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NAPLEX - OUR cards > Pregnancy and Lactation > Flashcards

Pregnancy and Lactation Flashcards

1
Q

What lab result confirms pregnancy?

A

human chorionic gonadotropin (hCG+)

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2
Q

Which trimester is the embryo most susceptible to birth defects?

A

1st trimester

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3
Q

Teratogenic drugs must cross the placenta to be considered teratogenic (t/f)

A

TRUE

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4
Q

Folate deficiency can causes..

A

neural tube defects

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5
Q

Recommended folate intake during pregnancy

A

600 mcg/day

400 mcg for all women of child-bearing age

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6
Q

Calcium and vit-d requirments for pregnant women

A

Ca: 1000 mg/day

Vit D: 600 IU/day

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7
Q

Old pregnancy category A meaning

A

Animal & human studies show no risk in 1st trimester

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8
Q

Old pregnancy category B meaning

A

Animal studies have demonstrated no risk, but no human studies available
OR animal studies show risk, but human studies didn;t show the same risk

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9
Q

Old pregnancy category C meaning

A

Animal studies have shown harm to fetus and there are no studies in humans
Or studies in humans and animals are not available

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10
Q

Old pregnancy category D meaning

A

Positive evidence of fetal risk is available

But benefits might outweigh risk in life-threatening conditions

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11
Q

Old pregnancy category X meaning

A

Studies show fetal abnormalities

contraindicated in pregnancy

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12
Q

New guidelines for pregnancy section in package inserts

A
  1. 1: Pregnancy risk summary
  2. 2: Lactation - include whether drug/metabolites go into human milk, possible adverse effects of baby and milk production
  3. 3: Affects of male and female fertility
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13
Q

Main tertiary source for pregnancy & lactation

A

Brigg’s Drugs in pregnancy and lactation

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14
Q

Key teratogenic drugs

A 
Isotretinoin
Quinolones, Tetracyclines
Warfarin
Statins
All RAAS inhibitors (ARBs, Acei, etc.)
Pretty much all hormones 
Hydroxyurea
Methotrexate
Lithium
Topiramate, Valporic acid
Paroxetine
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15
Q

Preferred treatment for morning sickness, N/V

A 
Lifestyle first (smaller meals, more frequent meals, etc)
Pyridoxine +/- doxylamine
Pyridoxine/doxylamine (Diclegis; Rx)

Ginger - “possibly effective”

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16
Q

Preferred treatment for GERD/heartburn

A

Lifestyle first

Antacids with Calcium (Tums: calcium carbonate)

17
Q

Preferred treatment for Flatulence

A

simethicone (Gas-X)

18
Q

Preferred treatment for constipation

A

Lifestyle first: incr activity, water & fiver intake

Use fiber laxative with adequate fluid intake

19
Q

Preferred treatment for cough,cold, allergies

A

1st line: 1st gen antihistamines (chlorpheniramine, benadryl)
Loratadine + cetirizine recommended sometimes in 2nd +3rd trimester
Nasal steroids: budesonide, beclomethasone (both B’s)

NO oral decongestants in 1st trimester
Generally avoid guaifenisen and dextromethorphan (little evidence)

20
Q

Preferred treatment for pain

A

Non-drug options

1st line: APAP

Avoid NSAIDs and opioids generally

21
Q

Preferred treatment for asthma

A

controller: budesonide
rescue: albuterol

22
Q

Preferred treatment for hypertension

A

Labetalol
methyldopa
nifedipine

23
Q

Preferred treatment for diabetes

A

Insulin is preferred

metformin and glyburide are also used

24
Q

Preferred treatment for infections

A

PCNs, cephalosporins, azithromycin are generally considered safe
Vaginal fungal infections use topical agents; avoid fluconazole
UTI’s: treat even if asymptomatic bacteriuria
cephalexin
Ampicillin
Bactrim and nitrofurantoin: LAST LINE (esp. 1st trimester), only use if serious PCN allergy

25
Q

Preferred treatment for VTE treatment/prevention

A

LMWH > UFH

Warfarin is teratogenic

NOACs have limited data and are not recommended

26
Q

Preferred treatment for hypothyroidism

A

MUST be treated
levothyroxine
usually requires 30-50% INCREASE in dose

27
Q

Preferred treatment for hyperthyroidism

A

1st trimester: propylthiouracil
2nd-3rd trimester: methimazole

Mild cases do not require treatment
iodines are teratogenic

28
Q

Breastfed babies require supplementation of which nutrients?

A

400 IU of Vit D

1 mg/kg of calcium

29
Q

Pain meds that should be avoided during breastfeeding

A

tramadol and codeine

Cause infant resp failure

30
Q

Women with this condition should not breastfeed:

A

HIV

31
Q

Specific meds that should be avoided during breastfeeding [6]

A 
Amphetamines
ergotamines (for migraines)
lamotrigine
lithium
statins
metronidazole

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