoprostol, tetracyclines, androgens, estrogens, fluconazole, chemotherapy, mycophenolate, NSAIDs

Question 35

implications of alcohol use during pregnancy

Answer 35

fetal alcohol syndrome

Question 36

implications of nicotine use during pregnancy

Answer 36

premature rupture of membranes abruptio placentae low birthweight preterm birth stillbirth SIDS

Question 37

implications of cannabis use during pregnancy

Answer 37

unsafe, low birth weight, premature birth, NICU care