1M - Drugs and Immunization in Pregnancy Flashcards by Medicine Files

Mild sedative used for treatment of nausea in pregnancy that caused phocomelia?

Thalidomide

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What is the current use of thalidomide today?

For leprosy and multiple myeloma

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Within 20 days after fertilization, what is the possible effect of the drugs to the fetus?

All or nothing

Fetus is highly resistant to birth defects

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What weeks of gestation does organogenesis take place?

3-8 weeks

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What trimester is it safe to give drugs?

2nd and 3rd

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What category involves animal studies with no evidence of harm to fetus but no human studies with harm to human fetus or animal studies with harm to fetus but human studies which show no harm to fetus?

Cat B

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What category involves well controlled human studies without any harm or risk to fetus?

Cat A

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What category involves animal studies which show adverse effects but no studies involving pregnant women or no animal studies as well as studies among pregnant women?

Cat C

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What category involves studies in pregnant women eliciting risk to fetus but the benefit outweighs the risk?

Cat D

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Category involving studies showing positive evidence of fetal abnormalities among animals or pregnant women which suggest contraindication of the drug?

Cat X

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Effect of benzodiazepines on the fetus?

Bradypnea or withdrawal symptoms

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Possible effects of aminoglycosides to the fetus?

ototoxicity, nephrotoxicity

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Possible effects of chloramphenicol to the fetus?

Grey baby syndrome

Due to inability to conjugate drugs

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Possible effects of nitrofurantoin to the fetus?

Contraindicated in pregnant women near term, and labor due to possibility of hemolytic anemia

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Possible effects of co trimoxazole to the fetus?

Trimethoprim - What inhibition of folic acid metabolism; sulphonamides cause jaundice and hemolytic anemia

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What can be the effect of warfarin to the fetus?

Fetal abnormalities and fetal hemorrhage

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Fluconazole is the only antifungal given orally and it is given during pregnancy? T or F?

False

It is the only oral anti fungal but it is contraindicated during pregnancy

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What are the possible effects of spirinolactone to the fetus?

Development of female char to male fetus

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Possible effects of ACE inhibitors to fetus?

Kidney damage if taken in the last trimester together with oligohydramnios, facial, limb and lung defects

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What antihypertensive drugs are given during pregnancy?

Methyldopa and Nifedipine

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Possible effects of beta blockers to fetus?

Bradycardia and fetal growth restriction

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Possible effects of CCB to fetus?

If taken during the first trimester, birth defects in fingers and toes

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Possible effects of haloperidol to the fetus?

In first trimester, limb defects

in third trimester, extrapyramidal symptoms with possible withdrawal

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Possible effects of phenytoin to the fetus?

Cleft palate and heart defects

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Possible effects of valproic acid to fetus?

heart, face, skull and limb defects and neural tube defects

What are possible effects of methotrexate during pregnancy?

If taken early, abortion Structural abnormalities methotrexate aminopterin syndrome - craniosyntosis with clover leaf skull

Possible effects of danazol to fetus?

Opposite of spirinolocatone - masculinization of the female fetus

Possible effects of isotretinoin to fetus?

1st trimester, pregnancy loss and malformations

Possible effects of radioactive iodine to fetus?

Fetal hypothyroidism, mental retardation and increased risk of malignancy during infancy

Antimicrobials are generally what category?

category B

Aminoglycosides are what catefory?

cat D

Fluconazole is what category?

Cat D

Tetracylcines are category D drugs due to their effect when given for atleast 1g/day for 3 days. What is the effect?

Yellow staining of teeth Risk at 2nd and 3rd trimester

Nitrofuratoin is used if no alternative is available due to the possibility of hemolytic anemia. It is however, contraindicated to those with what condition?

G6PD deficiency

What GI drugs used for nausea and vomiting are generally not recommended in the last 2 weeks of pregnancy due to retrolental dysplasia?

Diphenhydramine and Meclizine

Which drug for nausea and vomiting may cause extrapyramidal symptoms?

Metoclopramide

Nausea and vomiting drugs are generally what category?

B Pyridoxine - A or C

What drug for nausea and vomiting is used for those after surgeries and post chemo?

Ondasetron

Which drug for heartburn and and GERD may cause delay in closure of of esophageal sphincter causing a more severe heartburn?

H2 receptor blockers

Which drug for heartburn and GERD is avoided during the first trimester due to animal studies resulting in risk to fetus?

PPI

PPI are what category?

Cat C

Senna, a drug used for constipation is what category?

Cat C

First choice nonsalicylate antipyretic and pain reliever for pregnant women?

paracetamol - Cat B

NSAIDs are what category for those with less than 30 weeks of gestation?

Cat C Cat D - for 30 weeks onward

Possible effects of NSAIDS to fetus?

orofacial clefts and cardiac abnormalities | at 3rd trimester, Premature closure of ductus artriosus

Category of opioids during pregnancy and possible effects?

Cat C; physical dependence and withdrawal

Which drug used for preeclampsia was changed from A to D due to fetal and neonatal bone demineralization if used for more than 5-7 days?

Magnesium sulfate Effects in pregnancy: Tx of seizures fetal neuroprotection if less than 32 weeks short term prolongation of pregnancy

Recommended drug for preeclamptic patients and also used as tocolytic?

Nifedipine

What is the 1st line treatment for hypertension of pregnant women?

Methyldopa - cat B

Possible effects of hydralazine to the fetus?

Thrombocytopenia and lupus Used for emergency hypertensive patients

Most serious maternal complication with the use of terbutaline?

pulmonary edema

Type of vaccines not given during pregnancy and to those immunocompromised?

Live attenuated vaccine ``` MY BICEPT MMR yellow fever BCG Influenza (intanasal) Chickenpox Endemic Typhus Polio Oral (sabin) Typhoid ```

Type of vaccine which is not alive and cannot replicate?

Inactivated vaccine

Three inactivated whole vaccines

Hep A Polio IV Rabies

Fractional Vaccines?

HHIAT ``` Hep B HPV Influenza (yearly) Acellular pertussis Toxoids ```

Vaccines composed of long chains of sugar molecules from the surface capsule of bacteria?

Polysaccharide vaccines

This process increases the immunogenicity in infants and antibody booster response to multiple vaccines?

Conjugation

Pure Polysaccharide vaccines?

Pneumococcal Meningococcal Salmonella typhi

Conjugated polysaccharide vaccines

Hib - commonly given to babies PMHT

What is the route of administration among live attenuated vaccines?

Subcutaneous Others are IM

3 dose regimen for Hep B vaccine?

0, 1, 6 months 4 accelerated dose is 0, 7, 21, days, 12 months

Vaccine given yearly to prevent serious illness, pneumonia and otitis media?

Influenza

If woman is pregnant an has not yet taken pertussis vaccine or has been 10 years since last dose, when can we administer the vaccine?

1 does Tdap at 27-36 weeks of GA

Which of the following is more commonly given to adults and which is preferred for those > 65 yrs old? Td and Tdap

Td for adults - 0, 1, 6-12 mos Tdap for >65 yrs old - 1 time dose give immediately post partum and to all close contacts of infants aged <12 months

Which of the following pneumococcal vaccine should be given first as single dose? PCV13 or PPSV23

PCV 13 PPSV after 1 year

For high risk patients, what is the regimen for pneumococcal vaccine?

PCV13 then PPSV23 after 8 weeks

Revaccination for PPSV23 happens every?

5 years no revaccination if over 65 years old

Vaccination regimen for HPV vaccine for females

HPV 2, 4, 9 | For women aged 9-45 years old

Vaccination regimen for HPV for men

HPV 4 and 9 | for men 9-26 years old

For patients less than 15 years old, which HPV vaccines are given and their regimen

HPV 2, 4, 9 | 0, 5-13 months

For patients older than 15 years old, which HPV is given and their regimen

HPV 4 and 9 0, 2, 6 mos HPV 2 0, 1, 6 mos

If patient is pregnant, when will the next dose of HPV vaccine given?

After pregnancy

For MMR vaccine, how many month should pregnancy be delayed if vaccine is given?

3 mos Dose - 0, 1 mos

If patient is pregnant and wants to be vaccinated for MMR, when can she be vaccinated?

Immediately post partum because MMR or live attenuated vaccines are contraindicated during pregnancy

Indicated patients for Zoster vaccine?

more than 60 yes old with history of shingles

Rabies post exposure regime for unvaccinated and previously vaccinated patients

Unvaccinated Ig + vaccine (0, 3, 7, 21 days) ``` Vaccinated Vaccine only (0 and 3 days olny) ```