Pregnancy and Lactation Flashcards
A pregnant female approaches the pharmacy counter with a bottle of ibuprofen. She informs the pharmacy intern that she has a headache and that she has been told that ibuprofen is safe to take during pregnancy. Which of the following is correct regarding the use of NSAIDs during pregnancy?
a. Ibuprofen is safe to use during the 3rd trimester.
b. NSAIDs shouldn’t be taken regularly but are safe to take PRN.
c. Naproxen is the safest option in pregnancy.
d. NSAIDs aren’t recommended, acetaminophen is preferred.
e. The prescription drug, etodolac, is the safest NSAID option in pregnancy.
d
Which of the following is a preferred tx for constipation during pregnancy?
a. Prokinetic agents, such as metoclopramide
b. Fiber, such as psyllium
c. Stimulant laxatives, such as senna
d. Osmotic laxatives, such as polyethylene glycol
e. Lubricant laxatives, such as mineral oil
b
Fiber is the 1st line tx for constipation in pregnancy. Obtaining fiber from the diet is preferable, but often supplemental fiber is needed.
In October, KM comes in for a routine checkup at 30 weeks pregnant. She has not received any vaccines in the past year. Which vaccines should KM be given at her appointment?
a. Inactivated influenza
b. MMR
c. Tdap
d. Shingrix
e. Hib
a, c
- All pregnant women should receive the inactivated flu vaccine during flu season.
- Tdap is recommended once during each pregnancy (optimally between 27 and 36 weeks).
BB is in the 3rd month of pregnancy. She has a condition that’s usually treated with a Pregnancy Category X drug. Select the correct statement concerning Pregnancy Category X:
a. Contraindicated in pregnancy, under all circumstances
b. Can be used if the mom has a serious condition
c. Can be used if the life of the fetus is in danger
d. Safe to use in the 1st trimester only
e. Can cause infertility in males and females
a
JB is a 17 y/o female who enters the pharmacy to pick up her BC pills. The pharmacist would provide a benefit by ensuring that JB is receiving adequate intake of which B vitamin?
a. B2
b. B6
c. B9
d. B12
e. B3
c
- Folic acid (vitamin B9) is recommended for all women of childbearing age.
- Folic acid is in many foods, including fortified cereals, dried beans, leafy green veggies, and OJ.
- An OTC multivitamin that contains 400-800 mcg of folic acid can be recommended.
Which of the following are preferred medications for HTN in pregnancy?
a. Labetalol
b. Lisinopril
c. Nifedipine
d. Methyldopa
e. Valsartan
a, c, d
ACE inhibitors and ARBs are contraindicated during pregnancy.
Which stage of pregnancy is the most susceptible to birth defects caused by teratogens?
a. 1st trimester
b. 2nd trimester
c. 3rd trimester
d. 30 days prior to delivery
e. 7 days prior to delivery
a
The first trimester (weeks 0-12) is when organ development occurs, making the embryo most susceptible to teratogens during this period. It’s best to avoid all drugs during the first trimester and use lifestyle recommendations instead, if possible.
Which of the following is a preferred tx for allergy symptoms (runny nose, itchy eyes) during pregnancy?
a. Echinacea
b. Pseudoephedrine
c. Chlorpheniramine
d. Phenylephrine
e. Benzonatate
c
- Chlorpheniramine (Chlor-Trimeton) is a 1st generation antihistamine and is a DOC in pregnancy.
- Other 1st generation antihistamines may be used, such as diphenhydramine (Benadryl).
Which of the following is the preferred tx for VTE during pregnancy?
a. Enoxaparin
b. Pneumatic compression devices
c. Warfarin
d. Clopidogrel
e. Aspirin
a
- LMWHs, such as enoxaparin, are 1st line for tx of VTE during pregnancy.
- If VTE prophylaxis is needed for a pregnant pt, either pneumatic compression devices or LMWH is preferred.
- Warfarin is contraindicated for use in any stage of pregnancy but cam be used selectively in some pregnant pts with mechanical valves or inherited thrombophilias.
Select the correct definition for the meaning of Pregnancy Category D:
a. Studies in animals or humans show fetal abnormalities; use in pregnancy is contraindicated.
b. Positive evidence of fetal is available, but the benefits may outweigh the risk if it’s a life-threatening or serious disease.
c. No controlled studies in humans have been performed and animal studies have shown AEs, or studies in humans and animals aren’t available; give only if potential benefits outweighs the risk.
d. Either animal studies haven’t demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal studies have shown an AE that wasn’t confirmed in controlled studies in females in the 1st trimester.
e. Controlled studies in animals and women have shown no risk in the 1st trimester, and possible fetal harm is remote.
b
Select the correct definition for the meaning of Pregnancy Category A:
a. Studies in animals or humans show fetal abnormalities; use in pregnancy is contraindicated.
b. Positive evidence of fetal is available, but the benefits may outweigh the risk if it’s a life-threatening or serious disease.
c. No controlled studies in humans have been performed and animal studies have shown AEs, or studies in humans and animals aren’t available; give only if potential benefits outweighs the risk.
d. Either animal studies haven’t demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal studies have shown an AE that wasn’t confirmed in controlled studies in females in the 1st trimester.
e. Controlled studies in animals and women have shown no risk in the 1st trimester, and possible fetal harm is remote.
e
Select the lifestyle changes that can help reduce the symptoms of heartburn during pregnancy:
a. Sleep on the right side of the body to prevent reflux.
b. Split large meals into smaller, more frequent meals.
c. Avoid foods that worsen heartburn.
d. Avoid eating three hours prior to bedtime.
e. Elevate the head of the bed while sleeping.
b, c, d, e
Which of the following is true about the tx of hypothyroidism during pregnancy?
a. Tx of hypothyroid can cause birth defects.
b. Levothyroxine is the TOC and will require a dose increase.
c. Levothyroxine is the TOC, and the dose will need to be decreased.
d. Propylthiouracil is the TOC.
e. Methimazole is the TOC.
b
- Hypothyroidism in pregnancy is always tested and treated if present.
- If hypothyroidism is untreated, severe consequences can occur, including preeclampsia, low birth weight, and fetal death.
- Levothyroxine is the DOC, and d/t an increased volume of distribution during pregnancy, the dose will need to be increased.
A pregnant woman at 38 weeks gestation has tested positive for bacteria in her urine that’s sensitive to amoxicillin, cephalexin, ciprofloxacin, sulfamethoxazole-trimethoprim, and nitrofurantoin. She has no known drug allergies. Which antibiotic is preferred to treat the infection?
a. Nitrofurantoin
b. Ciprofloxacin
c. Cephalexin
d. SMX-TMP
e. UTI tx isn’t recommended during pregnancy unless symptomatic.
c
- Cephalexin is a preferred tx for UTIs during pregnancy.
- Bactrim and nitrofurantoin shouldn’t be used in the last 2 weeks of pregnancy.
- Quinolones shouldn’t be used during any stage of pregnancy.
- Bacteriuria must be treated in pregnant patients, even if asymptomatic.
Which organization publishes most of the recommendations for drug use during pregnancy?
a. ADA
b. ACOG
c. AHA
d. AMA
e. NCEP
b
The American College of Obstetricians and Gynecologists (ACOG) sets the recommendations for the safe and effective use of meds for most female conditions, including pregnancy.
