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PHM 602- Pregnancy, Labor/Delivery/Lactation, Menopause > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

1st trimester length

A

Week 1- end of week 13

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2
Q

2nd trimester length

A

Week 14- end of week 26

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3
Q

3rd trimester length

A

Week 27 until birth

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4
Q

What is day 1 of pregnancy?

A

First day of menses (still counts as day 1 even though conception hasn’t taken place yet!)

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5
Q

Risk of harming the fetus at weeks 3 and 4

A

All or none effect; fetus may be fine or die via spontaneous abortion

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6
Q

Risk of harming the fetus at weeks 5-10

A

Major congenital anomalies likely

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7
Q

Risk of harming the fetus at weeks 11-birth

A

Functional defects and minor anomalies possible

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8
Q

What can harm the fetus? (Causes for birth defects and the like)

A

“Naturally occurring” congenital anomalies, other causes like genetics/chromosomal, environmental, unknown causes, medication-induced

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9
Q

Teratogens definition

A

Exposure to an agent that causes malformation of an embryo

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10
Q

Teratogenic medications during weeks 5-11 that can result in structural abnormalities

A

Methotrexate, cyclophosphamide, diethylstilbestrol, lithium, retinoids, thalidomide, anti-epileptic drugs (AEDs), Coumadin/warfarin

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11
Q

Teratogenic medications after 11 weeks that may result in growth retardation, CNS, or other abnormalities or death

A

NSAIDs, TTC ABX

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12
Q

3 mechanisms on how medications can harm the fetus

A
  1. Act directly on the fetus to cause damage, abnormal development, or death
  2. Alter the function of the placenta by causing blood vessels to construct and reduce the supply of oxygen and nutrients to the fetus
  3. Cause the muscle of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery
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13
Q

When estimating risk for whether or not a medication can be used in a pregnant patient, what do you have to consider and take into effect?

A

Consider the quality of evidence; use safety data from randomized, controlled trials if possible

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14
Q

Principles for drug use during pregnancy

A
  1. selecting drugs that have been used safely for a long time
  2. prescribing doses at the lower end of the dosing range
  3. elimination nonessential medications and discouraging self-medication
    4, avoiding medications known to be harmful (teratogens)
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15
Q

How do most drugs move from the maternal to fetal circulation?

A

Diffusion through the placenta

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16
Q

Functions of the placenta

A

Transfers oxygen and nutrients from mother to fetus and permits release for CO2 and waste from the fetus

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17
Q

Effect of lipophilicity on medication diffusion across the placenta

A

More lipophilic, will cross more readily

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18
Q

Effect of molecular weight on medication diffusion across the placenta

A

MW <5000Da readily crosses the placenta

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19
Q

Effect of protein binding on medication diffusion across the placenta

A

Unbound (low protein binding) drugs cross more easily but highly protein-bound drugs will cross more easily as pregnancy progresses

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20
Q

Effect of pH on medication diffusion across the placenta

A

Weak bases cross more easily

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21
Q

Maternal plasma volume, cardiac output, and GFR increase by ≥30-50% on medication use

A

Lowers concentration of renally cleared medications

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22
Q

Maternal increase in body fat on medication use

A

Increased Vd of fat-soluble medications

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23
Q

Maternal decrease in plasma albumin concentration on medication use

A

Increased Vd of highly protein-bound medications; unbound drugs cleared more rapidly by the liver and kidney so little effect on concentration

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24
Q

Maternal hepatic perfusion increase on medication use

A

Increased hepatic extraction of drugs

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25
Q

Maternal N/V on medication use

A

Altered absorption

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26
Q

Maternal delayed gastric emptying on medication use

A

Altered absorption

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27
Q

Maternal increase in gastric pH on medication use

A

Absorption of weak acids and bases affected

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28
Q

Maternal increase in estrogen and progesterone levels on medication use

A

Altered liver enzymatic activity (either increases or decreases removal)

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29
Q

Maternal factors that go into determining appropriate medication use

A

Will the medication harm her?
Will the medication need dosing or frequency changes due to maternal PK/PD?
How will an untreated disease impact the health of the mother and fetus?

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30
Q

Fetal factors that go into determining appropriate medication use

A

Is the medication teratogenic or able to cause fetal adverse outcomes?
Which trimester and how many weeks gestation is the infant?
How will an untreated disease impact the mother and fetus?

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31
Q

Nonpharm treatment for constipation

A

physical activity and increasing/supplementing fiber

32
Q

Pharm treatment for constipation

A

stool softener (Docusate) –> osmotic laxatives (lactulose, sorbitol, PEG) –> stimulant laxatives (Senna or bisacodyl)

33
Q

Which medications do you not use for constipation in pregnancy?

A

Castor oil and mineral oil

34
Q

Nonpharm treatment for hemorrhoids

A

Dietary fiber, increased fluid intake, sitz baths

35
Q

Pharm treatment for hemorrhoids

A

laxatives, stool softeners, topical anesthetics, hydrocortisone

36
Q

Nonpharm treatment for GERD

A

small, frequent meals, no food before bed, avoid alcohol/tobacco/food triggers

37
Q

Pharm treatment for GERD

A

TUMS, cimetidine, omeprazole OTC (reserved for if/when cimetidine fails)

38
Q

Which medications do you not use for GERD in pregnancy?

A

Sodium bicarbonate, Mg trisilicate

39
Q

Nonpharm treatment for N/V

A

Small, infrequent meals, bland meals

40
Q

OTC pharm treatment for N/V

A

B2 or doxylamine, ginger

41
Q

Rx pharm treatment for N/V

A

1st line: doxylamine and B6 (Diclegis)
2nd line: metoclopramide
3rd line: ondansetron (conflicting data though)

42
Q

Nonpharm treatment for gestational DM

A

Dietary modification, exercise, checking BG QID

43
Q

Pharm treatment for gestational DM

44
Q

BP level for HTN in pregnancy

45
Q

Chronic HTN definition

A

HTN prior to pregnancy or before 20 weeks gestation; pre-existing and doesn’t resolve post-pregnancy

46
Q

Gestational HTN definition

A

HTN with no proteinuria, developing after 20 weeks gestation

47
Q

Preeclampsia definition

A

HTN with proteinuria

48
Q

High-risk factors for preeclampsia

A

Preeclampsia in prior pregnancy, antiphospholipid syndrome, underlying medical conditions, chronic HTN, renal disease, DM

49
Q

Moderate risk factors for preeclampsia

A

Multiple gestations, nulliparity, family Hx, obesity with BMI >35, maternal age >40, ethnicity

50
Q

Preeclampsia signs and Sx

A

proteinuria, severe-persistent headache, persistent new epigastric pain, visual changes, vomiting, hyperreflexia, swelling of hands/face/feet, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), increased SCr

51
Q

Eclampsia definition

A

HTN with proteinuria AND SEIZURES

52
Q

Eclampsia signs and Sx

A

cerebral irritation, severe and persistent headaches not relieved by medication therapy, new-onset blurred vision or vision changes (flashes of light), photophobia, hyperreflexia, altered mental status

53
Q

Nonpharm treatment for HTN

A

activity restriction, stress reduction, exercise, calcium

54
Q

Pharm Tx for HTN

A

Labetalol (1st line), nifedipine ER (1st line), methyldopa

55
Q

Preeclampsia Tx

A

Same antihypertensives, ASA 81mg QD until delivery

56
Q

Eclampsia Tx

A

Same antihypertensives, ASA 81mg QD until delivery, magnesium sulfate IV for seizure prevention

57
Q

Only cure for preeclampsia and eclampsia

A

Placenta delivery

58
Q

Treatment for hypothyroidism

A

Levothyroxine

59
Q

Treatment for hyperthyroidism

A

MMI or PTU (1st trimester of pregnancy)

60
Q

Treatment for thromboembolism

A

LMWH, continue for duration of pregnancy and 6 weeks postpartum

61
Q

Treatment for UTIs

A

Beta-lactam ABX for 7-14 days (penicillin, cephalosporins) or nitrofurantoin

62
Q

Can infants be infected with STIs in utero?

63
Q

Nonpharm treatment for headache

A

relaxation, stress management, biofeedback

64
Q

Pharm treatment for headache

65
Q

Seizure management

A

Seizures may become more frequent because of changes in the mother, but the risk of uncontrolled seizures to the fetus are considered to be greater than those associated with the anti epileptic drugs

66
Q

Depression management

A

Don’t use paroxetine; switch to a different antidepressant

67
Q

Folic acid purpose

A

Prevention of NTD

68
Q

Folic acid dosing for patients who aren’t taking AEDs

A

0.4-0.9mg QD

69
Q

Folic acid dosing for patients taking AEDs and/or previously delivering a child with NTD

70
Q

Smoking cessation for prenatal care

A

Cease tobacco use prior to conception, can try the gum, TD patch as long as they limit the time they wear to to 16 hrs/day, bupropion

71
Q

Alcohol cessation for prenatal care

A

Stop consumption prior to conception

72
Q

Illicit drug cessation

A

Stop before conception

73
Q

Up-to-date vaccinations

A

…GET VACCINATED

74
Q

AED management

A

use lowest possible AED dose to maintain control, folic acid 4mg QD, use effective pregnancy protection

75
Q

Isotretinoin management

A

use effective pregnancy prevention, on REMS list

76
Q

Warfarin management

A

Switch to LMWH prior to becoming pregnant, use effect pregnancy protection

77
Q

Obesity management

A

Weight loss with appropriate nutritional intake before pregnancy

PHM 602- Pregnancy, Labor/Delivery/Lactation, Menopause (4 decks)

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