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A - NAPLEX > Chapter 48: Drugs in Pregnancy & Lactation > Flashcards

Chapter 48: Drugs in Pregnancy & Lactation Flashcards

1
Q

Which lab tests confirms pregnancy

A

positive hCG

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2
Q

Which trimester is the embryo most susceptible to birth defects caused by teratogens

A

First trimester

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3
Q

Which organization 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

Folate deficiency causes

A

neural tube defects

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5
Q

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

A

400 mcg/day

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6
Q

Pregnant women require ___ mg/day of calcium and ___ IU/day of vitamin D

A

1000 Ca

600 Vit D

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7
Q

In the previous pregnancy categories & interpretation, a category A drug describes:

A

No risk in first trimester

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8
Q

In the previous pregnancy categories & interpretation, a category B drug describes:

A

Animal studies have not demonstrated a fetal risk

but no well-controlled studies in pregnant women

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9
Q

In the previous pregnancy categories & interpretation, a category C drug describes:

A

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

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10
Q

In the previous pregnancy categories & interpretation, a category D drug describes:

A

Use in pregnancy in contraindicated

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11
Q

In the updated pregnancy category sections in package inserts, section 8.1 on Pregnancy includes

A

risk of adverse developmental outcomes

Pregnant women are encouraged to participte in registries for select disease states and drugs

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12
Q

In the updated pregnancy category sections in package inserts, section 8.2 on Lactation includes

A

Whether the drug/metabolites are present in human milk

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13
Q

In the updated pregnancy category sections in package inserts, section 8.3 on Females and Males of Reproductive Potential includes

A

Any effects on fertility

and

requirements for pregnancy testing and contraception

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14
Q

Which two immunizations are routinely recommended for pregnant patients

A

Influenza (inactivated)

Single dose of Tdap at each pregnancy

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15
Q

Which key acne drugs are teratogens

A

Isotretinoin

and

topical retinoids (like tazarotine)

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16
Q

Which key antibiotic drugs are teratogens

A

Quinolones and tetracyclines

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17
Q

Which key anticoagulants are teratogens

A

Warfarin

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18
Q

Which key meds for dislipidemia, HF and HTN are teratogens

A

Statins, ACE, ARBs, aliskiren, sacubitril/valsartan (Entresto)

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19
Q

Which key hormone drugs are teratogens

A

Most, including estradiol, progesterone, raloxifene, Duavee, testosterone, contraceptives

20
Q

Which key migraine drugs are teratogens

A

Dihydroergotamine, ergotamine

21
Q

What are other key drugs that are teratogens

A 
Hydroxyurea
Lithium
MTX
Misoprostol
NSAIDs
Paroxetine
Ribavirin
Thalidomide
Topiramate
Weight loss drugs
Valproic acid/divalproex
22
Q

Teratogens are hazardous drugs according to which USP chapter

23
Q

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)

A

Daily low-dose ASA

24
Q

Preferred management for morning sickness/nausea/vomiting in pregnant patients

A
  • Lifestyle first
  • Pyridoxine (B6) + / - doxylamine
  • Ginger is possibly effective
25
Q

Preferred management for GERD/Heartburn in pregnant patients

A
  • Lifestyle first (smaller, more frequent meals; elevate head of bed and don’t eat 3 hours prior to sleep)
  • Calcium carbonate (Tums)
26
Q

Preferred management for flatulence in pregnant patients

A

Simethicone

27
Q

Preferred management for constipation in pregnant patients

A

lifestyle first

Fiber (psyllium, calcium polycarbophil)

28
Q

Preferred management for allergies in pregnant patients

A

First line: cromolyn
Second line: first-generation antihistamines. DOC = chlorpheniramine
Chronic allergy: nasal steroids (Budesonide and beclomethasone)

29
Q

Preferred management for pain in pregnant patients

A

APAP

avoid NSAIDs including ASA

30
Q

Preferred management for asthma in pregnant patients

A

Maintenance tx: Budesonide (also preferred steroids for infants)
Rescue tx: inhaled albuterol

31
Q

Preferred management for HTN in pregnant patients

A

Labetalol, methyldopa, nifedipine

32
Q

Preferred management for diabetes in pregnant patients

33
Q

Which antibiotics are generally safe to use in pregnancy

A

Remember: PEAC

  • PCNs (including amoxicillin and ampicillin)
  • Erythromycin
  • Azithromycin
  • Cephalosporins
34
Q

Preferred antibiotic for vaginal fungal infection in pregnant pt

A

Topical antifungals

35
Q

Preferred antibiotics for UTI in pregnant pt

A
  • Keflex
  • Ampicillin
  • Nitrofurantoin and Bactrim last line during the first trimester & should not be used in the last 2 weeks of pregnancy
36
Q

Women can be tested for toxoplasmosis prior to pregnancy with a(n)

37
Q

Preferred VTE tx in pregnancy

A

LMWH

pneumatic compression devices for ppx

38
Q

Preferred treatment for hypothyroidism in pregnant pt

A

Levothyroxine (requires 30-50% dose increase)

39
Q

Preferred treatment for hyperthyroidism in pregnant pt

A

1st trimester: PTU

2nd & 3rd trimester: methimazole

40
Q

Babies receiving breast milk partially or exclusively should receive ___ IU of vitamin D daily

41
Q

Breastfed babies require __ mg/kg/day of iron during months __-__

42
Q

Which pain meds should not be used by breastfeeding mothers due to risk of excessive sleepiness, breathing difficulty and/or death in the infant

A

Codeine and tramadol

43
Q

Breastfed infants have died from being breastfed, especially in mothers taking certain pain meds who were _____ metabolizers

A

2D6 ultra-rapid

44
Q

T/F: a mother who is HIV positive can safely breastfeed

A

False - not recommended

45
Q

Which medications should be avoided during lactation

A

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

A - NAPLEX (83 decks)

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