Pregnancy and Lactation Dr. Dowling Flashcards
EXAM 2 (48 cards)
Which drugs are less likely to pass the placenta?
EXAM Q
-hydrophilic
-ionized
-high-protein-bound
-larger MW (>600 Daltons)
-when clinical data is not available, evaluate thee risk by predicting if the drug is able to pass the placenta
Which drugs may be used for medication-induced abortion?
-Mifepristone
-Misoprostol
Which common drugs should NOT be used during pregnancy?
-EtOH, nicotine
-Isotretinoin
-Methotrexate
-Mifepristone, Misoprostol
-NSAIDs
-RAAS inhibitor
-Phenytoin, Valproic acid
-Warfarin
When should Folic acid supplementation be initiated?
-consider for all women of childbearing age
-start at leat 3 months before conception and continue to 12 weeks gestation (which is beyond the early fetal development phase)
What is the recommended dose for folic acid supplementation?
0.4 mg (400 mcg) for most women
4mg daily for high risk of NTD (neural tube defect)
-previous NTD
-diabetes
-smoking
-BMI > 35 kg/m2
-antiepileptic drug use
Which supplements should a prenatal vitamin contain?
-Vitamin D
-Calcium
-Iron
-Folic acid
What are the recommended doses of iron for women?
18 mg per day for non-pregnant women
27 mg per day if pregnant
What are the recommended doses of Calcium for women?
1000 mg/day
What are the recommended doses of Vitamin D for women?
600 mg/day
Which vaccines are recommened for women
Hepatitis B
MMR (Live)
Varicella (Live)
Influenza - administere at the start of the season, in pregnant patients or those who try to conceive, use inactivated if pregnant
Which of the recommended vaccines are live vaccines?
MMR
Varicella
-> dont administer during pregnancy, wait until after pregnancy, due to an immunocompromised state (immune system is downregulated to prevent from targetin the fetus)
Which vaccine should be administered during pregnancy?
Tdap (Tetanus, Dipheteria, Pertussis)
-> for every single pregnancy
-> Pertussis especially bears a high risk for newborns
during 27-36 weeks
(normal window is 10 years)
When is the typical onset of gestational diabetes (GDM)?
midst pregnancy - 24-28 weeks
What is the first-line treatment for gestational diabetes?
patients get tested midst pregnancy
-> if positive: non-pharmacoligocal treatment
-nutrition and exercise for 1-2 weeks
Which meds are preferred in gestational diabetes?
-insulin is preferred (best studied for safety in pregnancy)
-metformin and glyburide are acceptable oral alternatives
What is the time of onset for HTN during pregnancy?
20 weeks or later
How is HTN of pregnancy diagnosed?
Patient with no preexisting HTN and with 2 readings of >140/90
When is medical treatment for HTN of pregnancy initiated?
After 2 readings of >160/110
severe HTN
Background: we wait until severe HTN to balance risk and benefits: side effects of antihypertensive meds such as hypotension
Which antihypertensive drugs are preferred for HTN of pregnancy?
-labetalol, nifedipine ER (BID)
2nd line: HCTZ, methyldopa
AVOID: RAAS inhibitors: ACEi, ARBs, renin inhibitors
How much should the dose of levothyroxine be increased in pregnant patients with hypothyroidism?
increase the dose by at least 25%
Which antidepressants are preferred in pregnant patients?
SSRIs (fluoxetine, sertraline)
-> paroxetine somewhat associated with cardiac malformation
if a pateint’s depression is controlled -> keep the antidepressant during pregnancy
pregnancy is an intense hormonal experience time, discontinuation can trigger depression and suicidal ideation
What is Eclampsia?
emergency situation
Preeclampsia (HTN and Proteinuria(loss of protein in the urine))
+
Seizures
= Eclempsia
What else should be monitered if a patient presents with HTN during pregnancy?
check for proteinuria
-> Interfere (treat HTN) to prevent seizures if high levels of protein in the urine (Eclempsia)
When is the predicted onset of Eclempsia during pregnancy?
-typically after 20 weeks (like HTN)
-postpartum: up to 6 weeks after delivery
