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Pregnancy and lactation Flashcards

EOR exam 5

1
Q

What are the trimesters of pregnancy ?

A
  1. First trimester (1-12 weeks)
  2. Second trimester (13-27 weeks)
  3. Third trimester (28-40 weeks)
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2
Q

what biomarker confirms pregnancy?

A

Human chorionic gonadotropin hCG in urine or blood

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3
Q

what trimester is most susceptible to birth defects and why?

A

the first trimester (0-12 weeks) is when most organ development occurs, making the embryo most susceptible to birth defects caused by teratogens during this time

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4
Q

what makes a drug teratogenic?

A

It is able to cross the placenta into the fetal circulation. Teratogenic drugs should be discontinued prior to pregnancy if possible

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5
Q

what is gravida and para ?

A
  1. Gravida:the number of times the person has been pregnant
  2. Para is the number of times a patient has given birth
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6
Q

what can folate deficiency lead to ?

A

Birth defects of the brain and spinal cord (neural tube defects)

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7
Q

what are the folate requirements for non pregnant and pregnant patients?

A
  1. Non pregnant: 400mcg of dietary folate per day
  2. Pregnant: 600 mcg of DFE/day
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8
Q

what are the calcium requirements for pregnant women ?

A

Pregnant women from 19-50 years old require 1,000 mg/ day of calcium

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9
Q

what are the vit D requirements for pregnant women ?

A

Pregnant women require 600 IU/ day

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10
Q

why should the pregnant patient have adequate vit d and calcium?

A

the babys skeleton requires adequate calcium and vit d. If the mother is deficient the mothers bone health will be sacrificed to provide for the baby

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11
Q

what are the iron requirements for pregnant women ?

A

27 mg/day of iron recommended for pregnancy

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12
Q

what are the components of most prenatal vitamins?

A
  1. Folate
  2. Vit D
  3. Calcium
  4. Iron
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13
Q

[previous] category A

A

controlled studies in animals and women show no risk in the first trimester.
-Risk of fetal harm is remote

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14
Q

[previous] category B

A

Animal studies have not demonstrated a fetal risk, but no well controlled studies are available in pregnant women

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15
Q

[previous] category C

A

Animal studies have shown harm to the fetus but there are no well controlled studies in pregnant women.
-Use only if potential benefit outweighs the risk

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16
Q

[previous] category D

A

Positive evidence of risk to the human fetus is available but the benefits may outweigh the risk with life threatening or serious diseases.

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17
Q

[previous] category X

A

Studies in animals or humans show fetal abnormalities. The risk involved clearly outweigh potential benefits
-use in pregnancy is contraindicated

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18
Q

What does the updated ‘Pregnancy’ section include in prescription drug package inserts?

A

Includes risk of adverse developmental outcomes based on human and animal data. Pregnant women should be encouraged to participate in registries.

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19
Q

What does the updated ‘Lactation’ section include in prescription drug package inserts?

A

includes whether the drug/ metabolites are present in human milk

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20
Q

What does the updated ‘Females and Males of Reproductive Potential’ section include in prescription drug package inserts?

A

includes any effects on fertility and requirements for pregnancy testing and contraception

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21
Q

what are the reputable, up-to-date resources when prescribing/dispensing to pregnant women?

A
  1. Briggs’ Drugs in pregnancy and lactation
  2. LactMed
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22
Q

what vaccines are recommended in pregnancy?

A
  1. Inactivated influenza vaccine during any trimester at the beginning of flu season
  2. Tdap recommended for each pregnancy (27-36 weeks)
  3. COVID during any trimester
  4. RSV vaccines (32-36 weeks)
    Abrysvo → Pregnancy (32–36 weeks)
    Arexvy → Adults ≥60 years
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23
Q

what acne drugs are teratogenic?

A
  1. Isotretinoin
    2.Topical retinoids
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24
Q

what antibiotics drugs are teratogenic?

A

1.Quinolones
2.Tetracycline

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25
what anticoagulants drugs are teratogenic?
1.Warfarin
26
what dyslipidemia/HF/HTN drugs are teratogenic?
1. Statins 2. RAAS inhibitors (ACE/ARB/aliskiren/ Entresto)
27
what hormone drugs are teratogenic?
1. Estradiol 2. Progesterone (megestrol) 3. Raloxifene 4.Duavee 5.Testosterone 6.contraceptives
28
what migraine drugs are teratogenic?
1.dihydroergotamine 2.Ergotamine
29
what other drugs are teratogenic?
1.Hydroxyurea 2.Lithium 3.MTX 4.NSAIDs 5.Paroxetine 6.Ribavirin 7.Topiramate 8.Weight loss drugs 9.Valproic acid/Divalproex
30
what is preeclampsia
A complication of pregnancy that presents with elevated blood pressure and evidence of organ damage (proteinuria) most often to the kidneys. Typically occurs after 20 weeks gestation and can occur in women with previously normal blood pressure
31
what is the only cure of preeclampsia?
delivery of the baby
32
based on ACOG and ADA guidelines what is the ppx for preeclampsia?
1. Low dose daily aspirin at the end of the first trimester for pregnant women at risk
33
what pregnant patients are at risk for preeclampsia?
1. Diabetes 2.Renal disease 3. History of preeclampsia 4. chronic HTN
34
what is the lifestyle management for morning sickness, nausea, vomiting?
1. Lifestyle first: avoid empty stomach, eat smaller, more frequent meals, drink plenty of water, avoid spicy or odorous foods and environmental triggers
35
what is the preferred management for morning sickness, nausea, vomiting if lifestyle txt fails?
1. Pyridoxine (Vit B6) +/- 2. Doxylamine are both first line RX: Doxylamine/pyridoxine (Bonjesta, Diclegis)
36
what are the natural products for morning sickness, nausea, vomiting?
1. Ginger is rated "possibly effective"
37
what is the lifestyle management for GERD/ Heartburn?
Eat smaller, more frequent meals, avoid foods that worsen GERD. If symptoms occur while sleeping recommend elevating the head of the bed and not eating 3 hours prior to sleep.
38
what is the preferred management for GERD/Heartburn if lifestyle txt fails?
1. Recommend antacids Calcium antacids such as calcium carbonate (tums) are good choice to also supplement calcium intake 2. PPI can be considered if heartburn sx are not relieved by antacids
39
what is the preferred management for flatulence?
1. Simethicone (gas-X, Mylicon)
40
what is the lifestyle management for constipation?
Increase fluid intake, dietary fiber intake and physical activity
41
what is the preferred management for constipation if lifestyle txt fails?
If lifestyle measures fail, fiber (psyllium, calcium, polycarbophil, methylcellulose) with adequate amounts of fluids is preferred Docusate and polyethylene glycol can also be used to prevent and treat constipation
42
what is the preferred management for cough cold and allergies ?
1. First line: Cromolyn 2. Second line: first gen antihistamines (Chlorpheniramine D.O.C, diphenhydramine) but cause sedation 3. Non sedating second gen loratadine and cetirizine 4. Budesonide preferred if nasal steroids needed but all intranasal steroids are safe
43
what formulations should be avoided when treating cough, cold, and allergies in pregnancy ?
avoid liquid formulations that contain alcohol
44
what is the preferred management for pain ?
1.Non drug: hot/cold packs, light massage or physical therapy can help limit or avoid the use of analgesics 2. ACOG recommends acetaminophen first line for mild pain during pregnancy
45
what medication should be avoided in treating pain for pregnant patients?
1. Avoid NSAIDS, including aspirin (except low dose for treating preeclampsia) especially at 20 weeks gestation or later because it can cause premature closure of ductus arteriosus 2. Only use of opioids if there are no alternatives
46
what is the preferred management for Asthma ?
maintenance therapy: Budesonide is preferred but all inhaled ICS are safe respules are used in a nebulizer Rescue therapy: ICS formoterol or albuterol (SABA)
47
what is the preferred management for HTN?
1. Labetalol 2.Nifedipine ER 3.Methyldopa *ACE, ARB,Aliskiren and entresto are CI
48
what is the preferred management for Diabetes?
Insulin is preferred it not controlled with lifestyle Metformin and glyburide are sometimes used - low dose aspirin is recommended for preeclampsia prevention in both DM1 and DM2
49
what antibiotics are generally considered safe to use?
1. Penicillins (amoxicillin and ampicillin) 2. Cephalosporins 3.Erythromycin 4. Azithromycin
50
what antibiotics are not considered safe to use?
1. Quinolones - due to cartilage damage 2. Tetracyclines - due to teeth discoloration
51
what is the preferred management for vaginal fungal infections?
1. Topical antifungals (creams, suppositories) for 7 days * avoid fluconazole
52
what is the preferred management for Urinary Tract infections?
1. cephalexin 500 mg PO Q6H x 7 days 2. Amoxicillin 500 mg PO Q8H x 7 days alt: 1. Nitrofurantoin and bactrim should be considered last line during 1st trimester and should not be used in the last 2 weeks of pregnancy 2. fosfomycin Must treat bacteriuria even if asymptomatic
53
what is the preferred management for Toxoplasmosis?
women can be tested prior to pregnancy with an IgM and IgG test. Pregnant women should avoid dirt food and water, unpasteurized dairy products and cat feces
54
what is the preferred management for VTE?
TXT: low molecular weight heparin is preferred over unfractionated due to ease of administration PPX: pneumatic compression devices +/- LMWH -Warfarin Teratogenic -oral factor Xa inhibitors and direct thrombin inhibitors are not recommended
55
what is the preferred management for HYPOthyroidism ?
1. Levothyroxine will require a 30-50% dose increase during pregnancy
56
what is the preferred management for HYPERthyroidism ?
1. Mild cases do not require treatment 2. Methimazole is preferred after first trimester 3. PTU is used in the 1st trimester both have high risk for liver damage
57
what should babies receiving breast milk be supplemented with?
1. 10 mcg (400 IU) of vit D supplementation daily 2. Iron supplementation (1 mg/kg/day) may be needed after 4 months of age until infant can obtain adequate iron from eating usually at 6 months
58
what drugs have a higher chance of being excreted into breast milk?
1. Non ionized 2. Small molecular weight 3. Low VD 4. High lipid solubility
59
what drugs should not be used by breastfeeding mothers?
1. Codeine and Tramadol due to risk of excessive sleepiness, breathing difficulty, and or death in the infant 2. Especially in mothers who were CYP450 and 2D6 ultra rapid metabolizers 3. Even small doses taken by the mother can cause serious side effects for the infant
60
What are the recommendations for breastfeeding in HIV?
1. Breastfeeding is not recommended for women with documented HIV
61
Which medications may require a breastfeeding patient to pump and discard breastmilk when drug concentrations are at their highest?
1. Amphetamines 2. Amiodarone 3. Ergotamines 4. Lithium 5. Metronidazole 6. Phenobarbital 7. stains

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