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NAPLEX 2024 > 48. Drug Use in Pregnancy + Lactation > Flashcards

48. Drug Use in Pregnancy + Lactation Flashcards

1
Q

Positive ____ lab result confirms pregnancy

A

human chorionic gonadotropin (hCG+)

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2
Q

____ trimester is when most organ development occurs making the embryo the most susceptible to birth defects caused by teratogens at this time

A

First (0-12 weeks)

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3
Q

____ is an organization that publishes guidelines for safe and effective drug use in conditions impacting women, including pregnancy

A

American college of obstetricians and gynecologists (ACOG)

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4
Q

A patient’s obstetric hx can be described using gravida para. Gravida (G) is ____ and Para (P) is ____

A

G = # of times pt has been pregnant
P = # of times pt has given birth

Example: G2, P1 = pregnant twice, gave birth once

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5
Q

___ is safe and sometimes effective strategy for prenatal smoking cessation

A

Behavioral intervention

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6
Q

What birth defects can folate deficiency cause?

A

Neural tube defects (defects of brain and spinal cord)

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7
Q

Adults should consume ___ of dietary folate equivalents (DFE) per day

A

400 mcg

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8
Q

During pregnancy, folate requirements increase to ____ DFE/day

A

600 mcg

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9
Q

What foods is folate (folic acid, vit B9) found in?

A

Fortified flour and cereals, dried beans, green leafy vegetables, and orange juice

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10
Q

Pregnant women from 19-50yo require ___ /day of calcium and 15mcg/day (___IU/day) of vitamin D

A

1000mg/day of calcium
15mcg/day (600IU/day) of vit D

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11
Q

Previous Pregnancy Categories Interpretation: A

A

No risk - Studies in animals and women showed no risk in first trimesters

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12
Q

Previous Pregnancy Categories Interpretation: B

A

Animal studies have not demonstrated fetal risk but no well-controlled studies available in pregnant women

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13
Q

Previous Pregnancy Categories Interpretation: C

A

Animal studies have shown harm to the fetus but no well-controlled studies in pregnant women
Use only if potential benefit outweighs risk

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14
Q

Previous Pregnancy Categories Interpretation: D

A

Positive evidence of risk to human fetus is available but benefits may outweigh risk with life-threatening or serious diseases

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15
Q

Previous Pregnancy Categories Interpretation: X

A

Use in pregnancy is contraindicated

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16
Q

What are the 2 immunizations routinely recommended for pregnant patients?

A

1) inactivated influenza vaccine (not life) - during any trimester at the beginning of flu season
2) single dose of Tdap during each pregnancy

Note: all live vaccines are contraindicated in pregnant pts

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17
Q

Common Teratogens: Acne

A

Isotretinoin, topical retinoids

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18
Q

Common Teratogens: Antibiotics

A

FQ, tetracyclines

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19
Q

Common Teratogens: Anticoagulants

A

warfarin

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20
Q

Common Teratogens: HLD, HF, HTN

A

Statins
RAAS inhibitors (ACEi/ARBs, aliskiren, sacubitril/valsartan)

21
Q

Common Teratogens: Hormones

A

Most, including estradiol, progesterone (including megestrol), raloxifene, Duavee, testosterone, contraceptives

22
Q

Common Teratogens: Migraine

A

Dihydroergotamine, ergotamine

23
Q

Common Teratogens: Misc

A

Hydroxyurea, ribavirin, lithium, thalidomide, methotrexate, topiramate, misoprostol, weight loss drugs, NSAIDs, paroxetine, valproic acid/divalproex

24
Q

____ is a complication of pregnancy that presents with elevated BP and evidence of organ damage (most often kidney/liver)

A

Preeclampsia

25
Q

What is the only cure of preeclampsia?

A

Delivery of the baby

26
Q

What does ACOG and ADA guidelines recommend to prevent preeclampsia?

A

Low-dose aspirin daily at the end of first trimester for pregnant women at risk for preeclampsia (e.g. type 1 or 2 DM, renal disease, hx of preeclampsia, chronic HTN)

27
Q

Managing morning sickness, N/V in pregnant pts

A

Lifestyle first - eat smaller, more frequent meals, drink water, avoid spicy/odorous foods, take more frequent naps, reduce stress
Ginger may help

If lifestyle measures fail, ACOD recommends pyridoxine (vit B6) ± doxylamine first line
Rx: doxtylamine/pyridoxine (Bonjesta, Diclegis)

28
Q

Managing GERD/Heartburn in pregnant pts

A

Lifestyle first- eat smaller, more frequent meals, avoid foods that worsen GERD
If symptoms occur while sleeping, elevate head of the bed and not eating 3 hrs prior to sleep

If lifestyle measures fail - antacids (calcium carbonate Tums)

29
Q

Managing flatulence in pregnant pts

A

Simethicone (Gas-X, mylicon)

30
Q

Managing constipation in pregnant pts

A

Lifestyle first - increase fluid intake, dietary fiber intake, and physical activity
If lifestyle measures fail - fiber (psyllium, calcium polycarbophil, methylcellulose) with lots of water
Docusate and PEG used to prevent/treat constipation

31
Q

Managing cough, cold, allergies in pregnant pts

A

First line: cromolyn
Second line: first-gen antihistamines, chlorpheniramine (drug of choice) and diphenhydramine are commonly used

Avoid oral decongestants during 1st trimester
Avoid liquid formulations that contain alcohol

32
Q

If nasal steroids are needed for chronic allergy in pregnant patients, what do you recommend?

A

All intranasal steroids are considered safe
Budesonide (Rhinocort Allergy) and beclomethsaone (Beconase AQ) are preferred

33
Q

Managing pain in pregnant pts

A

First line APAP
Avoid NSAIDs including aspirin (except low-dose for preeclampsia)

Non-drug options: hot/cold packs, light massage, PT

34
Q

Managing asthma in pregnant pts

A

Maintenance therapy: budesonide is preferred - also preferred steroid for infants; Respules are used in a nebulizer
Rescue therapy: inhaled albuterol

35
Q

Managing HTN in pregnant pts

A

Labetalol, methyldopa, nifedipine

ACEi/ARBS, aliskiren, and Entresto are contraindicated in pregnancy

Low-dose aspirin recommended for preeclampsia prevention in high-risk groups

36
Q

Managing DM in pregnant pts

A

Insulin preferred if not controlled with lifestyle
Metformin and glyburide are commonly used

Low-dose aspirin recommended for preeclampsia prevention in both type 1 and 2 DM

37
Q

Managing infections in pregnant pts

A

Generally considered safe to use: PCN (including amox, amp), cephalosporins, erythromycin, and azithromycin

Do NOT use quinolones (cartilage damage) and tetracyclines (teeth discoloration)

38
Q

Managing vaginal fungal infections in pregnant pts

A

Topical antifungals x7 days

Avoid fluconazole

39
Q

Managing UTI in pregnant pts

A

Cephalexin
Ampicillin
Nitrofurantoin and SMX/TMP (last line during 1st trimester, should NOT be used in last 2 weeks of pregnancy)

Must treat bacteriuria even if asymptomatic

40
Q

If a woman contracts toxoplasmosis during pregnancy, it can cause miscarriage, stillbirth, or damage baby’s brain/eyes.. Women can be tested prior to pregnancy with IgG test. If unsure, avoid dirty food and water, ___, and ____ with can contain the parasite

A

unpasteurized dairy products
cat feces (including contact with cat litter boxes)

41
Q

Managing conditions requiring anticoagulation in pregnant pts

A

VTE treatment: LMWH preferred over UFH
VTE ppx: pneumatic compression devices ± LMWH

Avoid warfarin, DOACs not adequately studied (do not recommend)

42
Q

Managing hypothyroidism in pregnant pts

A

Levothyroxine (will require 30-50% dose increase during pregnancy)

43
Q

Managing hyperthyroidism in pregnant pts

A

Mild cases will not require treatment
If drugs necessary (i.e. Graves’ disease): propylthiouracil (PTU) preferred if trying to conceive or in 1st trimester
Can be switched to methimazole for remainder of pregnancy but both carry potential fetal risks + liver damage

44
Q

Babies receiving breast milk partially or exclusively should receive ____ of vitamin D daily (not necessary for formula fed babies)

A

10mcg (400IU)

45
Q

Breastfed babies require ___ daily of iron during months ____ d/t lack of iron in human milk (unlike formula)

A

1 mg/kg daily during months 4-6

46
Q

Which pain meds should not be used by breastfeeding mothers d/t risk of excessive sleepiness, breathing difficulty, and/or death?

A

Codeine and tramadol

47
Q

Breastfed infants have died, especially in mothers taking codeine who were CYP___ ultra-rapid metabolizers

A

2D6

48
Q

In what pregnant pt population is breastfeeding not recommended?

A

If HIV infection, including those women receiving antiretroviral therapy

49
Q

Meds to avoid when breastfeeding?

A

Amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital, and statins

NAPLEX 2024 (74 decks)

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