Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Endocrine Module > Teratogenesis, Pregnancy, and Postpartum Issues > Flashcards

Teratogenesis, Pregnancy, and Postpartum Issues Flashcards

(150 cards)

Start Studying
1
Q

What factors influence teratogenic potential?

A
  1. Duration of Use
  2. Susceptibility of Fetus
  3. Placental Transfer
  4. Timing of Exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mechanism of Placental Transfer?

A

Passive Diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What factors influence rate and extent of passive diffusion?

A
  1. MW
  2. Protein Binding
  3. Lipid Solubility
  4. Ionization
  5. Concentration Gradient
  6. Uterine Blood Flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In terms of MW, what are the sizes that cross and do not cross the placenta?

A

<500 daltons, readily cross
>1000 daltons, do not cross in significant amounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do highly protein bound drugs cross the placenta?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ionized or Unionized drugs cross the placenta?

A

Unionized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The Pre-Embyronic Stage is 0-14 days after fertilization, what is the teratogen effect?

A

Teratogen exposure produces ALL or NOTHING effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The Embryonic Stage is 14-56 days, what is the teratogen effect?

A

MOST Susceptible = MAJOR structural anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The Fetal Stage is 57 days - term, what is the teratogen effect?

A

Anomalies more likely to involve growth and functional aspects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the limitations of the OLD FDA Categories?

A

Derived from animal data
No distinction between drugs in the same class
Majority in Category C
Lacks informative data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the REVISED FDA labeling include?

A
  1. Removed letter category
  2. Pregnancy Subsection
  3. Lactation Subsection
  4. Females and Males of Reproductive Subsection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are agents to avoid DURING pregnancy?

A
  1. ACE/ARBs/Renin Inhibitors
  2. DOACs
  3. Isotretinoin
  4. NSAIDs
  5. Retinoids
  6. Thalidomide
  7. Trimethoprim
  8. Valproic Acid
  9. Warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the concern with Thalidomide and does it have a REMs?

A

Contraindicated in Pregnancy
YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the requirements for the REMS of Thalidomide?

A
  1. Prescription filled <7 days and no more than a 4-week supply at one time
  2. Patients required to use contraceptive measures
  3. Females must have neg pregnancy test within 24 hrs prior to starting treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the concern with Lenalidomide and does it have a REMs?

A

Contraindicated in pregnancy
YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the concern with Retinoids?

A

Contraindicated in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is the greatest risk for Retinoids?

A

At 4-7 weeks gestation and risk persists after stopping therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the contraception requirement for Isotretinoin?

A

Contraception 1 month following DC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the contraception requirement for Acitretin (Soriatane)?

A

Contraception for 3 years following DC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the iPLEDGE Program?

A

REMs for Isotretinoin, requires all patients, prescribers, pharmacists, and wholesale distributors to register

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

For iPLEDGE patients must complete an informed consent with pick prescription within?

A

30 days for men and women who cannot get pregnant
7 days for women of childbearing potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

For females of childbearing potential, iPLEDGE requires what?

A

2 negative pregnancy tests before starting, negative pregnancy test every month, and use of 2 forms of contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Can you donate blood while taking Isotretinoin?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does the dating of pregnancy (gestation) work?

A

Gestation age refers to age of fetus beginning the first days of the last menstrual period which is ~2 weeks prior to fertilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Prematurity is defined as?
<37 weeks gestation
26
Late Pretrerm is defined as?
34-36 weeks gestation
27
Gravidity (G) means what?
Number of pregnancies
28
Parity (P) means what?
Number of pregnancies that exceed 20 weeks of gestation and outcome of each pregnancy
29
What are the PK changes in pregnancy?
1. Delayed gastric emptying, INCREASED gastric pH 2. Decreased motility 3. Increased total body water 4. Increased body fat 5. Increased cardiac output 6. Increased GFR 7. Decreased plasma albumin
30
Increase in gastric pH causes what?
Increase availability of acid-labile drugs or decrease availability for drugs that require acidic environment
31
Decrease gastric emptying causes what?
Delay time to peak concentration after admin
32
Decrease in GI motility causes what?
Increased absorption of enteral meds
33
Increase in total body water causes what?
Increase volume of distribution for hydrophilic meds = increase dose
34
Increase body fat causes what?
Increase volume of distribution for lipophilic meds
35
Increase cardiac output causes what?
Increase hepatic blood flow = increase hepatic metabolism
36
Increase GFR causes what?
Increase clearance of renal eliminated drugs
37
Decrease plasma albumin causes what?
Increase free drug for drugs that are highly protein bound
38
What Vitamins and Supplements should be taken?
1. Pre-Natal Multi-Vitamin 2. Iron 3. Folate 4. Calcium/Vitamin D
39
What is the minimum amount of iron that should be taken?
30 mg
40
What amount of iron is recommended during pregnancy?
30 mg/day 60-120 if iron deficiency anemia is present
41
What amount of iron is recommended in prenatal vitamin?
30-90 mg of elemental iron
42
What is the recommended amount of folate for all women of child-bearing age?
0.4 mg/day
43
What is the recommend amount of folate for women during pregnancy?
0.8 mg/day
44
What is the recommend amount of folate in prenatal vitamins?
0.8-1 mg of folic acid
45
What is the recommend amount of calcium and vitamin D for pregnancy?
1000 mg of calcium and 600 IU of vitamin D
46
When is dietary modifications recommended to treat diabetes in pregnant women?
Type 2 DM
47
What is the first line choice treatment of type 1 and 2 diabetes in pregnant women?
Insulin, does not cross placenta
48
If insulin is not used in Type 2 DM, what oral agents are recommended?
First Line: Metformin Second Line; Glyburide
49
What is the concern with Glyburide in pregnant women?
May result in more neonatal hypoglycemia
50
What is chronic hypertension defined as in pregnancy?
Diagnosed before pregnancy or before 20 weeks gestation
51
What is the treatment for Mild-Mod Hypertension 140-149/90-108 mmHg?
Watch and Wait Decrease salt, protein, stress
52
What is the treatment for CHRONIC Severe Hypertension >160/100 mmHg?
1st Lne: Labetalol PO or Nifedipine ER PO 2nd/3rd Line: Methyldopa PO or HCTZ PO
53
What is the goal BP for CHRONIC Severe Hypertension?
120-159/80-106 mmHg
54
What is the treatment for ACUTE Severe Hypertension >160/100 mmHg?
Hydralazine IV, Labetalol IV, Nifedipine IM Start within 60 mins, not one is 1st line, if one doesn't work at max dose move on to the next
55
When do you avoid ACE/ARBs in pregnancy?
2nd/3rd, with concern in the first
56
When do you avoid MRAs in pregnancy?
1st
57
What is the FDA box warning for ACE/ARBs?
DC use as soon as possible once pregnancy is detected
58
What is the drug of choice for asthma that is a beta agonist?
Albuterol
59
What is the drug of choice for asthma that is an inhaled corticosteroid?
Budesonide
60
What is the drug of choice for asthma that is a long-acting beta agonist?
Salmeterol/Formoterol
61
What are the anti-epileptic agents?
Valproic Acid, Phenytoin, Phenobarbital, Carbamazepine, and Topiramate
62
What does Valproic Acid cause?
Neural tube defects Facial Cleft
63
What does Phenytoin cause?
Cleft palate Limb defects
64
What does Phenobarbital cause?
Cardiac malformations
65
What does Carbamazepine cause?
Cleft palate
66
What does Topiramate cause?
Cleft palate
67
How do you manage epilepsy when pregnant?
Monotherapy at lowest effective dose, AVOID valproic acid, phenobarbital, and phenytoin if possible
68
What is the recommended folate supplementation for patients with epilepsy?
1 mg/day for w/epilepsy 4 mg/day for patients on carbamazepine or valproic acid
69
When is nonpharmacologic psychotherapy appropriate treatment for depression in pregnant women?
Effective for most with mild to moderate depression
70
What is the drug of choice for depression in pregnancy?
SSRIs are drug of choice Sertaline and Fluoxetine AVOID paroxetine and citalopram
71
What is the alternative drug for depression in pregnancy?
Tricyclic Antidepressants Desipramine and Nortiptyline
72
What are the neonatal effects of SSRIs?
Persistent Pulmonary Hypertension of the newborn Poor neonatal adjustment syndrome
73
What are the pregnancy-induced conditions?
1. N/V 2. Constipation 3. GERD 4. Gestational Diabetes 5. Gestational HTN 6. Preeclampsia 7. Thromboembolism
74
What is the treatment goal for N/V (hyperemesis gravid arum)?
Decrease symptom severity and frequency, prevent and treat complications, and minimize potential fetal effects
75
What is the treatment algorithm for N/V?
1. Dietary Changes 2. Vitamin B6 and Doxylamine 3. Add Dimenhydrinate, Diphenhydramine, Promethazine, or Prochlorperazine 4. Add Metoclopramide or Ondansetron 5. Add Chlorpromazine or Methylprednisolone Add On: Ginger Extract
76
What are the precautions of Promethazine second line drug for N/V?
Dystonia, sedation, extrapyramidal reactions
77
What are the precautions of Prochlorperazine second line drug for N/V?
Dystonia, sedation, extrapyramidal reactions
78
What are the precautions of Metoclopramide second line drug for N/V?
Caution with use at < 10 weeks gestation, prolong QT interval
79
What are the precautions of Ondansetron third line drug for N/V?
Caution with use at < 10 weeks gestation, prolong QT interval
80
What are the precautions for Pyridoxine/Doxylamine (Diclegis) combination for N/V?
Delayed release tablet, sedation
81
What are the precautions for Pyridoxine/Doxylamine (Bonjesta) combination for N/V?
Extended release tablet, sedation
82
What is the first line option for N/V?
Pyridoxine
83
What are the OTC meds for N/V?
Diphenhydramine, Doxylamine, Meclizine, Pyridoxine, and Ginger
84
What is first line therapy for constipation in pregnancy?
Nonpharmacologic, dietary changes
85
What are the first line agents for constipation in pregnancy?
Antacids, H2 Antagonists, and PPI
86
What are the Antacids, and which one is most recommended?
Calcium Carbonate (most) Aluminum Hydroxide (least) Magnesium Hydroxide
87
What are the H2 Antagonists, and which one is most recommended?
Ranitidine (no) Famotidine (most) Cimetidine (avoid)
88
What are the PPIs and which one is most recommended?
Lansoprazole Omeprazole (most) Pantoprazole
89
What drugs should be avoided in constipation with pregnancy?
Antidiarrheal/Antisecretory Bismuth Subsalicylate and Antacid Sodium Bicarb
90
Why do you avoid Bismuth Subsalicylate?
Closure of ductus arterious
91
Why do you avoid Sodium Bicarbonate?
Maternal/Fetal metabolic alkalosis
92
What are the risk factors for Gestational Diabetes?
1. Age >25 2. Overweight 3. Ethnic group with high incidence DM 4. FH of DM 5. History of abnormal glucose test
93
When should screening with oral glucose tolerance test OGTT occur?
24-48 weeks gestation
94
What is the drug of choice for gestational diabetes?
Insulin
95
What is the alternative oral agent for gestational diabetes?
Metformin
96
What is the classification for Gestational Hypertension?
Increase BP SBP>140 mmHg or DBP> 90 mmHg, after 20 weeks gestation
97
What is Preeclampsia?
Increase BP with proteinuria, Increase BP with thrombocytopenia, renal/hepatic insufficiency, pulmonary edema, or new onset headache
98
What is Eclampsia?
Tonic clonic seizures with preeclampsia
99
Is Eclampsia a medical emergency?
YES, requires intubation to protect airway, seizures can occur antepartum, intrapartum, or postpartum
100
What are the HELLP Complications for Preeclampsia?
H: Hemolysis E: Elevated L: Liver Function tests L: Low P: Platelets
101
What are the risk factors for Preeclampsia?
1. Chronic HTN 2. Chronic Renal Disease 3. Maternal Age >40 4. Multiple Gestation 5. Preeclampsia in a previous pregnancy 6. Gestational diabetes or diabetes 7. Obesity
102
Management of Severe Preeclampsia applies to what patients?
1. BP <160 SBP or >110 DBP on two occasions 4 hours apart 2. Thrombocytopenia 3. Impaired hepatic function 4. Renal insufficiency 5. Pulmonary edema 6. New onset HA/or visual disturbances
103
What should be used to manage BP in Severe Preeclampsia?
IV Labetalol or Hydralazine
104
What should be used to manage Seizure Prevention in Severe Preeclampsia?
Magnesium Sulfate
105
What is the goal range for magnesium concentration for prevention of eclampsia?
4-7 mEq/L
106
What can be used for prevention of preeclampsia?
Low dose ASA may be used after 12 weeks of pregnancy for women at high risk for preeclampsia
107
How does the ASA dose change for patients with Type 1 or 2 DM?
100-150 mg/day
108
What is the preferred treatment for Thromboembolism in Pregnancy?
LMWH
109
What is the alternative first line treatment for Thromboembolism in Pregnancy?
UFH
110
When can Warfarin be used in pregnancy?
TERATOGEN, avoid unless used in women with mechanical heart valves (teratogenic risk decrease with doses <5mg)
111
Drug of Choice for Pain in Pregnancy?
Acetaminophen
112
Alternative Choice for Pain in Pregnancy?
NSAIDs, avoid in 1st/2nd trimester
113
Drug of Choice for Allergies in Pregnancy?
Chlorpheniramine or Intranasal Corticosteroids
114
Alternative Choice for Allergies in Pregnancy?
Diphenhydramine, Loratadine, and Cetirizine
115
Drug of Choice for Cough/Congestion in Pregnancy?
Oxymetazoline (nasal) Pseudoephedrine (oral) Dextromethorphan
116
Alternative Choice for Cough/Congestion in Pregnancy?
Guaifenesin, avoid due to congenital effects
117
Drug of Choice for UTI in Pregnancy?
Amoxicillin-Clavulanta or Nitrofurantoin
118
Alternative Choice for UTI in Pregnancy?
Cephalexin Bactrim (avoid in 2nd/3rd trimester)
119
Drug of Choice for Diarrhea in Pregnancy?
Stool bulking
120
Alternative Choice for Diarrhea in Pregnancy?
Loperamide, use sparingly
121
What is defined as preterm labor?
Cervical dilation and/or uterine contractions at <37 weeks gestation
122
What are Tocolytic Agents used for?
Postpone delivery long enough (up to 38 hours) to allow for: administration of antenatal corticosteroids or transport of mother
123
What is the tocolytic beta agonist?
Terbutaline, not ideal due to hypotension, arrhythmias, and hyperkalemia
124
What is the tocolytic CCB?
Nifedipine, predominant agent May cause hypotension
125
What is the tocolytic NSAID?
Indomethacin, predominant agent May cause premature closure of ductus arterioles
126
What is the tocolytic magnesium?
Magnesium Sulfate, limited efficacy
127
What are the antenatal steroids that are utilized to accelerate fetal lung maturation?
Betamethasone or Dexamethasone
128
When is Betamethasone 12 mg IM or Dexamethasone 6 mg IM recommended?
Risk for delivery >24 to <34 weeks Risk for delivery at >34 to <37 weeks with no previous course
129
What are the Cervical Ripening Agents?
Misoprostol (intravaginal/oral) Dinoprostone (intravaginal/intracervical)
130
Dinoprostone Gel (prepidil) is what route?
Intracervical
131
Dinoprostone Vaginal (Cervidil) is what route?
Intravaginal
132
What drug stimulates/induces labor?
Oxytocin
133
How does drug excrete into breast milk?
Passive Diffusion
134
Maternal Serum Concentration in relation to breast milk
High maternal concentration = greater passive diffusion into milk
135
Lipid Solubility in relation to breast milk
Higher lipid solubility = greater transfer into milk
136
Protein Binding in relation to breast milk
Higher protein bound = less transfer into breast milk
137
Ionization in relation to breast milk
Unionized = greater transfer into milk
138
Molecular Weight in relation to breast milk
Low MW = greater transfer into milk
139
Acid/Base in relation to breast milk
Weak bases can be ionized when in breast milk
140
What drugs are contraindicated or use with caution in lactation?
1. Bromocriptine 2. Chemotherapy 3. Codeine 4. Cyclophosphamide 5. Cyclosporine 6. Iodine 7. Lithium Carbonate 8. Methotrexate 9. Radiopharmaceutical 10. Tetracyclines
141
What are acceptable meds for pain with lactation?
Acetaminophen or Ibuprofen NOT ASA
142
What are acceptable meds for allergies with lactation?
Loratadine or Diphenhydramine Can dry up milk supply
143
What are acceptable meds for cough/congestion with lactation?
Nasal Decongestants or Dextromethorphan NOT Psuedoephedrine
144
What are acceptable meds for heartburn/reflux with lactation?
Antacids/Famotidine/Pantoprazole NOT bismuth subsalicylate or cimetidine
145
What are acceptable meds for constipation with lactation?
Bulking Agents, Docusate, Bisacodyl, PEG NOT Senna
146
What are acceptable meds for diarrhea with lactation?
Bulking Agents or Loperamide NOT bismuth subsalicylate
147
What medications can cause low milk production?
1. Bromocriptine 2. Estrogen Containing contraceptive 3. Oral Decongestants 4. Antihistamines 5. Nicotine 6. Diuretics
148
What is a pharmacologic therapy for low milk production?
Metoclopramide
149
What is the management for Mastitis?
1. Antibiotics for 10-14 days (cephalexin) 2. Anti-Inflammatory Medications for Pain (ibuprofen) 3. Nonpharmacologic Therapy
150
What is pharmacologic therapy for postpartum depression with lactation?
Sertraline First Line Paroxetine or Nortriptyline Second Line Fluoxetine CAUTION

Endocrine Module (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions