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PHA 397 - Make-Up Therapeutics > Exam 1 - Drug Use in PG > Flashcards

Exam 1 - Drug Use in PG Flashcards

1
Q

What is the term for “Due Date?”

A

GESTATION

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2
Q

Define gestation.

A

267 days from conception OR 280 days (40 weeks) from last menstrual period

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3
Q

How many trimesters are there in pregnancy?

A

3

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4
Q

How many weeks does each trimester last?

A

13 weeks

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5
Q

How long is a term in pregnancy?

A

37-42 weeks gestation

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6
Q

What is the term for the number of times a woman has been pregnant?

A

GRAVIDITY

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7
Q

What is the term for the number of a woman’s pregnancies which exceed 20 weeks gestation?

A

PARITY

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8
Q

What is a term for the number of babies a woman has had past 20 weeks gestation?

A

PARITY

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9
Q

Name some physiologic changes in PG?

A 
Increased cardiac output
Increased renal perfusion and function
Increased blood volume
Decreased GI motility
Increased weight gain
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10
Q

How many pounds can a woman expect to gain in PG?

A

20-30 lbs

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11
Q

Name the physiologic changes in PG that require an increased demand.

A

Increased demand for:

  • Calories
  • Protein
  • Calcium
  • Folic acid
  • Iron
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12
Q

How many additional calories do pregnant women need?

A

300/day

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13
Q

How many additional proteins do pregnant women need?

A

10 g/day

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14
Q

How much additional calcium do pregnant women need?

A

1200 mg/day

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15
Q

How much additional folic acid do pregnant women need?

A

400 mcg/day

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16
Q

What does folic acid help with?

A

Neural tube

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17
Q

How much additional iron do pregnant women need?

A

30 g/day from 2nd trimester on

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18
Q

T/F: PG women have shorter t 1/2 of renally eliminated drugs.

A

TRUE

-Perfusing kidneys really well because of extra blood volume

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19
Q

T/F: PG women have larger apparent Vd for lipophobic drugs.

A

TRUE

-More fat and volume for drugs to go into

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20
Q

In preconception planning, how much folic acid would low risk women take for neural tube defects?

A

Low risk 0.4 mg/day

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21
Q

In preconception planning, how much folic acid would high risk women take for neural tube defects?

A

High risk 0.4 mg/day

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22
Q

What can smoking lead to in PG?

A

Low birth weight

Premature birth

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23
Q

Which immunizations should women in preconception planning have?

A

Rubella and Hepatitis B

Influenza vaccine

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24
Q

What is the term for something that is capable of producing congenital abnormalities?

A

TERATOGEN

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25
Q

What can teratogens cause?

A

Organ teratogenicity
Perinatal complications
Neurobehavioral complications

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26
Q

In exposure to teratogens, what is meant by timing of exposure?

A

Conception to 14 days results in “all or none” effects

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27
Q

When exposed to a teratogen, when is the greatest risk of organogenesis?

A

Second through eighth week

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28
Q

Which trimesters are less risky in exposure to teratogens?

A

Second and third trimesters

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29
Q

What factors effect placental transfer?

A
  • Low protein binding
  • High lipophilicity
  • Low molecular weight (<600 daltons)
  • Unionized state
  • Placental barrier (thins as PG progresses)
  • Uterine blood flow (increases with gestation)
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30
Q

T/F: Drugs that want to bind to protein won’t cross placenta because the fetus has less protein.

A

TRUE

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31
Q

T/F: A drug that is highly lipophilic won’t cross the placenta because mom has more fat.

A

TRUE

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32
Q

T/F: Vancomycin, Insulin, and LMWH won’t cross because their molecular weight is too big.

A

TRUE

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33
Q

T/F: Unionized drugs won’t cross the placenta.

A

TRUE

34
Q

What is the brand name for Retinoic Acid?

A

Accutane

35
Q

What is the generic name for Accutane?

A

Retinoic Acid

36
Q

What happens when pregnant pts take Accutane?

A

Embryopathy

  • CNS craniofacial and Cardiac defects
  • Microtia
37
Q

Name the important human teratogens.

A
  • ACE-inhibitors
  • Carbamazepine
  • Phenytoin
  • Valproic acid
  • Alcohol
  • Lithium
  • Misoprostol
  • Retinoids (systemic use)
  • Tetracyclines
  • Thalidomide
  • Warfarin
38
Q

What abnormality do ACE-inhibitors cause in PG?

A

Renal failure/agenesis

39
Q

What abnormality does Carbamazepine cause in PG?

A

Neural tube defects

40
Q

What abnormality does Phenytoin cause in PG?

A

Fetal hydantoin syndrome

41
Q

What abnormality does Valproic acid cause in PG?

A

Neural tube defects

42
Q

What abnormality does Alcohol cause in PG?

A

Fetal alcohol syndrome

43
Q

What abnormality does Lithium cause in PG?

A

Ebstein’s anomaly

44
Q

What abnormality does Misoprostol cause in PG?

A

Mobius syndrome

45
Q

What abnormality do Retinoids (systemic use) cause in PG?

A

Retinoid embryopathy

46
Q

What abnormality do Tetracyclines cause in PG?

A

Discoloration of teeth

47
Q

What abnormality does Thalidomide cause in PG?

A

Phocomelia

48
Q

What abnormality does Warfarin cause in PG?

A

Fetal warfarin syndrome

49
Q

Name the additional teratogens.

A
  • Androgens
  • Antineoplastics
  • Cocaine
  • Diethylstibestrol
  • Etretinate
  • Iodides (radioactive)
  • Live vaccines (MMR, Varicella)
  • Methimazole
  • Penicillamine
  • Vitamin A (>18,000-25,000 IU/day)
50
Q

What are the signs of Fetal Alcohol Syndrome?

A
  • Small head circumference
  • Low nasal bridge
  • Thin reddish upper lip
  • Epicanthic folds
  • Short nose
  • Small midface
51
Q

What does Dilantin (Phenytoin) do to the fetus?

A
  • Growth retardation
  • Profuse scalp hair
  • Short upturned nose
  • Long philtrum
  • Ear anomalies
  • Wide space between eyes
  • Short nose
  • Digital hypoplasia
52
Q

What was Thalidomide used for?

A

Hyperemesis

53
Q

Name the suspected teratogens.

A
  • ACE inhibitors
  • Benzodiazepines
  • Estrogens
  • Progesterones
  • Quinolones
54
Q

Name the drugs that have nonteratogenic adverse effects.

A
  • Antithyroid drugs
  • Aminoglycosides
  • Aspirin and NSAIDs
  • Barbiturates - chronic use
  • Benzodiazepines
  • Beta-blockers
  • Caffeine
  • Chloramphenicol
  • Cocaine
  • Diuretics
  • Isoniazid
  • Narcotic analgesics - chronic use
  • Nicotine
  • Oral hypoglycemic agents
  • PTU
  • Sulfonamides
55
Q

Why do you want to avoid beta-blockers in diabetes?

A

B/C it masks the s/s of hypoglycemia

56
Q

Name the agents considered safe while pregnant.

A
  • Acetaminophen
  • Cephalosporins
  • Corticosteroids
  • Docusate sodium
  • Erythromycin
  • Multiple vitamins
  • Narcotic analgesics
  • Penicillins
  • Phenothiazines
  • Thyroid hormones
  • Tricyclic antidepressants
57
Q

“PC CANT TEMP” = Safe agents

A

P - Peninicillins
C - Cephalosporins

C - Corticosteroids
A - Acetaminophen
N - Narcotic analgesics
T - Thyroid hormones

T - TCAs
E - Erythromycin
M - Multiple vitamins
P - Phenothiazines

58
Q

What is the term for a severe form of morning sickness that may lead to dehydration, electrolyte disturbances, and acid-base imbalances?

A

Hyperemesis gravidarium

59
Q

What is the nonpharmacologic treatment for morning sickness?

A
  • Small, frequent meals high in carbs
  • Limit spicy foods
  • Avoid nausea producing situations, smells, etc.
  • Cracker at bedside
  • Acupuncture/pressure points
60
Q

What is the pharmacologic treatment for morning sickness?

A
  • First line agents = Pyridoxine (Vit B6), Diclegis/Bonjesta, Antihistamines (Doxylamine, Meclizine), Promethazine
  • 2nd Line = Metoclopramide
  • Ondansetron
  • Cyanocobalamin (Vit B12)
  • Dimehydrinate
  • Ginger
61
Q

What is the first line treatment for morning sickness?

A
  • Pyridoxine (Vit B6)
  • Diclegis/Bonjesta
  • Antihistamines (Doxylamine, Meclizine)
  • Promethazine
62
Q

What is the 2nd line treatment for morning sickness?

A

Metoclopramide

63
Q

When is constipation common in PG?

A

2nd and 3rd trimester

64
Q

_____ may be a side effect of iron, calcium supplementation.

A

CONSTIPATION may be a side effect of iron, calcium supplementation.

65
Q

What are the treatments for constipation in PG?

A
  • Fluids
  • Physical exercise
  • High fiber foods
  • Bulk-forming laxatives
  • Stool softeners
  • Osmotic laxatives
66
Q

T/F: No enemas or strong stimulant laxatives.

A

TRUE

-Can cause contractions

67
Q

Which types of laxatives should be avoided?

A
  • Bisacodyl - short term
  • Senna
  • Castor and mineral oil
68
Q

When is heartburn (GERD) most common?

A

Late in 2nd or 3rd trimester

69
Q

What is the treatment for heartburn (GERD) in PG?

A
  • Small, frequent meals, no late night meals
  • Decreased caffeine, nicotine, chocolate, etc.
  • Increased HOB or sleep on 2 pillows
  • Antacids for mild to moderate (H2RA, PPIs, Reglan for severe, Sucralfate); avoid magnesium and aluminum

NO sodium bicarbonate

70
Q

T/F: All anticonvulsants are considered teratogenic in PG.

A

TRUE

71
Q

How much folic acid supplementation in epilepsy?

A

4-5 mg qd

72
Q

How much vitamin K supplementation in epilepsy?

A

10 mg po qd in the LAST month

73
Q

T/F: Treat status epilepticus as usual without regard to PG.

A

TRUE

74
Q

What are the risks when a pg woman has bacterial vaginosis?

A
  • Pre-term labor
  • Premature ROM
  • Spontaneous abortion
  • Postpartum endometritis
75
Q

What bacteria causes bacterial vaginosis?

A
  • Usually anaerobic
  • Mycoplasmas
  • Gardnerella vaginalis
76
Q

What is the treatment for bacterial vaginosis?

A
  • Metronidazole 500 mg BID x 7 days

- Clindamycin 300 mg po BID x 7 days

77
Q

T/F: Avoid ACE inhibitors and ARBs in pg.

A

TRUE

78
Q

What do you try first in HA in pregnancy?

A

Non-pharmacologic treatment

79
Q

What pharmacologic treatments are okay to take for HA in pregnancy?

A
  • APAP, caution with codeine, narcotics (Fioricet)
  • NSAIDs and ASA - contraindicated in late PG; IBU, Naproxen
  • Sumatriptan - drug of choice
  • Propranolol, then amitriptyline/nortriptyline
80
Q

What drugs are contraindicated in HA in pregnancy?

A

Ergotamine and Dihydroergotamine

81
Q

T/F: Never use Naloxone in a mother or infant.

A

TRUE

82
Q

What immunizations for pg women?

A
  • Pertusis (Tdap, Td); each pregnancy, 3rd trimester
  • Influenza
  • After delivery = MMR, Varicella; b/c they are live vaccines and only if not up to date

PHA 397 - Make-Up Therapeutics (15 decks)

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