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443-SRH and MSK > Considerations in Pregnancy + drug use in pregnancy and lactation > Flashcards

Considerations in Pregnancy + drug use in pregnancy and lactation Flashcards

1
Q

what CV characteristics are increased in pregnancy?

A

blood volume
cardiac output by 8wks

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2
Q

what are some possible causes to increased lower limb venous pressure with pregnancy

A

enlarging uterus impedes inferior vena cava pressure + placenta acts as AV shunt

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3
Q

3rd trimester may see ___________ episodes from gravid uterus impeding flow in ____________

A

supine hypotensive
inferior vena cava

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4
Q

what CV characteristics are decreased in pregnancy?

A

BP in first trimester
systemic peripheral vascular resistance

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5
Q

what respiratory characteristics are increased in pregnancy?

A

oxygen consumption
sensitivity of medullary respiratory center to CO2
minute ventilation (tidal volume and resp rate)

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6
Q

what resp characteristics are decreased in pregnancy?

A

residual volume

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7
Q

in pregnancy, there may be compensatory respiratory ________
1. acidosis
2. alkalosis

A

alkalosis

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8
Q

why does the medullary respiratory center become more sensitive to CO2 in pregnancy?

A

effects of progesterone

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9
Q

how much iron supplementation is recommended during last half of pregnancy?

A

50-60mg

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10
Q

absorption of iron
1. increases
2. decreases
in pregnancy

A

increases by 15%

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11
Q

pregnancy sees an increase in clotting factors due to

A

increased estrogen

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12
Q

why is there an increased risk of thrombosis peripartum

A

Virchow’s triad: venous stasis (rest), hypercoagulability (E), endothelial damage (from delivery)

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13
Q

in pregnancy, the smooth muscle of the GIT ____________, resulting in _____________
1. relaxes, faster gastric emptying
2. relaxes, slower gastric emptying
3. increases tone, faster gastric emptying
4. increases tone, slower gastric emptying

A

2

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14
Q

delayed gastric emptying in pregnancy results in

A

upper GI sx like heartburn/ GERD
N/V

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15
Q

what are some renal adaptations seen in pregnancy

A

increased blood flow and GFR
increased activity of the RASS system (from E)
increased glucosuria

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16
Q

in pregnancy, is glucosuria present in nondiabetics?

A

yes- GFR increases but ability to absorb glucose remains teh same
may not be a good indicator of glucose control in diabetics

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17
Q

a T1DM pregnant patient is having glucosuria, this
1. indicates a loss of blood glucose control
2. indicates diabetic ketoacidosis
3. may be present at normal blood glucose levels
4. is a good indicator of diabetes in pregnancy

A

3

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18
Q

PK changes in pregnancy includes

A

increased Vd adn CL
decreased GI motility = slower absorption time = later peak
decreased protein binding (albumin)

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19
Q

Maternal and fetal drug response during pregnancy are influenced by 2 factors

A

Pregnancy induced physiologic changes
Placental fetal unit

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20
Q

rank the following teratogens on incidence of congenital manifestations
unknown, genetic, medication exposure, environment

A

unknown > genetic > environment > med exposure

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21
Q

list 3 factors that can influence teratogenicity

A

The embryonic stage at exposure
Genotypes of the mother a fetus
The extent to which the drug crosses the placenta
Type of agent: dose, duration of exposure
Simultaneous exposure to other drugs/ environmental agents

22
Q

placental drug transfer can occur by

A

simple diffusion, differential diffusion, active transport, and pinocytosis

23
Q

placental drug transfer is influenced by

A

MW, protein binding, lipid solubility, degree of ionization, placental blood flow, placental metabolism, thickness of placental membrane

24
Q

list 3 reasons why it is difficult to determine the safety of drugs in pregnancy

A

most RCTs exclude pregnant women
oevrall risk of most teratogens is low = needs large number of exposures
most data currently from case reports that is not generalizable to all women
small sample sizes
contribution of maternal disease unknown
recall bias in retrospective studies
unbalanced reporting

25
Q

what are pregnancy registrise

A

post marketing data, voluntary, recorded prospectively
what meds mother was taking, if there are any effects on baby

26
Q

what 4 drugs can affect brain development

A

isotretinoin, phenytoin, carbamazepine, valproic acid

27
Q

lsit the 9 proven teratogens

A

thalidomide
DES
alcohol
cocaine
androgens
isotretinoin
warfarin
methotrexate
valproic acid

28
Q

Alcohol use during pregnancy is associated with a range of complications called

A

FASD

29
Q

FASD
1. results in lifelong physical, behavioural, intellectual effects
2. is completely preventable by avoiding alcohol in pregnancy
3. severity depends on amount of alcohol drank, timing of drinking
4. all of the above

A

4

30
Q

when is the fetus most vulnerable to alcohol

A

days 19-21

31
Q

what is the most severe subtype of FASD

A

FAS- physical + brain damage + neurodevelopmental effects

32
Q

what % of FAS have the classical characteristics

A

10%

33
Q

what are some classical sx of FAS

A

low nose bridge, short nose/ flat midface, smooth philtrum, thin upper lip, small jaw, microcephaly, epicanthal folds, short palpebral fissures, minor ear abnormalities, height/ weight <10th percentile

34
Q

neurodevelopmental effects, no physical evidence

A

ARND

35
Q

many birth defects (ex- cardiac, skeletal, renal, etc) from alcohol

A

ARBD (alcohol related birth defects)

36
Q

what is pFAS

A

(partial fetal alcohol syndrome): partial physical effects and neurodevelopmental effects

37
Q

neonatal adaptation sx usually resolves in

A

~2wks

38
Q

common drugs precipitating neonatal withdrawal includes

A

drugs of abuse, psychotropic drugs, antidepressants (SSRIs)

39
Q

Some drugs can cause withdrawal sx in the neonate (if taken during the ________________)

A

last trimester around the time of delivery

40
Q

cannabis in pregnancy may affect ________, ____________, ___________ consequences

A

May affect fetal growth (inconsistent evidence), neurodevelopment, learning and behavioral consequences

41
Q

evidence of cannabis in pregnancy mostly comes from
1. smoking
2. edibles
3. sprays

A

1

42
Q

general guidelines for ITC use with pregnancy (4)

A

Try nonpharm first
Try to avoid meds during first trimester
Use noncombination, short acting agents
Choose topical over oral meds

43
Q

passage of medication into milk is primarily from

A

passive diffusion

44
Q

drug transfers into human milk more easily if it is

A

Highly lipid soluble
Low in protein binding
Low in MW (<500d)
Nonionized (pKa important)
High conc in mother

45
Q

general rules for taking meds in breastfeeding

A

Choose drug with less secretion into milk
Avoid nursing at times of peak drug conc
Take med before infant’s longest sleep period
If ST tx, consider temp holding BF

46
Q

medication levels tend to peak in breastmilk ____ after oral dose

A

1-3hrs

47
Q

Relative infant dose

A

Relative infant dose = infant’s dose via milk (mg/kg/d)/ mother’s dose (mg/kg/d)

48
Q

what is L1 in Hale’s medication

A

safest

49
Q

if the RID is < ____, it is generally safe to use

A

10%

50
Q

RID of most meds are ___

A

<1%

51
Q

what % of THC exposed to the mother reaches the baby?

A

0.8-2.5%

443-SRH and MSK (24 decks)

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