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Obstetrics > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

How does administration of a drug change in pregnancy?

A

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

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2
Q

How does dispersion of a drug change in pregnancy?

A

increase volume distribution (increase TBW, ECF, fat)

decrease serum protein

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3
Q

How does metabolism of drugs change in pregnancy?

A

decrease in CYP 1A2 and 2C19 activity

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

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4
Q

How does elimination of a drug change during pregnancy?

A

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

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5
Q

What type of medications are likely to cross the placenta?

A

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

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6
Q

When in pregnancy is the fetus most sensitive to teratogens?

A

first 8 weeks

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7
Q

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

A

studies in pregnant women show no risk to fetus

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8
Q

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

A

risk of using in pregnant women outweighs the possible benefit

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9
Q

Medications to avoid in pregnancy

A

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

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10
Q

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

A

multivitamin

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11
Q

Nausea and vomiting usually begins around ____ and usually resolves around

A

4-6 weeks

16-20 weeks

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12
Q

first line for treating nausea and vomiting in pregnancy

A

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

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13
Q

what causes GERD in pregnancy?

A

increase in progesterone resulting in relaxation of LES

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14
Q

First line management for GERD in pregnancy

A

lifestyle modifications

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15
Q

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

A

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

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16
Q

GERD drugs to avoid in pregnancy

A

sodium bicarbonate, magnesium trisilicate

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17
Q

first line for managing constipation in pregnancy

A

moderate physical activity, increase dietary fiber and fluid intake

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18
Q

Why do pregnant women experience constipation?

A

uterus compresses colon and increase in progesterone levels

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19
Q

second line for managing constipation in pregnancy

A

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

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20
Q

Third line for constipation in pregnancy

A

non saline osmotic laxative (PEG)

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21
Q

Fourth line for constipation in pregnancy

A

short term use of stimulant laxatives (bisocodyl, senna)

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22
Q

Constipation medcations to avoid in pregnancy

A

magnesium citrate, sodium phosphate, castor oil, mineral oil

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23
Q

Why do pregnant women get hemorrhoids?

A

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

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24
Q

Medications for hemorrhoids a pregnant woman should avoid

A

NSAID

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25
Q

First line for treating hemorrhoids in pregnancy

A

increase dietary fiber and fluid intake

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26
Q

second and third line treatments for hemorrhoids in pregnancy

A

stool softeners, sitz baths

topical anesthetic, skin protectant and astringent

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27
Q

4th and last line for hemorrhoids in pregnancy

A

hydrocortisone suppositories

surgery

28
Q

what percent of women have improvements in migraines in pregnancy?

A

60-70%

29
Q

What can you use for headaches during pregnancy?

A

acetaminophen

30
Q

Use to treat migraine headaches in pregnancy

A

sumatriptan

31
Q

why do pregnant women experience allergic rhinitis?

A

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

32
Q

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

A

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

33
Q

Drugs for allergies to avoid in pregnancy

A

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

34
Q

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

A

24-28 weeks

35
Q

first line therapy for gestational diabetes

A

insulin

36
Q

2nd and 3rd line drug therapy for gestational diabetes

A

metformin

glyburide

37
Q

what do you use to treat hypothyroidism in pregnant patient?

A

levothyroxine (may need to increase dose)

38
Q

Drugs used to treat hyperthyroidism in pregnancy

A

propylthiouracil → 1st trimester

methimazole → 2nd and 3rd trimesters

39
Q

Thyroid medication to avoid in pregnancy

A

iodine 131

40
Q

4 categories of hypertension in pregnancy

A

preeclampsia-eclampsia
chronic
chronic with superimposed preeclampsia
gestational

41
Q

Goal BP in pregnancy

A

120-160/80-105

42
Q

Pharmacotherapy safe for hypertension in pregnancy

A

labetolol
nifedipine
methyldopa

43
Q

hypertension meds to avoid in pregnancy

A

ACE inhibitors, ARBs, renin inhibitors, mineralocorticoid receptor antagonists

44
Q

anticoagulation therapy safe in pregnancy

A

LMWH or UFH

45
Q

anticoagulation therapy to avoid in pregnancy

A

warfarin, DOAC, fondaparinus, lepirudin, bivalirudin

46
Q

Drugs approved for UTI in pregnancy

A

penicillins and cephalosporins

47
Q

antibiotics to avoid for UTI in pregnancy

A 
sulfa drugs (3rd trimester), trimethoprim (1st trimester), fluoroquinolones, tetracycline
Nitrofurantoin (caution in 1st trimester &amp; last month)
48
Q

Definition of preterm labor

A

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

49
Q

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

A

antenatal corticosteroids → betamethasone or dexamethasone

50
Q

Who should receive antenatal steroids in pregnancy?

A

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

51
Q

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

A

magnesium

52
Q

drug used to prolong delivery

A

tocolytic

53
Q

why would you administer a tocolytic in preterm labor?

A

allow for administration of antenatal steroids or magnesium

transportion of mother to another facility

54
Q

ADE of nifedipine (CCB) in preterm labor

A

hypotension or reduction in uroplacental blood flow

55
Q

ADE of prostaglandin inhibitors (NSAID) in preterm labor

A

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

56
Q

ADE of B-adrenergic receptor agonists in preterm labor

A

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

57
Q

ADE of magnesium sulfate in preterm labor

A

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

58
Q

indications for labor induction

A

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

59
Q

Drugs that cause cervical ripening/labor induction

A

misoprostol and dinoprostone

60
Q

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

A

misoprostol

61
Q

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

A

dinoprostone

62
Q

This drug induces labor by stimulating uterine contractions

A

oxytocin (pitocin)

63
Q

nonpharmacological ways to induce labor

A

mechanical cervical dilator, membrane stripping, amniotomy, nipple stimulation

64
Q

medications to avoid in breastfeeding

A

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

65
Q

medications that can decrease milk produciton in breast feeding women

A

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

66
Q

medications that can increase milk production (galactagogues)

A

metoclopramide and fenugreek

67
Q

medicaitons likely to be excreted in breast milk

A

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

Obstetrics (17 decks)

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