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Endocrine and Women's Health > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Physiology of Pregnancy

A
  1. fertilization: sperm attaches to the outer layer of the egg, penetrates, and the sperm and egg combine to create a new cell called zygote
  2. 6 days after fertilization, cells are termed blastocysts
  3. hCGis nor produced in appreciable amounts
  4. implantation begins with blastocysts resting on and beginning growth into endometrial wall.
  5. by day 10, blastocysts is implanted under the endometrial surface and receives nutrients by maternal blood supply.
  6. on first day of third week post fertilization, cells are known as embryos
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2
Q

parity

A

number of pregnancies after 20 weeks gestations

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3
Q

gravida

A

of pregnancies regardless of gestation

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4
Q

abortus:

A

of miscarriages/ abortions

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5
Q

how to determine gestational age

A

day1 of pregnancy (gestational age) starts from the first day of menses, even though conception has not taken place yet

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6
Q

gestational age cut offs

A

1st trimester: weeks 1-13
2nd trimester: weeks 14-26
3rd trimester: week 27 until birth

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7
Q

risks of harming fetus at different time periods

  1. week 3 and 4
  2. weeks 5-10
  3. week 11 to birth
A
  1. all or nothing effect. destroy fetus or have no ill effects
  2. (embryonic period) major congenital anomalies likely
  3. (fetal period) functional defects ad minor anomalies possible
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8
Q

when do most miscarriages occur ?

A

during weeks 3 and 4

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9
Q

when do organs usually develop

A

in embryonic period (weeks 5-10)

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10
Q

when do organs start to develop their functions

A

during fetal period (weeks 11-40

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11
Q

what can happen if teratogens are exposed during weeks 5-11 of organogenesis.

examples of these teratogens

A

structural abnormalities

  1. methotrexate
  2. cyclophospamide
  3. diethylstilbestrol
  4. lithium
  5. retinoids
  6. thalidomide
  7. nti epileptic drugs (AEDs)
  8. coumadin
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12
Q

what can happen if teratogens are exposed after 11-weeks of organogenesis.

examples of these teratogens

A

functional abnormalities, growth retardations, CNS or other abnormalities or death

  1. NSAIDS
  2. tetracyclines
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13
Q

3 mechanisms on how medications can harm fetus

A
  1. act directly on the fetus
  2. alter the function of the placenta, constricting blood vessels and decreasing and nutrients.
  3. cause muscles of uterus to contract forcefully , triggering preterm labor and delivery
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14
Q

what are the most common congenital anomalies

A

neural tube defects, cleft palate/lip, cardiac anomalies

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15
Q

main way to prevent neural tube defects

A

folic acid supplementation

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16
Q

normal folic acid supplementation dose

A

0.4-09 mg daily

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17
Q

folic acid supplementation dose for women on anti epileptic drugs and why?

A

4 mg daily

AEDs increase risk of neural tube defects

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18
Q

who needs higher folate doses

A

women who previously delivered a child with NTD or are taking AEDs (valproic acid)

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19
Q

principles for drug use during pregnancy

A
  1. select drugs that have been used safely for a long time
  2. prescribe doses at the lower end of the dosing range
  3. eliminating non essential meds and discouraging self-medication
  4. avoiding meds known to be harmful
20
Q

why do we not use pregnancy categories?

A

do not take into account risk vs benefit of taking the drug

21
Q

new labeling

A
  1. pregnancy
  2. lactation
  3. females and males of reproductive age
22
Q

what is the placenta

A

organ of exchange for a number of substances including meds btw. mother and fetus. mostly by DIFFUSION

23
Q

functions of placenta

A
  1. transfers oxygen and nutrients from mother to fetus

2. permits release of CO2 and waste from the fetus

24
Q

mechanism of placental delivery 4 properties

A
  1. lipophilicity
  2. molecular weight
  3. protein binding
  4. pH
25
Q

lipophilicity

A

high lipophilic drugs will crossfire readily due to lipid membrane of the placenta

26
Q

molecular weight

A

MW < 500 daltons readily crosses the placenta

27
Q

protein binding

A

unbound drugs cross more easily

high protein bound drugs cross more as pregnancy progresses due to increases in fetal albumin and decreases in maternal albumin

28
Q

pH

A

weak bases diffuse more easily. then becomes ionized in fetal circulation, so wont diffuse back

29
Q

PKPD changes during pregnancy. what are their effects on medications

  1. increase in plasma volume, co, and GFR
  2. increase in body fat
  3. decrease in plasma proteins
  4. hepatic perfusion decreases
  5. N&V
  6. delayed gastric emptying
  7. increase in gastric pH
  8. increased estrogen and progesterone levels
A
  1. lowers concentration of renal cleared meds
  2. increase Vd of fat soluble meds
  3. increase vd of high protein bound meds.
  4. increased hepatic extraction of the drug
  5. altered absorption
  6. altered absorption
  7. absorption of weak acids and bases affected
  8. alter liver enzyme activity
30
Q

pregnancy medication considerations

A

consider drug/disease risks/ benefits to mom AND fetus

do not make recommendations solely based on pregnancy categories

regardless of risk, counseling on all medications used in pregnancy and teratogenic risk is recommended

31
Q

preconception risk factors

  1. teratogens
  2. Lifestyle factors
A

teratogens:

  1. AEDs-
    a. can cause NTD, use west dose possible and b.supplement with folic acid 4mg daily
  2. isotretinoin:
    a. can cause miscarriage and other problems
    b. use effective pregnancy prevention
  3. warfarin
    a. cause fetal warfarin syndrome
    b. switch to LWMH

Lifestyle factors:

  1. alcohol misuse
    a. fetal alcohol syndrome
    b. cease alcohol before conception
  2. tobacco use
    a. can cause preterm birth and low birthweight
    b. idealy cease before conception. use non pharm therapies. NRT controversial
  3. obesity
    a. can cause nth, preterm delivery, DM, HTN, etc.
    b. weight loss w. appropriate nutritional intake before pregnancy
32
Q

constipation

non pharm
pharm
notes

A

non pharm: physical activity, increase fiber

pharm:
a. stool softeners : decussate sodium
b. osmotic lax: (lactulose, sorbitol,PEG
c. Stimualnt lax: senna or bisacodyl

notes: DO NOT USE castor or mineral oil. stimulate uterine contractions.
constipation can lead to hemorrhoids or exacerbate them

33
Q

hemmoroids

non pharm
pharm

A

non pharm: dietary fiber, increase fluid intake, sitz bath

pharm: laxatives, stool softeners, topical anesthetics, or hydrocortisone

34
Q

GERD

Non pharm

pharm

notes:

A

non pharm small frequent meals, no food before bed, avoid alcohol/tobacco/ certain foods

pharm:
antacids: TUMS (Al or Mg prep good too)
H2RA: cimetidine (best)
PPI: omeprazole (if H2RA fails)

notes: don’t use sodium bicarb or mg trisilicate

35
Q

N&V

non pharm

pharm

notes

A

non pharm: small, frequent meals, bland meals

pharm: 
OTC: b6 or doxylamine; ginger
RX: 1st line: doxylamine +B6 (Rx Diclegis) (or antihistamines (can cause sedation) and phenothiazines)
2nd line: metaclopramide
3rd: ondansetron
36
Q

gestational diabetes

risk factors

A 
BMI>25
high risk race or ethnicity
previous gestational diabetes
HTN
CVD
strong hx of diabetes
37
Q

gestational diabetes

non pharm
pharm
notes

A 
non pharm (1st line treatment):
exercise, BG monitoring 4x daily,

pharm:
insulin

notes: metformin and glyburide have also been used but are inferior.

38
Q

hypertension disorders of pregnancy

main definition.

define further classifications

a. chronic HTN
b. chronic HTN w. superimposed preeclampsia
c. gestational HTN:
d. pre-eclampsia:
e. eclampsia

A

> 140/90 mmhg

a. HTN dx prior to pregnancy or before 20 weeks gestation. preexisting and does not resolve after pregnancy
b. CHRONIC HTN superimposed preeclampsia
c. HTN+ no proteinuria developing after 20 weeks gestation
d. HTN+ proteinuria
e. eclampsia: HTN+proteinuria, + seizures

39
Q

hypertension

non pharm:

pharm:

a. HTN
b. preeclampsia
c. eclampsia

notes

A

non pharm: activity restriction, stress reduction, exercise, calcium

Pharm:
a. htn: labetalol and nifedipine (first line). methyldopa may be used
B.antihypertensives +aspirin 81 mg po daily. only cure is delivery of the placenta
c. eclampsia: antihypertensives +aspirin 81 mg po daily. only cure is delivery of the placenta. SEIZURE: magnesium sulfate IV for prevention of seizures (supers to other AEDs)

notes: DO NOT USE atenolol, ACE-I, ARBS, renin inhibitors

40
Q

thyroid abnormalities

non pharm:

pharm:

A

non pharm: may resolve after 20 weeks.
transient hyperthyroidism for 6 mo, then transient hypothyroidism, then euthyroid (1 yr)

Pharm:
levothyroxine if severe hypothyroid, >6 month, breast feeding, or another pregnancy
methimazole or PTU for hyperthyroid (benefit outweigh risks)
TSH goals vary based on trimester

41
Q

thromboembolism

pharm

notes:

A

pharm: LMWH preferred over UFH and oral agents
continue for duration of pregnancy + weeks post partum (min duration should not be less than 3 months

recurrent VTE and prosthetic heart valves: LMWH and monitor anti Xa levels

notes: DO NOT USE WARFARIN

42
Q

UTI

what happen if untreated

treatment

A

can cause pyelonehritis

beta lactase (penecillin, cephalasporins) or nitrofurantoin

43
Q

STI’s

risk of not treating

A

can cross placenta, infect baby prenatally, be transmitted during birth, cause neonatal infection or pose a threat to preterm labor.
such as…

BV
chlamydia
genital herpes
gonorrhea
syphillis
trichomoniasis
44
Q

headaches

primary
secondary

non pharm:

pharm

A

primary headaches: common
secondary headaches: preeclampsia, stroke, etc.
non pharm: relaxation, stress management, biofeedback

pharm: acetaminophen

45
Q

seizures

treatment

A

AEDs at lowest dose possible with supplementation of folic acid at 4 mg/ day. risks of uncontrolled seizures, particularly tonic clonic seizures, t the fetus are considered to be greater than those associated with AEDs.

46
Q

depression

treatment

A

while paroxetine may cause an increase in cardiac malformations, others are generally not teratogenic

Endocrine and Women's Health (14 decks)

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