Drug use During Pregnancy

Question 1

What are 4 physiological changes in a pregger woman that influence the effect of drugs on the body?

Answer 1

1. GI changes: decrease gastric acid secretion, high pH
2. CV changes: plasma volume expansion, increased cardiac output (which influences change in drug distribution and elimination)
3. Blood composition: decreased albumin levels (changed binding of drugs)
4. Renal changes: increased blood flow and increased GFR (increased renal clearance of drugs)

Question 2

What are the changes in hepatic enzyme activity in pregger women?

Answer 2

Increased metabolism by CYP3A4, CYP2D6 (often need more drugs to get same effect. Example: methadone)

Question 3

Caudal regression syndrome is associated with what disorder?

Answer 3

Maternal diabetes mellitus.

Question 4

Thalidomide’s significance?

Answer 4

This drug was tested in dogs, which metabolize drugs differently than we do. The dogs were fine, but in humans it caused severe limb abnormalities in children (there was specific link between time of exposure and defect). This taught us that the placenta is not a barrier, we need to pick our testing animal carefully and that there is a precise relationship between time of exposure to drug and the defect

Question 5

FDA category A drug

Answer 5

Category A: No risk, human studies done

Question 6

FDA category B drug

Answer 6

Category B: Animal studies show no risk but no human studies OR animal studies show increased risk and human studies show no risk.

Question 7

FDA category C drug

Answer 7

Category C: Animal studies show increased risk, no human studies OR no human or animal studies

Question 8

FDA category D drug

Answer 8

Category D: Proven risk for humans, but benefits may outweigh risks

Question 9

FDA category N drug

Answer 9

Category N: Drug is not classified

Question 10

FDA category X drug

Answer 10

Category X: Proven risk for humans, animals or both, risks outweigh benefits.

Question 11

Example of Category A drug

Answer 11

Prenatal vitamins, T4

Question 12

Example of Category B drugs

Answer 12

Penicillin or Acetaminophen

Question 13

Example of Category C drugs

Answer 13

Nifedipine, Sumatriptan (migraine meds) Lamotrigine

Question 14

Example of Category X drug

Answer 14

Warfarin

Question 15

What category do ACE inhibitors fall under?

Answer 15

C and D

Question 16

Example of Category D drug

Answer 16

Valproic acid

Question 17

What can ACE inhibitors cause in children

Answer 17

CV anomalies

Fetal Renal failure

Olioghydramnios

Pulmonary Hypoplasia

Stillbirth

Question 18

Anti-seizure medications increase your risk for

Answer 18

Neural tube defects

Question 19

What’s an example of an acne medication that can cause spontaneous abortion in 40% of cases

Answer 19

Isotretinoin (Accutane)

Question 20

Based on the trimester of warfarin exposure, what are the possible effects on the fetus?

Answer 20

1st trimester: Fetal Warfarin Syndrome

2nd trimester: Mental retardation, blindness

3rd trimester: hemorrhage, stillbirth

Question 21

What kind of problems can result from the use of Diethylstilbestrol (DES)

Answer 21

Mullerian Anomalies or Vaginal Clear Cell Carcinoma

Question 22

What can DES be used for now (not contraception)

Answer 22

Palliative care for inoperable breast cancer and progressive inoperable prostate cancer

Question 23

What are the adverse effects of using Metronidazole in pregnancy?

Answer 23

NONE in pregnancy but….

1. Carcinogenic in rodents
2. Mutagenic in bacteria
3. No associated malformation in humans
4. Avoid 1st trimester

Question 24

What are the adverse effects of using Sulfonamides during pregnancy?

Answer 24

1. Competes with bilirubin-binding sites
2. Potential for hyperbilirubinemia
3. No known malformations

Question 25

What are the adverse effects of using Aminoglycosides in pregnancy??

Answer 25

1. Potential for ototoxicity (ear problems) (1-2%) 2. No associated malformations

Question 26

What are some adverse effects of Quinolones in pregnancy?

Answer 26

1. High affinity for bone/cartilage 2. Arthropathy in children 3. No known malformations

Question 27

What's bad about drinking whisky\* while pregnancy? \*Read: alcohol

Answer 27

Dose-dependent Effects: ≥ 3 oz. EtOH/day: 50% abnormal 1-2 oz EtOH/day:functional & growth disturbances \<1 oz EtOH/day: usually no effect

Question 28

Real bad outcome of drinking alcohol while pregnancy (hint: it has FETAL and ALCHOL in the name)

Answer 28

Fetal Alcohol Syndrome: * Absent Philtrum (space between base of nose and upper lip) * Midface Hypoplasia * Low Nasal Bridge * Low Set Ears * Microcephaly (small head) * Shortened Palpebral Fissures (opening between the eye lids) On a practice question, saddle nose came up. I jumped straight to Syphilis. Don't do that, it could be FAS...

Question 29

What's a bad outcome associated with cocaine use during pregnancy (that's right folks, cocaine)

Answer 29

Vascular disruption

Question 30

What about using LSD during pregnancy?

Answer 30

NO CLINICAL EFFECTS. Huh.

Question 31

Smokin a J while pregnant? What'll happen?

Answer 31

Dose related IUGR (intrauterine growth restriction)

Question 32

Taking amphetamines while pregnant? Just going cray while having a baby, its totally fine. Nawt.

Answer 32

IUGR, cardiac defects, facial clefts

Question 33

Heroin/Methadone use while pregnant?

Answer 33

Neonatal withdrawal

Question 34

What drugs can you used to prevent preterm births?

Answer 34

1. 17-OH progesterone 2. Tocolytics (MgSO4, Beta mimetics, indomethacin, Ca2+ channel blockers)

Question 35

Drugs that you can use to induce labor?

Answer 35

1. Oxytocin 2. Cervical ripening agents (their words not mine) such as prostaglandin E1 and dinoprostone (giving the mom something to get that DINO inside her out. Ha. Ha)

Question 36

What's the problem with giving Misoprostol aka Cytotec (an inducer of labor, also used in abortions) during pregnancy?

Answer 36

1. increased risk of miscarriage (40%!) 2. Use during 1st trimester is associated with Mobius syndrome

Question 37

What is Mobius syndrome and what can cause it again?

Answer 37

Caused by: Misoprostol Sx: cranial nerve VI/VII palsy, limb malformations, craniofacial abnormalities

Question 38

What category does the FDA put Misoprostol/Cytotec in?

Answer 38

Category X Which means that it has proven risk for humans, animals or both, risks outweigh benefits.

Question 39

How can you treat hemorrhage during prganncy/labor

Answer 39

1. Oxytocin 2. Methyl Ergonovine (Methergine) 3. Prostaglandin E1, F2 alpha

Question 40

What do you use MgSO4 for in pregnancy women?

Answer 40

Prophylaxis for seizures/eclampsia

Question 41

What do you use Beta-Methadone for

Answer 41

Fetal benefits: treats 1. Pulmonary immaturity 2. Neonatal necrotizing enterocolitis 3. Intracranial bleeding

Question 42

HIGH YIELD: How to you prevent neonatal group B strep?

Answer 42

Give penicillin to the mother DURING LABOR