Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

pharmacotherapy 3270 > pregnancy and breastfeeding > Flashcards

pregnancy and breastfeeding Flashcards

1
Q

how is absorption of drugs affected in pregnancy? (e.g. GI motility, gastric pH and pulmonary alveolar drug uptake)

A

-GI motility is decreased
-gastric pH is increased therefore more basic
-pulmonary alveolar drug uptake is increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how is the metabolism of drugs affected in pregnancy? (e.g. hepatic metabolism)

A

-CYP 3A4 and 2D6 enzymes are increased
-CYP 1A2, xanthine oxidase and N-acetyltransferase is decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is the distribution of drugs affected in pregnancy? (e.g. Vd and albumin binding)

A

-Vd is increased
-albumin binding is decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how is the elimination of drugs affected in pregnancy? (e.g. renal blood flow and GFR)

A

-renal blood flow is increased
-GFR is increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the three main questions that should be asked when assessing risk for drugs in pregnancy.

A
  1. can the drug cross the placental barrier
  2. is the fetus at a vulnerable developmental stage
  3. is the drug teratogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when is the fetus fully functional (in weeks)

A

18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what gets transferred from mom to baby?

A

-oxygen and nutrients
-antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what gets transferred from baby to mom?

A

-CO2
- waste products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when do antibodies get transferred to the fetus?

A

after week 28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what characteristics prevent drugs from crossing the placental barrier?

A

-high molecular weight
-strong ionization
-high protein binding
-high water solubility (therefore lipophilic drugs cross more rapidly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what molecular weight of drugs cross the placental barrier readily?

A

<500 Da

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what molecular weight of drugs cross the placental barrier more slowly?

A

600-1000 Da

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what molecular weight of drugs do not cross the placental barrier in significant amounts?

A

> 1000 Da

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are two examples of drugs that do not cross the placental barrier in significant amounts?

A

heparin and insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

is the fetal or maternal pH more acidic?

A

fetal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

do weak acids or weak bases cross the placental barrier?

A

weak bases - once in fetal circulation, become ionized and less likely to diffuse back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is an example of a class of lipophilic drugs that cross the placental barrier

A

opioids!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what period of fetal developing is there the greatest risk and why?

A

3-8 weeks due to organogenesis - formation and differentiation of organs and organ systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

of, relating to, or causing developmental malformations

A

teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what 5 things should be considered when determining if a drug is teratogenic?

A

-studies
-biological plausibility
-pattern of anomalies
-duration, dose and health of mother and baby
-time of exposure (what developmental stage is fetus exposed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what kind of studies are conducted to determine if a drug is teratogenic?

A

-animal studies
-cohorts
-pregnancy registries
-case reports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

true/false: the baby is only susceptible to teratogenic effects from drug therapy during the first three months of the pregnancy

A

false - first three months is the most risk for congenital malformations but fetus is always developing throughout the pregnancy therefore always a risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when can neural tube defects occur (in weeks) if the fetus is exposed to a teratogen

A

3-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD)

A

spina bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what will occur if a fetus is exposed to a teratogen at weeks 5-6
-small eyeballs -heart abnormalities -facial cleft
26
what will occur if a fetus is exposed to a teratogen at week 6
-mixed sexual characteristics -cleft lip/palate
27
what will occur if a fetus is exposed to a teratogen at weeks 7-8
-heart valve malformations -shortness of the head -short fingers/toes
28
this is an example of a teratogen that was used in the 50's and 60's as a sedative/anxiolytic. it was widely used in the 1st trimester of pregnancy. several years later there was a strong relationship between this drug and limb malformations in the babies
thalidomide
29
what other effects may occur if the fetus is exposed to a teratogen?
-fetal loss -limb deformaties -cognitive/behavioural problems -low birth weight -carcinogenesis -fetal/neonatal toxicity or withdrawl
30
_____ is a drug that caused vaginal cancer in babies once they became adolescents. it was used to prevent miscarriages and still births
DES - diethylstilbesterol
31
what are some discriminating features of fetal hydantoin syndrome?
- flat midface - short nose -indistinct philtrum - thin upper lip
32
exposure to this teratogen may cause: - developmental delay - dysmorphic craniofacial features - short fingers
phenytoin (anti-seizure medication)
33
exposure to this teratogen may cause: - prenatal and postnatal growth retardation -facial abnormalities -CNS dysfunction
alcohol
34
a drug is more likely to cross the placenta if it has: a) high molecular weight >500 Da b) low protein binding c) high water solubility d) properties of a weak acid
B - low protein binding
35
what are some known examples of teratogens to watch out for
- ACE inhibitors - tetracyclines - corticosteroids (systemic) - cannabis - cocaine - Ethanol - misoprostol
36
can acetaminophen be used in pregnancy?
in low doses for short period of time it can be used - not recommended if not needed
37
how can the risks be minimized in terms of teratogenic drugs
- avoid drugs with known teratogenic effects -use single entity drugs - use drugs that have difficulty crossing the placenta - use lowest effective dose
38
what can you do to minimize the risk of teratogenic effects for planned pregnancy?
- taper and discontinue unecessary drugs - switch to a safer alternative - if poss. wait until medical condition is resolved before getting pregnant
39
what is folate/folic acid necessary for?
preventing neural tube defects
40
folic acid can be found in our diet. how much is bioavailable?
50%
41
folic acid can also be supplemented. how much is bioavailable?
100%
42
what foods is folate/folic acid found in?
dark leafy greens, oranges, fortified grains and corn
43
what individuals put the fetus at high risk for neural tube defects?
women or men with - personal history of NTD - previous pregnancy with NTD
44
what individuals put the fetus at moderate risk for neural tube defects?
women or men with: - family history with NTD (second or third degree relative) women with: - maternal diabetes (I or II) - GI malabsorption conditions (e.g. Crohns, celiac, kidney disease, alcohol misuse) -teratogenic meds
45
what individuals put the fetus at low risk for neural tube defects?
- no history of NTD
46
what is the dosing of folic acid for those with low risk of NTD
0.4mg 3 months before conception until 4-6 weeks postpartum or when completed breastfeeding
47
what is the dosing of folic acid for these with moderate risk of NTD
1mg 3 months before conception and 3 months after conception until 4-6 weeks postpartum or when completed breastfeeding
48
what is the dosing for folic acids for those with high risk of NTD
4-5mg 3 months before conception and 3 months after conception and then 0.4-1mg until 4-6 weeks postpartum or when completed breastfeeding
49
what are some unintended effects of supplementation of folic acid?
- mask vitamin B12 anemia - make asthma in baby - increase colorectal cancer in mom - increased probability of twins (also caused by shitty diet)
50
what is the recommended dose of iron in pregnancy
16-20mg
51
what benefits does iron supplementation have?
- supports baby's Brian development - builds baby's iron stores in third trimester - lowers risk of anemia in mom -may lower risk of low birth weight in baby
52
what is the recommended dose of calcium in pregnancy?
<18 years: 1300mg/day >18 years: 1000mg/day
53
what is the recommended dose of vitamin D in pregnancy?
600 units/day
54
what benefits does calcium and vitamin D supplementation have
- supports fetal skeletal development - maintains maternal stores - reduces the risk of hypertension and pre-ecclampsia
55
what is the recommended dose of iodine in pregnancy?
150mcg/day
56
- increased requirement to maintain maternal metabolism - essential for baby's neurological development
iodine
57
what benefits does supplementing with a multivitamin have (e.g. folic acid + multivitamin)?
- decreased risk of congenital anomalies (heart, oral facial clefts, limb defects) -decreased risk o paediatric cancers (brain tumours and leukemia)
58
this vitamin can be teratogenic if > 10,000 units or 3000 mcg/day
A
59
this type of immunization have the same adverse reactions in pregnant and breastfeeding women as they do in the regular population
inactivated vaccinations
60
this type of immunization should generally NOT be given during pregnancy because of a theoretical risk of disease transmission to the baby
live vaccinations
61
what are some signs of a miscarriage
- heavy bleeding (soaking 2 pads an hour) - cramping - fever - weakness or other signs of infection
62
what might you use to treat a patient experiencing pain with a miscarriage
acetaminophen or ibuprofen
63
what might you use to treat a patient experiencing nausea with a miscarriage
dimenhydrinate (gravol)
64
what medication is used to help carry out a miscarriage
misoprostol and mifepristone
65
how many ducts are there per nipple
15-25
66
true/fasle: size is related to milk production
false
67
know the oxytocin/prolactin cycle
1. infant starts suckling 2. stimulation of nerve endings in moms nipple/areola sends signal to hypothalamus/pituitary 3. pituitary releases oxytocin and prolactin 4. hormones travel via blood stream to mammary gland to stimulate milk production and let down
68
know the function of prolactin and oxytocin
oxytocin: milk ejection reflex (milk letdown) prolactin: milk production
69
when does lactation occur?
30-40 hours after birth
70
this is the first milk produced - yellow in colour. delivery occurs until days 2-5. also known as "liquid gold" thick and small in quantity . high in immunoglobulins/antibodies
colostrum
71
this type of milk occurs from days 2-5 until days 10-14 - light yellow in color. high in fat, lactose, water-soluble vitamins
transitional milk
72
what type of immunity is the transfer of immunoglobulins/antibodies from mom to baby via milk?
passive immunity
73
has a white to blue tinge, 90% water and 10& fats, carbs and proteins
mature milk
74
this is a type of mature milk; beginning of a feed. higher in lactose, water, vitamins and protein
foremilk
75
this is a type of mature milk; after initial milk release. higher in fat
hindmilk
76
what are some beneficial effects of breastfeeding for baby?
- decrease in gastroenteritis - decrease in DM - decrease in cancer
77
what are some beneficial effects of breastfeeding for mom
- decrease in postpartum bleeding - more rapid uterine involution - burns 500-600 calories/day - decreased risk of postpartum depression
78
what are some contraindications to breastfeeding
- galactosemia (rare disorder where baby cannot tolerate breastmilk) - if the mom has the following conditions: HIV, herpes on both breasts, TB
79
what are the three main questions for assessing the risk of drugs in breast milk
1. is the drug secreted into the breastmilk 2. is it harmful for the baby to ingest this particular drug at this concentration 3. can the drug decrease or stop lactogenesis
80
what type of transport are drugs usually secreted into the milk by?
passive diffusion
81
what four factors determine if the concentration of a drug in breastmilk EXCEEDS that in plasma
- low molecular weight - lipophilic - low protein brining - long half life
82
true/false: most drugs have a milk:plasma < 1
true
83
true/false: in general, RID (relative infant dose) < 10 % is thought to be safe
true
84
what are some substances harmful to lactogenesis
- alcohol - nicotine -estrogen (oral contraceptives) - pseudoephidine - dehydration due to vomitting or diarrhea - dopaminergic agents (buproprion)
85
how can we determine if baby is getting enough milk
- appropriate gains in weight, length and head circumference - hear swallowing when fedding - breasts feel softer after feeding - no signs of dehydration (urine and stools)
86
what are non-charm options if not getting enough milk
- try and get the best possible latch, latch is KEY for successful breastfeeding - increase duration and frequency of feeds - feed lying on side - breast compressions - switch sides - refer to lactation consultant
87
what pharmacological treatment may be recommended for milk insufficiency
-domperidone -metformin -metoclopramide
88
this is a dopamine type 2 receptor blocker which is located in the pituitary gland and increases prolactin production - does not readily cross the BBB. acts on parts of the CNS outside the BBB (CTZ of the medulla -> anti nausea effects). before using, screen for comorbities and QT prolonging drugs
domperidone
89
herbal; taste and door resemble maple syrup. ADR = diarrhea, increased asthma symptoms, decreased blood glucose
fenugreek
90
herbal; low oral bioavailability. ADR = mild diarrhea, headache, skin reactions
milk thistle
91
what are some non-charm options for milk oversupply or engorgement
- decreased nipple stimulation (suckling, pumping, etc) - well fitting bra - expressing some milk to relieve symptoms - cold cabbage leaves for pain/swelling
92
what is the most common cause of nipple pain
poor latch
93
know the management for nipple pain
- warm nipple after feeding - expose nipples to air as much as possible - protect nipples from rubbing on clothing after feeding with breast shells - ointment: jack newmans all purpose nipple ung
94
what should the mother do if baby cannot be put to breast due to pain
- may be able to take a 3-5 day break tp heal - avoid rubber nipples on bottle thus finger or cup feed
95
what conditions should be ruled out regarding nipple pain?
- yeast infection: treat with jack Newmans APNO, fluconazole or grapefruit seed extract -mastitis: redness, pain, fever, chills, ashiness, fatigue. usually caused by staph aureus. medical emergency

pharmacotherapy 3270 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions