Introduction to Therapeutic concepts in Pregnancy

Question 1

Describe the BRAN decision making technique

Answer 1

benefits, risks, alternatives, do nothing

Question 2

List the critical periods of development and the weeks they occur

Answer 2

All or none weeks 2-4 weeks after last menstrual period, Embryonic period weeks 4-11, fetal period weeks 11-birth

Question 3

explain the all or none period

Answer 3

first 2 weeks after conception where drug can either result in miscarriage or have no effect

Question 4

describe the embryonic period

Answer 4

most critical period of fetal development, major malformations can occur as major formation is occurring

Question 5

describe the fetal period

Answer 5

if drug is taken it will not cause malformations since every is already formed but may cause disruptions of normally formed organs eg deafness

Question 6

what is the baseline risk of congenital abnormalities in pregnancy?

Answer 6

3-5%

Question 7

describe the different types of defects that can occur

Answer 7

major: cause significant medical problems possibly requiring surgery or treatment
minor: not significant and not requiring surgery or treatment
functional: changes how part of the body works but not how it looks

Question 8

List the influencing factors of a drug’s possibility of causing harm

Answer 8

dose, route of exposure, pharmagenomics, how much is transferred across placenta

Question 9

List the characteristics of teratogens

Answer 9

produce deformities in >2-3%, produce consistent pattern of deformities

Question 10

Describe category A for Medications

Answer 10

safe for pregnancy

Question 11

Describe category B for Medications

Answer 11

B1: limited women, animal studies have shown no evidence of AE
B2: limited women, limited animal studies but available data shows no AE
B3: limited women, animal studies have shown evidence of AE, significance uncertain in humans

Question 12

Describe category C for Medications

Answer 12

C: suspected to have caused harmful effects without malformations, may be reversible

Question 13

Describe category D for Medications

Answer 13

D: suspected or expected to cause malformation with irreversible damage

Question 14

Describe category X for Medications

Answer 14

X: high risk causing permanent damage to fetus and should not be used in pregnancy

Question 15

Explain the considerations when referring to medication categories for pregnancy

Answer 15

the categories are simplistic and not hierarchical, not a scale of risk and same category does not mean same risk, no consideration for trimester/critical stage of development when drug is taken, no consideration for context of med use or route of administration, information not updated over time in some resources