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Pharm > Drugs in Pregnancy > Flashcards

Drugs in Pregnancy Flashcards

1
Q

2 Drugs that are safe in pregnancy

A
  • Folic Acid

- Levothyroxide (in hypothyroidism)

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2
Q

Example of drug that req two types of contraception

A
  • Ribavirin
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3
Q

A ______ must be present for the admin of any drug

A

true indication

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4
Q

Drug metabolism in pregnancy is ________ than in the non-pregnant state

A

much slower

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5
Q

Which trimester is often most sensitive for fetal malformation

A

First

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6
Q

Critical factors regarding drugs during pregnancy (6)

A
  • Physical/chemical drug properties
  • Rate at which the drug crosses the placenta and amt reaching fetus
  • Duration of exposure to the drug
  • Distribution in various fetal tissues
  • Stage of dev at which drug exposure occurs
  • Effect of combo with other drugs
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7
Q

Are drugs that are more or less lipid soluble most likely to cross the placenta?

A

Drugs that are HIGHLY lipid sol are very likely to cross placenta
- highly ionized less likely

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8
Q

What drug that is highly ionized has small non-ionized fractions that are highly lipid sol –> cross placenta

A
  • Salicylate
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9
Q

Molecular size and crossing placenta

A
  • Molecular wt 1000 unlikely to cross
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10
Q

Why can heparin be used in pregnancy and warfarin cannot?

A

Heparin is too large to cross the placenta, unlike warfarin

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11
Q

What pumps many drugs and toxic compounds back into maternal circulation?

A

P-glycoprotein

- Keeps drugs like vincristine, doxorubicin and protease inhibitors from crossing placenta

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12
Q

The binding affinity of fetal proteins is _____ so drugs that may be highly bound in the maternal blood may be ______ in the fetus

A
  • lower

- less so

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13
Q

What types of drugs are more influenced by rate of blood flow?

A
  • Highly lipid soluble drugs

- ie anesthetics

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14
Q

Example of a drug that enters fetal circulation thats metabolites are more toxic that the parent drug

A

ethanol

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15
Q

Drug that is recommended to all pregnant women to prevent ______

A
  • Folic acid
  • neural tube defects
  • 400 microgram
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16
Q

At what level is HTN treated in preg

A

> 160/105

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17
Q

DOC for HTN in preg

A

Methyldopa

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18
Q

Drugs used in hospitalization for severe HTN

A
  • Hydralazine

- Labetalol

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19
Q

Drug used to stimulate fetal lung maturation

A
  • Corticosteroids
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20
Q

Drugs used to prevent transmission of HIV or herpes to baby

A
  • Zidovudine

- Valacyclovir

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21
Q

Drugs used to control fetal heart probs

A

Antiarrythmics

22
Q

Drug used to promote fertility

A

clomifene

23
Q

Drug used to maintain preg

A

progesterone

24
Q

Teratogenic drugs that bind to DNA that may inhibit DNA dep RNA synthesis or damage/fragment DNA in rapidly proliferating mammalian cells

A

Cancer drugs

25
Q

Teratogenic drugs that inhibit production of essential nucleotides or decrease cell proliferation

A

Antimetabolites

26
Q

Teratogenic drug produces free radicals, which act selectively on the -SH group of certain essential enzymes

A

Radiation (I125)

27
Q

Teratogenic drug thats breakdown products appear to act as folic acid antagonists, or antagonists of riboflavin and/or other vitamins

A

Thalidomide

28
Q

Teratogenic drugs that inhibit differentiation of cells in fetus (2)

A
  • Vitamin A

- Isotretinoin

29
Q

Excessive exposure to _____ may lead to alterations in development

A

some hormones

30
Q

Definition of teratogen (4)

A
  • Results in set of malformation, indicating selectivity for target organs
  • Exerts its effect at a particular stage of fetal dev
  • Dose-dependent incidence
  • Some drugs are so teratogenic that they must NEVER be used in pregnancy
31
Q

When does organogenesis begin

A
  • 20th day of gestation and continues through the third month
32
Q

Category A definition and examples (3)

A
  • Adequate, well CONTROLLED STUDIES SHOWED NO RISK in many trimester of pregnancy
  • Possibility of fetal harm is remote
  • Levothyroxine and folic acid
33
Q

Category B definition (3)

A
  • Adequate, well-controlled studies NO EVIDENCE OF RISK IN HUMANS despite adverse findings in animals
  • In the absence of adequate human studies, animal studies indicated NO fetal risk
  • Change of fetal harm is remote, but still possible
34
Q

Category C definition (4)

A
  • RISK CANNOT BE RULED OUT
  • No adequate, well-controlled human studies
  • Adverse effects shown in animal studies, or are lacking
  • There is a possibility of fetal harm, so drugs in this category may be prescribed only if the BENEFIT > RISK to fetus
35
Q

Category D definition (4)

A
  • POSITIVE EVIDENCE OF HUMAN FETAL RISK
  • Studies in humans or post marketing demonstrated risk
  • The benefits for pregnant women MAY OUTWEIGH RISK
  • WARNING statement about such drug should appear on drug
36
Q

Category X definition (4)

A
  • CONTRAINDICATED IN PREGNANCY
  • Demonstrated evidence of human fetal risk based on human experience
  • RISK OF DRUG > POSSIBLE BENEFIT
  • These drugs are contraindicated in women who are or may become pregnant while taking such drugs
37
Q

Features of Fetal Alcohol Syndrome (5)

A
  • Low forehead
  • Sunken bridge of nose, small upturned nose
  • Retracted lips
  • Receding chin and ear deformations
  • Cardiac defects with intrauterine and extrauterine growth retardation
38
Q

Features of Warfarin Syndrome (5)

A
  • Hypoplastic saddle nose
  • Broad short hands, short distal phalanges
  • Multiple ophthalmic abn (optic atrophy, cataracts)
  • Bone abn
  • Fetal death in utero is also common
39
Q

Thalidomide Embryopathy

A
  • multiple limb deformities
40
Q

Features of Fetal Hydantoin Syndrome (5)

A
  • Intrauterine growth retardation, mental deficiency
  • Short nose, low nasal bridge, cleft lip/palate
  • Cardiac defects
  • Abn genitalia
  • Absence of nails on fingers or toes
41
Q

Features of Diethylstilbestrol Syndrome (3)

A
  • Females may have abn of vagina, cervix, uterus
  • Vaginal and/or cervical ridges
  • Adenocarcinoma of the vagina or cervix as female entered their 20s
42
Q

Vacterl Syndrome after use of Steroid Hormones

A
  • Vertebral, Anal, Cardiac, Tracheal, Esophageal, Renal and Limb malformations
  • Steroid hormones CATEGORY X, although progesterone sometimes used
43
Q

Sex hormone that is sometimes used in preg

A

Progesterone

44
Q

Isotretinoin Tx and MOA

A
  • Severe acne
  • Activates retinoic acid receptors and retinoid X receptors that bind the specific DNA sequences and affect cellular differentiation and proliferation, or induce apoptosis
45
Q

Isotretinoin SE

A
  • Photosensitivity
  • Increased lipids
  • Arthralgias and mylagias
  • HA
  • Alopecia
  • Depression
  • Staph infections
46
Q

A single exposure to this drug in first 3 weeks of pregnancy can cause birth defects

A

Isotretinoin

47
Q

Features of Isotretinoin

A
  • Hydrocephaly
  • Microcephaly
  • Mental retardation
  • Ear and eye abn
  • Cleft lip/palate
  • Facial abn
  • Heart abn
  • Mental retardation
48
Q

Drug that requires iPLEDGE

A

Isotretinoin

- Cannot take St. John’s Wort

49
Q

Contraindicated during 1st Trimester

A
  • Metronidazole

- Tinidazole

50
Q

Contraindicated during 3rd Trimester

A
  • Aspirin, NSAIDs
  • SMX/TMP
  • Nitrofurantoin
51
Q

Category X Drugs (24 groups)

A
  • All statins
  • Warfarin
  • Temazepam, Flurazepam, Triazolam
  • All ergot derivatives
  • Clomiphene
  • Estrogens
  • GnRH analogues
  • Progestins (unless needed to maintain preg)
  • Testosterone, Androgens
  • Misoprostol
  • Mifepristone (RU 486)
  • Raloxifen
  • Anastrozole
  • Finasteride, Dutasteride
  • Ribavirin
  • Amphetamines, Ephedra, Guarana
  • Leflunomide
  • Methotrexate
  • Colchicine + probenicid
  • Thalidomide
  • Isotretinoin, all retinoids, Vit A
  • Ethanol
  • Ginko, Feverfew, Hawthorn, Black Cohosh, Kava Kava, marijuana, melatonin
  • Gallium 69, Iodine, Technitium 99

Pharm (10 decks)

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