Chapter 48: Drugs in Pregnancy & Lactation Flashcards
Which lab tests confirms pregnancy
positive human chorionic gonadotropin (hCG)
Which trimester is the embryo most susceptible to birth defects caused by teratogens
First trimester
Which organization publishes guidelines for safe and effective drug use in conditions impacting women, including pregnancy
American College of Obstetricians and Gynecologists (ACOG)
Folate deficiency causes
neural tube defects
All women of childbearing age should obtain __ mcg/day of folic acid (folate, vitamin B9) from a combination of dietary supplements, fortified foods, and regular diet
400 mcg/day
increased to 600 DFE/day once pregnant
Pregnant women require ___ mg/day of calcium and ___ IU/day of vitamin D
1000 Ca
600 Vit D
In the previous pregnancy categories & interpretation, a category A drug describes:
No risk in first trimester
In the previous pregnancy categories & interpretation, a category B drug describes:
Animal studies have not demonstrated a fetal risk, but no well-controlled studies in pregnant women
In the previous pregnancy categories & interpretation, a category C drug describes:
Animal studies have shown harm to the fetus, but there are no well-controlled studies in pregnant women. Use only if potential benefit outweighs the risk
In the previous pregnancy categories & interpretation, a category D drug describes:
positive evidence of risk to human fetus; benefits may outweigh risk
In the updated pregnancy category sections in package inserts, section 8.1 on Pregnancy includes
risk of adverse developmental outcomes
Pregnant women are encouraged to participte in registries for select disease states and drugs
In the updated pregnancy category sections in package inserts, section 8.2 on Lactation includes
Whether the drug/metabolites are present in human milk
In the updated pregnancy category sections in package inserts, section 8.3 on Females and Males of Reproductive Potential includes
Any effects on fertility and requirements for pregnancy testing and contraception
Which two immunizations are routinely recommended for pregnant patients
Influenza (inactivated)
Single dose of Tdap at each pregnancy
all live vaccines are contraindicated during pregnancy
Which key acne drugs are teratogens
Isotretinoin and topical retinoids (like tazarotine)
Which key antibiotic drugs are teratogens
Quinolones and tetracyclines
Which key anticoagulants are teratogens
Warfarin
Which key meds for dislipidemia, HF and HTN are teratogens
Statins, ACE, ARBs, aliskiren, sacubitril/valsartan (Entresto)
Which key hormone drugs are teratogens
Most, including estradiol, progesterone, raloxifene, Duavee, testosterone, contraceptives
Which key migraine drugs are teratogens
Dihydroergotamine, ergotamine
What are other key drugs that are teratogens
Hydroxyurea Lithium MTX Misoprostol NSAIDs Paroxetine Ribavirin Thalidomide Topiramate Weight loss drugs Valproic acid/divalproex
Teratogens are hazardous drugs according to which USP chapter
800
To prevent preeclampsia, ACOG and ADA guidelines recommend adding ___ at the end of the first trimester for pregnant women at risk (e.g., type 1 and type 2 diabetes)
Daily low-dose ASA
1st trimester ends at 12 weeks
Preferred management for morning sickness/nausea/vomiting in pregnant patients
- Lifestyle first
- Pyridoxine (B6) + / - doxylamine
- Ginger is possibly effective
