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D&T3 Exam 1 > Pregnancy Drugs > Flashcards

Pregnancy Drugs Flashcards

(50 cards)

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1
Q

Teratogens

A

Chemical or physical event which can induce fetal malformations

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2
Q

Teratogens

Examples

A

DES

Thalidomide

Bendectin

Fetal alcohol syndrome

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3
Q

Teratogens

Diethylstilbestrol

A

No steroidal estrogen (initially for prevention of premature birth)

Clear cell adenocarcinoma of vagina of offspring

Transplacental

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4
Q

Only known transplacental carcinogen

A

Diethylstilbestrol

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5
Q

Teratogens

Bendecin

A

For n/v during pregnancy

No evidence to support teratogenic

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6
Q

Teratogens

Thalidomide

A

Sedative/hypnotic for n/v

Amelia, phocomelia and altered facial and ear development (limb abnormalities)

Now chemotherapy

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7
Q

Teratogen

During fetogenesis

A

Typically gonadal or nervous system abnormalities

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8
Q

MC etiology of developmental defects

A

Unknown

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9
Q

Inc in pregnancy

Distribution

A

Inc plasma volume and total body water

Dec albumin (inc fraction of drugs)

Inc biotransformation and GFR

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10
Q

Chemicals pass through placenta by

A

Passive diffusion

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11
Q

Nutrients pass placenta via

A

Active transport

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12
Q

pregnancy category X

A

Thalidomide

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13
Q

Most drugs used in practice category

A

B and C

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14
Q

Drugs to avoid in early pregnancy

A

Antineoplastic (methotrexate): congenital defects
Tetracyclines: teeth and bone growth
Warfarin: congenital defects
Systemic retinoids: craniofacial, CV (for acne)

Theoretical
Antibiotics, sulfonylureas
General anesthesia

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15
Q

Drugs to avoid late in pregnancy

A

Benzodiazepines: floppy infants
Oral anticoagulants
Thiazide diuretic: thrombocytopenia (inc bleed risk)
Aspirin: kernicterus, hemorrhage

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16
Q

Special considerations

Drugs in pregnancy

A

Antibiotics: risk-benefit

Tetracyclines: teeth discoloration, hepatic toxicity
Streptomycin: ototoxicity in fetus

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17
Q

Common infxns during pregnancy

A

UTI-nitrofurantoin, penicillins, Bactrim

Common cold

Bacterial vaginosis: metronidazole

Vaginal candidiasis-topical azoles

Sinusitis: Bactrim, penicillins, azithromycin

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18
Q

Common medical problems during pregnancy

A

Anemia: physiologic and iron deficiency::folic acid deficiency

Iron or folic acid: leads to n/constipation: use min amount

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19
Q

Drugs in pregnancy

Hyperthyroidism

A

Avoid radioactive iodine

Carbimazole, methimazole, propythiouricil: must treat because hyperthyroidism deadly to fetus

Surgery best

Avoid breast feeding

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20
Q

Drugs in pregnancy

DM

Preexisting

A

Insulin req inc. switch from oral hypoglycemic to insulin

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21
Q

Drugs in pregnancy

DM

Gestational diabetes

Study These Flashcards
A

Utilize human insulin

Don’t use hypoglycemic may cause teratogenesis an ad fetal hypoglycemia but metformin and glyburide are used

22
Q

Drugs in pregnancy

Pre-eclampsia hypertension

Study These Flashcards
A

Develops after 20 wks. HELLP syndrome ass

Only tx is delivery

23
Q

Medical care. During pregnancy

Pre-eclamptic hypertension

Drug tx

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A

May use hydralazine for rapid results or methyldopa or labetalol

Avoid nitroprusside, ace inhibitors, arb’s and diuretics

24
Q

Chronic hypertension and pregnancy

Study These Flashcards
A

Methyldopa DOC

Alt: hydralazine, b-blockers, ca channel blockers

Avoid ace inhibitors/arbs, lonidine, reserpine, clonidine, diuretics

Tx: preeclampsia: delivery

25
Anticoagulation and pregnancy Indications
DVT, prosthetic cardiac valve, recurrent fetal loss
26
Anticoagulation and pregnancy Use
Heparin (low molecular weight doesn't have to be IV)-doesnt cross placenta Stop 2-3 wks before delivery. Avoid warfarin
27
Epilepsy Antiepileptics
All teratogenic Narrow therapeutic index (since albumin dec w pregnancy) Monotherapy with low dose
28
Epilepsy Phenytoin
10% fetal hydantoin syndrome: cardiac malformations, gu defects, craniofacial
29
Epilepsy Carbamazepine
Neural tube defects
30
Epilepsy Valproic acid
Neural tube defects
31
Epilepsy Supplementation
With folic acid. Bump to 4 mg/day
32
Asthma
MC respiratory condition of pregnancy
33
Asthma Ass
With preterm labor and low birth weight
34
Asthma Tx
Avoid triggers Short acting b-sympathomimetics for acute exacerbation (albuterol or terbutaline)
35
Asthma Inhaled glucocorticoids
First line (betamethasone, fluticasone) no evidence of teratogenesis
36
Asthma Systemic glucocorticoids
Prednisone: maybe for severe exacerbation (if chance of death and need ventilator) 5x inc risk of cleft palate Use late in pregnancy, use for organ rejection
37
Asthma Leukotriene inhibitors
Could be safe 3rd line agents
38
N/v Tx
Only if severe
39
Asthma Hyperemesis gravidarium
Severe form Hospitalization
40
Asthma Tx
Non drug first (ginger, small freq meals, pyridoxine) Ondansetron (med)
41
Depression tx
SSRI thought to be safe but may be teratogenic Sertraline is safest
42
Depression Paxil
Cardiac defects (RR 50%)
43
depression
Ass with PPHN (persistent pulmonary hypertension of the newborn), inc 5-6x
44
Fetal alcohol syndrome
Totally preventable Malformations: up to 32%
45
FAS Characteristics
Small birth weight Small head Epicanthic folds Small, widely spaced eyes Flat midface Short upturned nos Smooth wide philtrum Thin upper lip and underdeveloped jaw
46
Tobacco use
Most important modifiable risk
47
Tobacco abuse Ass
Premature labor, low birth weight, inc fetal loss
48
Tobacco abuse Narcotic withdrawal
Babies born to opiate addicted mothers are physically addicted Tx: treat to prevent withdrawal
49
Signs of narcotic withdrawal
Inc irritability, high pitched cry Tremor, frantic first sucking Inc respirations and stools, sneezing Yawning, vomiting and fever No consensus on management
50
Breast feeding
Dose to infant 1-2% of moms

D&T3 Exam 1 (19 decks)

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