Pharmacology

Question 1

How does administration of a drug change in pregnancy?

Answer 1

delayed gastric emptying, nausea and vomiting, decreased esophageal sphincter tone

Question 2

How does dispersion of a drug change in pregnancy?

Answer 2

increase volume distribution (increase TBW, ECF, fat)

decrease serum protein

Question 3

How does metabolism of drugs change in pregnancy?

Answer 3

decrease in CYP 1A2 and 2C19 activity

increase in CYP 3A4, 2D6, 2C9, UGT activity

Question 4

How does elimination of a drug change during pregnancy?

Answer 4

GFR increases by 50% (increased CO and renal blood flow)

Question 5

What type of medications are likely to cross the placenta?

Answer 5

lipophilic
unionized; weak bases
low MW < 600 Da
not highly protein bound

Question 6

When in pregnancy is the fetus most sensitive to teratogens?

Answer 6

first 8 weeks

Question 7

If a drug is pregnancy category A, what does this mean?

Answer 7

studies in pregnant women show no risk to fetus

Question 8

If a drug is pregnancy category X, what does this mean?

Answer 8

risk of using in pregnant women outweighs the possible benefit

Question 9

Medications to avoid in pregnancy

Answer 9

carbamazepine, VPA, lithium, phenytoin, barbituates, opiods/benzodiazepines, statins, ACEi/ARBs/allskiren, warfarin, NSAID, tetracycline, Isotretinoin, chemotherapy, methotrexate, misoprostol, thalidomide

Question 10

Women taking ___ at time of fertilization are less likely to develop serious nausea and vomiting

Answer 10

multivitamin

Question 11

Nausea and vomiting usually begins around ____ and usually resolves around

Answer 11

4-6 weeks

16-20 weeks

Question 12

first line for treating nausea and vomiting in pregnancy

Answer 12

B6, switching prenatal vitamin to folic acid, nausea bands, unisom

Question 13

what causes GERD in pregnancy?

Answer 13

increase in progesterone resulting in relaxation of LES

Question 14

First line management for GERD in pregnancy

Answer 14

lifestyle modifications

Question 15

If lifestyle modifications are not effective in female patient with GERD, what medications do you want to try?

Answer 15

antacids (Mg, Ca) → H2 blockers (ranitidine) → PPI (omeprazole)

Question 16

GERD drugs to avoid in pregnancy

Answer 16

sodium bicarbonate, magnesium trisilicate

Question 17

first line for managing constipation in pregnancy

Answer 17

moderate physical activity, increase dietary fiber and fluid intake

Question 18

Why do pregnant women experience constipation?

Answer 18

uterus compresses colon and increase in progesterone levels

Question 19

second line for managing constipation in pregnancy

Answer 19

bulk forming laxatives (psyllium) or stool softener (docusate)

Question 20

Third line for constipation in pregnancy

Answer 20

non saline osmotic laxative (PEG)

Question 21

Fourth line for constipation in pregnancy

Answer 21

short term use of stimulant laxatives (bisocodyl, senna)

Question 22

Constipation medcations to avoid in pregnancy

Answer 22

magnesium citrate, sodium phosphate, castor oil, mineral oil

Question 23

Why do pregnant women get hemorrhoids?

Answer 23

increased abdominal pressure by large uterus → vascular engorgement and venous stasis

Question 24

Medications for hemorrhoids a pregnant woman should avoid

Answer 24

NSAID

Question 25

First line for treating hemorrhoids in pregnancy

Answer 25

increase dietary fiber and fluid intake

Question 26

second and third line treatments for hemorrhoids in pregnancy

Answer 26

stool softeners, sitz baths | topical anesthetic, skin protectant and astringent

Question 27

4th and last line for hemorrhoids in pregnancy

Answer 27

hydrocortisone suppositories | surgery

Question 28

what percent of women have improvements in migraines in pregnancy?

Answer 28

60-70%

Question 29

What can you use for headaches during pregnancy?

Answer 29

acetaminophen

Question 30

Use to treat migraine headaches in pregnancy

Answer 30

sumatriptan

Question 31

why do pregnant women experience allergic rhinitis?

Answer 31

nasal congestion due to vascular engorgement of nasal passages and hormonal effects on mucus secretion

Question 32

what drugs can you use to treat allergic rhinitis in pregnancy?

Answer 32

intranasal steroid (intranasal cromolyn) → oral antihistamine → intranasal decongestant (oxymetazoline)

Question 33

Drugs for allergies to avoid in pregnancy

Answer 33

oral decongestants, initiating or altering immunotherapy, systemic budesonide and triamicinolone, fexofenadine

Question 34

women who are not diagnosed with diabetes should undergo screening with OGTT @

Answer 34

24-28 weeks

Question 35

first line therapy for gestational diabetes

Answer 35

insulin

Question 36

2nd and 3rd line drug therapy for gestational diabetes

Answer 36

metformin | glyburide

Question 37

what do you use to treat hypothyroidism in pregnant patient?

Answer 37

levothyroxine (may need to increase dose)

Question 38

Drugs used to treat hyperthyroidism in pregnancy

Answer 38

propylthiouracil → 1st trimester | methimazole → 2nd and 3rd trimesters

Question 39

Thyroid medication to avoid in pregnancy

Answer 39

iodine 131

Question 40

4 categories of hypertension in pregnancy

Answer 40

preeclampsia-eclampsia chronic chronic with superimposed preeclampsia gestational

Question 41

Goal BP in pregnancy

Answer 41

120-160/80-105

Question 42

Pharmacotherapy safe for hypertension in pregnancy

Answer 42

labetolol nifedipine methyldopa

Question 43

hypertension meds to avoid in pregnancy

Answer 43

ACE inhibitors, ARBs, renin inhibitors, mineralocorticoid receptor antagonists

Question 44

anticoagulation therapy safe in pregnancy

Answer 44

LMWH or UFH

Question 45

anticoagulation therapy to avoid in pregnancy

Answer 45

warfarin, DOAC, fondaparinus, lepirudin, bivalirudin

Question 46

Drugs approved for UTI in pregnancy

Answer 46

penicillins and cephalosporins

Question 47

antibiotics to avoid for UTI in pregnancy

Answer 47

``` sulfa drugs (3rd trimester), trimethoprim (1st trimester), fluoroquinolones, tetracycline Nitrofurantoin (caution in 1st trimester & last month) ```

Question 48

Definition of preterm labor

Answer 48

cervical dilation or effacement with regular uterine contractions between 20 and 37 weeks gestation

Question 49

administered to preterm baby to promote maturation of fetal lungs and other organ systems

Answer 49

antenatal corticosteroids → betamethasone or dexamethasone

Question 50

Who should receive antenatal steroids in pregnancy?

Answer 50

women 24-34 weeks gestation at risk for delivery within 7 days

Question 51

administered to preterm baby to provide fetal neuroprotection (reduces risk for cerebral palsy)

Answer 51

magnesium

Question 52

drug used to prolong delivery

Answer 52

tocolytic

Question 53

why would you administer a tocolytic in preterm labor?

Answer 53

allow for administration of antenatal steroids or magnesium | transportion of mother to another facility

Question 54

ADE of nifedipine (CCB) in preterm labor

Answer 54

hypotension or reduction in uroplacental blood flow

Question 55

ADE of prostaglandin inhibitors (NSAID) in preterm labor

Answer 55

increased risk of premature closure of PDA if used > 32 weeks for > 48 hours

Question 56

ADE of B-adrenergic receptor agonists in preterm labor

Answer 56

tachycardia, arrhythmia, hyperkalemia, hyperglycemia, hypotension, pulmonary edema

Question 57

ADE of magnesium sulfate in preterm labor

Answer 57

rare (unless at toxic levels) tetany, cardiac arrest, respiratory depression

Question 58

indications for labor induction

Answer 58

post term pregnancy, maternal medical conditions (DM, renal disease, COPD, HTN, pre-eclampsia, infections), fetal compromise or demise

Question 59

Drugs that cause cervical ripening/labor induction

Answer 59

misoprostol and dinoprostone

Question 60

this drug is synthetic PGE1 analogue that is administered intravaginally that causes cervical ripening

Answer 60

misoprostol

Question 61

This drug is PGE2 vaginal gel or insert that causes cervical ripening

Answer 61

dinoprostone

Question 62

This drug induces labor by stimulating uterine contractions

Answer 62

oxytocin (pitocin)

Question 63

nonpharmacological ways to induce labor

Answer 63

mechanical cervical dilator, membrane stripping, amniotomy, nipple stimulation

Question 64

medications to avoid in breastfeeding

Answer 64

amphetamines, cocaine, chemo, lithium, benzo, ergotamine, nicotine

Question 65

medications that can decrease milk produciton in breast feeding women

Answer 65

alcohol, dopamine agonists, estrogen, testosterone, pseudophedrine, high dose steroids, strong antihistamines

Question 66

medications that can increase milk production (galactagogues)

Answer 66

metoclopramide and fenugreek

Question 67

medicaitons likely to be excreted in breast milk

Answer 67

lipophilic, unionized; weak bases, low MW, not highly bound, high maternal plasma concentration