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DT4-Exam 1 > Pharm-Pregnancy Drugs-Melissa** > Flashcards

Pharm-Pregnancy Drugs-Melissa** Flashcards

1
Q 
What are the top ten drugs consumed during preggos?
specifically:
-#1?
-#9?
#10?
A

1 analgesics, #9 alcohol, #10 Fe + vitamins

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2
Q

Diethylstilbestrol (DES):
What was its former therapeutic use?
What was its teratogenic effect**?

A

Used to prevent premature birth

ONLY KNOWN TRANSPLACENTAL CARCINOGEN
-Causes VAGINAL clear cell adenocarcinoma in daughters born to mothers taking drug

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3
Q

Bendectin:
What was its former therapeutic use?
Why was it withdrawn from the market?

A
  • # 1 anti-emetic used during preggos in 1950s-60s

- suspected teratogenicity (not confirmed)

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4
Q

Thalidomide:
What was its former/ current therapeutic use?
Why was it withdrawn from the market?

A
  • Former anti-emetic
  • Currently used chemotherapeutic agent
  • Teratogenic effects: amelia (missing limb), phocomelia (misshapen limbs), facial/ear abnormalities
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5
Q

When is MOST damage by drugs done to fetuses?

A

During embryonic period: weeks 3-8 (patient may not know they are preggos)

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6
Q

List the fetal anomalies that can result during the following stages of intrauterine development:
Pre-organogenesis
Embryonic
Fetogenesis

A

Pre-organogenesis (wks1-2)–> all or nothing
Embryogenesis (wks3-8)–> CNS problems (spinabifida…), cardiac defects, etc.
Fetogenesis (wks9-38)–> gonadal, CNS, etc.

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7
Q

What percentage of birth defects are associated with drug exposure? What is the most common cause of birth defects? How does pregnancy influence drug absorption?

A

-4-5 percent of all birth defects due to drugs
-most defects have unkown cause
-note that pregnancy doesn’t change drug absorption
(the baby usually gets whatever you take!)

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8
Q

How does pregnancy influence drug distribution?

A
  • ^ plasma volume + total body water = dilute drug

- DECREASE plasma albumin = ^ FREE FRACTION DRUG

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9
Q

How does pregnancy influence drug biotransformation?

A

^ opportunities to biotransform!

Mom liver + placenta + fetal liver

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10
Q

How does pregnancy influence drug excretion?

A

^ GFR up to 70% (renally excreted drugs will be lost at faster rate)

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11
Q

How do most drugs pass from mom to placenta?
How do amino acids and glucose cross?
What two types of drugs DO NOT cross the placenta?

A
  • most: passive diffusion (larger go slower)
  • AA’s and glucose cross via active transport
  • Heparin + Insulin don’t cross, most others do
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12
Q

Define FDA Pregnancy Categories A, B, C, D, X:

–which is the target for therapy?

A

A = ZERO RISK (not many drugs fit here)

B = Goal; No risk in animal studies OR problems from animal studies not confirmed in human trials

C= No human studies available to trump problems from animal studies OR no studies available (still used)

D = PROBABLY NOT SAFE/ EVIDENCE OF HUMAN RISK; try not to use these

X = THESE ARE NOT ALLOWED IN PREGGOS; BENEFITS DO NOT OUTWEIGH RISK

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13
Q

Which category drugs are regularly used in preggos?

From where do we get most data confirming or denying safety of drug use in pregnancy?

A

A-C are commonly used with risk benefit analysis
*A don’t really exist, though.
Most data comes from data registries

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14
Q

Why should these drugs be avoided in early pregnancy?

  • DES
  • Warfarin
  • Systemic retinoids
  • Androgens in high doses
  • Steroids in high dose
  • Tetracyclines
A
  • DES–> adenocarcinoma in daughters
  • Warfarin–> MSK/CNS problems
  • Systemic retinoids –> CNS, craniofacial, CV
  • Androgens in high doses –> virilization etc.
  • Steroids in high dose–>cleft palate
  • Tetracyclines–>yellow teeth, decrease bone growth
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15
Q

Why are these drugs under high suspicion of producing abnormalities EARLY in preggos– what abnormalities are they thought to cause?

  • Lithium
  • Phenytoin
  • Chloroquine
A
  • Lithium –> Ebstein’s anomaly
  • Phenytoin –> Everything bad
  • Chloroquine–>deafness
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16
Q

List 5 antibiotic classses to be avoided in preggos and what they can do to the fetus:

A
  • Co-trimoxazole–> folate antagonist + hyperbilirubinimia
  • Chloramphenicol–> gray baby
  • Aminoglycosides–> ototoxicity
  • Sulfonamides–> Hyperbilirubinimia= kernicterus
  • TCN: tooth discoloration, bone problems
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17
Q

ASN: what can it do and when in preggos is it dangerous?

A

Late preggos

- Kernicterus and fetal or maternal hemorrhage

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18
Q

Antithyroid Drugs: what can they do and when in preggos are they dangerous?

A

Late preggos

-Goiter and hypothyroid in baby

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19
Q

BDZs: what can they do and when in preggos are they dangerous?

A

Late preggos

- Floppy baby

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20
Q

Oral anticoagulants: what can they do and when in preggos are they dangerous?

A

Late preggos
- fetal/ retroplacental hemorrhage, microcephaly
(not IV heparin, heparin ok.)

21
Q

Oral sulfonylurea hypoglycemics: what can they do and when in preggos are they dangerous?

A

Late preggos

- fetal hypoglycemia (intuitive, sulonfylureas = ^^ insulin)

22
Q

What are the first and second line treatments for preggos with UTI?

A 
#1 Nitrofurantoin, #2 Penicillins 
-Trimethoprim-Sulfamethoxazole (risk benefit!!)
23
Q

How do we treat bacterial vaginosis in preggos?

A

TOPICAL Metronidazole

24
Q

How do we treat vaginal candidiasis in preggos?

A

TOPICAL azoles

25
Q

How do we treat Sinusitis in preggos?

A

Penicillins or Azithromycin

- Trimethoprim-sulfamethozazole (risk benefit!!)

26
Q

What are 2 common causes of anemia in preggos and how do we treat/ prevent anemia in preggos?

A
  1. Physciologic anemia (due to dilution)
  2. Fe/ folic acid deficiency anemia (micro vs. macrocytic)

Treatment:

  • Supplement with Fe/ folic acid
  • Start prenatal vitamins before preggos
27
Q

How do we treat hyperthyroidism in preggos (2 drugs)?
What do we avoid?
Surgery ok?

A
  • Carb/methimazole, propylthiouracil
  • Rare surgical managment
  • Avoid radioactive iodine and breastfeeding

*Note: risk of hyperthyroidism GREATER than risk of treatment

Thyroid drug lecture says propylthiouracil>methimazole in preggos

28
Q

How do we treat pre-existing DM in preggos?

What can we use in the second trimester?

A
  • Pregnancy=^insulin requirement
  • switch from oral –>insulin
  • Metformin (preggos B) or Glyburide (preggos B or C) are OK in second trimester
29
Q

How do we treat gestational diabetes in preggos?

A

utilize human insulin

30
Q

How do we treat Preeclampsia/ Preeclampsia asstd HTN (3)?

Which drugs should be AVOIDED (4)?

A

Delivery of fetus is curative (not possible before 24 wks)

Tx HTN:

  • Hydralazine IV = RAPID DECREASE
  • Methyldopa
  • Labetalol

DO NOT USE: Nitroprusside, ACEi, ARBs, Diruetics

31
Q

What is the DOC for Chronic HTN in preggos +3 others?

A 
#1: Methyldopa
Others: Hydralazine, B-Blockers, Ca Channel blockers
32
Q

Drugs to AVOID when treating preggos chronic HTN (6):

A

Don’t use ANYTHING but hydralazine, labetolol, methyldopa/ BBers for CaCBers!

33
Q

DOC for anticoagulation in preggos?

When should you stop anticoagulation in preggos?

A

-Heparin (IV only) and LMW heparin
-Stop LMW anticoagulation 2-3 weeks before delivery
or
-switch to IV heparin + discontinue 12 hours before delivery (to prevent excessive bleeding)

34
Q

What is the preferred treatment for preggos with seizures?

How do we manage these patients (2)?

A

Monotherapy + avoid phenytoin, carbamazipine, VP acid

  • monitor plasma drug levels due to decrease in albumin
  • Folic acid supplementation 3 mos before conception + 4mg/ day in first trimester

*IF patient is already on VA, phenytoin, carbamazipine, keep them on drug!!
Goal is to keep seizures controlled. Just do not START these!!

35
Q

4 phenytoin teratogenic problems:

A
  • fetal hydantoin syndrome (broad range of problems)
  • craniofacial abnormalities
  • cardiac malformations
  • GU defects
36
Q

Carbamazipine + Valproic Acid: Assc Defects

A

neural tube defects

37
Q

What problems can asthma cause in pregnancy (2)

A

preterm labor and low birth weight

38
Q

How do we treat asthma in preggos?

A 
#1: Avoid environmental triggers 
First line = Inhaled glucocorticoids (Betamethasone + Fluticasone) +/- B2 agonists for acute exacerbation
39
Q

When do we use systemic glucocorticoids to treat Asthma?

Leukotriene inhibitors?

A
  • Systemic glucoscorticoids ONLY for severe exacerbation (^ risk cleft palate), usually do inhaled.
  • Leukotriene inhibitors = THiRD line agents
40
Q

How do we mange nausea in preggos?

A

Treat ONLY if severe
- First try: small-frequent meals, ginger, B6
- DOC = Ondancatron or zofran
(Keep on dancin’ –> ondancantron)

41
Q

Which SSRI is associated with VSD/ASD and should be avoided in preggos?

A

Paroxetine (Paxil)

42
Q

All SSRIs are assocated with what teratogenic risks?

A

Persistent pulmonary hypertension of the newborn (PPHN)

43
Q

What is the DOC to treat depression in preggos?

A

Sertaline (Zoloft) – SSRI

44
Q

List some common features of babies born with FAS

A
  • low birth weight
  • small head
  • wide set eyes
  • flat midface + upturned nose
  • smooth wide philtrum and thin upper lip
  • underdeveloped jaw
45
Q

What is the MOST IMPORTANT modifiable risk factor associated with poor fetal outcome?
What are some of the outcomes?

A 
TOBACCO ABUSE (12-22% preggos smoke)
- premature labor, low birth weight, fetal loss
46
Q

Describe the characteristics of a baby born with neonatal abstinence syndrome?

A
  • irritibility + high pitched cry
  • tremor, frantic fist sucking
  • ^ Respiratory rate, stools, sneezing
  • yawning, vomiting, fever

(same sx as opioid withdraw in adults….)

47
Q

How much of a drug typically makes it into breast milk?

A

1-2% (varies WIDELY based on lipid solubility, protein binding, passive diffusion)

48
Q

How do we modify risk of drugs getting to baby via breast milk?

A
  • choose safest med

- exercise timely dosing (pump and dump etc. )

DT4-Exam 1 (17 decks)

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