OB Considerations Flashcards
1
Q
Basic considerations
A
- benefits must outweigh the risk
- lack of clinical trials
- physiological changes
2
Q
physiological changes of pregnancy
A
- dose may need to increase in third trimester d/t doubled renal BF, and increased GFR
- some drugs hepatic metabolism increase (phenytoin, carbamazapine, Valporic acid)
- bowel motilty decreases: increase drug absorption; may need dose reduction
3
Q
Placenta drug transer
3 answers
A
- lipid soluble drugs cross placenta easily
- ionized, highly polar, or protetin bound have difficulty crossing
- ASSUME any drug will cross
4
Q
ADR during pregnancy
A
- same as non pregnant individuls but also unique effects
- asprin near term supresses labor contractions
- regular use of dependance drugs can result in infant drug dependance
5
Q
teratogenesis occurs about ____-____%
A
- 1-3%
- difficult to identify
6
Q
Causes of congenital abnormalities
A
- genetics
- enviromental chemicals
- drugs
7
Q
teratogenesis is dependent on ____
A
- drug given
8
Q
Three stages of development
A
- preimplantation presomite period (conception- week 2)
- embryonic period (week 3-8)
* gross malformations can occur - fetal period (week 9- term)
* functional impairement
9
Q
Category A risk
A
remote risk
10
Q
Category B risk
A
slightly more risk than A
11
Q
Category D risk
A
PROVEN risk for fetal harm
11
Q
Catgeory C risk
A
greater risk than B
12
Q
Category X risk
A
PROVEN risk for fetal harm; CI section will have a statement in drug labeling
13
Q
common drugs to avoid during preganancy
13
A
- SOME anticancer,immunosupressants, antiseizure
- sex hormones
- tetracycline
- trimethoprim- sulfamethoxazole
- alcohol/ nicotine
- 5-a reductase inhibitors
- ACE inhibitors
- SOME antithyroid hormones
- sotrtinoin/ other vitamin A
- lithium
- NSAIDS
- oral hypoglycemics
- warfarin
14
Q
DOC for pain
A
- acetaminophen
- ibuprofen
- ketorolac
- morphine
