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Endo/Eye/Derm - Women/Men > Pregnancy and Lactation Dr. Dowling > Flashcards

Pregnancy and Lactation Dr. Dowling Flashcards

EXAM 2

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1
Q

Which drugs are less likely to pass the placenta?
EXAM Q

A

-hydrophilic
-ionized
-high-protein-bound
-larger MW (>600 Daltons)

-when clinical data is not available, evaluate thee risk by predicting if the drug is able to pass the placenta

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2
Q

Which drugs may be used for medication-induced abortion?

A

-Mifepristone
-Misoprostol

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3
Q

Which common drugs should NOT be used during pregnancy?

A

-EtOH, nicotine
-Isotretinoin
-Methotrexate
-Mifepristone, Misoprostol

-NSAIDs
-RAAS inhibitor

-Phenytoin, Valproic acid
-Warfarin

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4
Q

When should Folic acid supplementation be initiated?

A

-consider for all women of childbearing age
-start at leat 3 months before conception and continue to 12 weeks gestation (which is beyond the early fetal development phase)

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5
Q

What is the recommended dose for folic acid supplementation?

A

0.4 mg (400 mcg) for most women

4mg daily for high risk of NTD (neural tube defect)
-previous NTD
-diabetes
-smoking
-BMI > 35 kg/m2
-antiepileptic drug use

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6
Q

Which supplements should a prenatal vitamin contain?

A

-Vitamin D
-Calcium
-Iron
-Folic acid

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7
Q

What are the recommended doses of iron for women?

A

18 mg per day for non-pregnant women

27 mg per day if pregnant

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8
Q

What are the recommended doses of Calcium for women?

A

1000 mg/day

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9
Q

What are the recommended doses of Vitamin D for women?

A

600 mg/day

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10
Q

Which vaccines are recommened for women

A

Hepatitis B
MMR (Live)
Varicella (Live)

Influenza - administere at the start of the season, in pregnant patients or those who try to conceive, use inactivated if pregnant

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11
Q

Which of the recommended vaccines are live vaccines?

A

MMR
Varicella

-> dont administer during pregnancy, wait until after pregnancy, due to an immunocompromised state (immune system is downregulated to prevent from targetin the fetus)

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12
Q

Which vaccine should be administered during pregnancy?

A

Tdap (Tetanus, Dipheteria, Pertussis)
-> for every single pregnancy
-> Pertussis especially bears a high risk for newborns

during 27-36 weeks

(normal window is 10 years)

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13
Q

When is the typical onset of gestational diabetes (GDM)?

A

midst pregnancy - 24-28 weeks

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14
Q

What is the first-line treatment for gestational diabetes?

A

patients get tested midst pregnancy
-> if positive: non-pharmacoligocal treatment
-nutrition and exercise for 1-2 weeks

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15
Q

Which meds are preferred in gestational diabetes?

A

-insulin is preferred (best studied for safety in pregnancy)

-metformin and glyburide are acceptable oral alternatives

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16
Q

What is the time of onset for HTN during pregnancy?

A

20 weeks or later

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17
Q

How is HTN of pregnancy diagnosed?

A

Patient with no preexisting HTN and with 2 readings of >140/90

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18
Q

When is medical treatment for HTN of pregnancy initiated?

A

After 2 readings of >160/110

severe HTN

Background: we wait until severe HTN to balance risk and benefits: side effects of antihypertensive meds such as hypotension

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19
Q

Which antihypertensive drugs are preferred for HTN of pregnancy?

A

-labetalol, nifedipine ER (BID)
2nd line: HCTZ, methyldopa

AVOID: RAAS inhibitors: ACEi, ARBs, renin inhibitors

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20
Q

How much should the dose of levothyroxine be increased in pregnant patients with hypothyroidism?

A

increase the dose by at least 25%

21
Q

Which antidepressants are preferred in pregnant patients?

A

SSRIs (fluoxetine, sertraline)
-> paroxetine somewhat associated with cardiac malformation

if a pateint’s depression is controlled -> keep the antidepressant during pregnancy

pregnancy is an intense hormonal experience time, discontinuation can trigger depression and suicidal ideation

22
Q

What is Eclampsia?

A

emergency situation

Preeclampsia (HTN and Proteinuria(loss of protein in the urine))
+
Seizures

= Eclempsia

23
Q

What else should be monitered if a patient presents with HTN during pregnancy?

A

check for proteinuria
-> Interfere (treat HTN) to prevent seizures if high levels of protein in the urine (Eclempsia)

24
Q

When is the predicted onset of Eclempsia during pregnancy?

A

-typically after 20 weeks (like HTN)

-postpartum: up to 6 weeks after delivery

25
Q

When is an acute treatment for HTN during pregnancy appropriate?

A

> 140/90 and proteinuria

26
Q

How is Preeclampsia treated?

A

Urgent HTN: IV or immediate release (oral)

-IV labetalol
-oral nifedipine IR
-IV/IM hydralazine

27
Q

What other interventions can be considered to prevent the progression from Preeclampsia to Eclampsia during active labor?

A

IV mag sulfate (short-term)

-usually during active labor and 12-24 hr postpartum

28
Q

What is the prophylaxis treatment for Preeclampsia?

A

Aspirin 81 mg daily
-after 12 weeks -> throughout the pregnancy

REMEMBER: NSAIDs are contraindicated in pregnancy, Aspirin is exception

29
Q

What are the high-risk factors that determine initiation of prophylaxis for Preeclampsia?

A

Any high-risk factors -> start Preeclampsia prophylaxis

-prior case of preeclampsia
-non-singleton pregnancy (twins, triplets)
-chronic HTN
-pre-gestational diabetes
-renal disease
-autoimmune disease

30
Q

What are the moderate-risk factors for Preeclampsia?

A

2 or more of moderate risk factors -> treat Preeclampsia

-Family history of Preeclampsia
-Nulliparity (never given birth before)

-Pre-pregnancy BMI > 30
-age > 35 (geriatric pregnancy)
->10 years between pregnancies
-previous poor birth outcome

31
Q

When to initiate Aspirin for Preeclampsia prophylaxis?

A

-one high-risk factor
-2 or more moderate risk factors

-wait until week 12! -> so we pass the early fetal development stage

32
Q

What are the first-line meds for N/V in pregnancy (morning sickness)

A

-Ginger (supplement, candy): 4 times daily
or
-B6 (pyridoxine) + doxylamine: up to 4 times daily
-> Bonjesta, Diclegis

33
Q

What are the first-line meds for pain in pregnancy?

A

Acetominophen

NSAIDs should be avoided during the first 20 weeks (but often we don’t know the exact gestational age)

Exception: with Aspirin and preeclampsai prophylaxis

34
Q

What are the first-line meds for VTE during pregnancy?

A

Low-molecular-weight heparin

-pregnancy is a hypercoagulable state
-> risk of blood clots (5x higher than normal)
AVOID Warfarin!

35
Q

What is the purpose of tocolytic therapy?

A

postpone early labor by 48h to 7 days
-> we want to keep the baby in the womb bc it still developing

36
Q

Meds used for tocolytic therapy

A

Nifedipine
Terbutaline (beta agonist)
Indomethacin
Magneisum sulfate

37
Q

Which drug helps with fetal lung maturation in early labor?

A

Steroids:
Betamethasone
Dexmethasone

38
Q

Which drug is indicated for cervical ripening?

A

Misoprostol (Prostaglandin E1 analog)
Dinoprostone (Prpstaglandin E2 analog)
-> helps with the dilation of the cervix

39
Q

Which drug is indicated for labor induction?

A

Oxytocin

40
Q

Which drug is indicated for comfort during labor?

A

Epidural: anesthetic injection in the epidural space (back)

Opioid or anesthetic (ex: fentanyl + bupivacaine)

41
Q

When should breastfeeding be initiated?

A

1st hour of birth -> continue for the first 6 months
-> greatest potential impact on reducing childhood mortality

-consider pumps, formulas for those who do not prefer to breastfeed

42
Q

What is the best way to schedule drug intake during the phase of breastfeeding?

A

use the time when they are not breastfeeding
-> take once daily tablets prior to baby’s longest sleep of the day
(we want to limit the time of drug exposure to the baby)

multiple daily dosing: after breastfeeding

43
Q

Common drugs that are not compatible with breast milk

A

Amiodarone Lithium
Amphetamines Nicotine
Certain Beta-blockers
(acebutolol, atenolol, sotalol)
Chemotherapeutics

Illicit drugs
Lamotrigine
Lithium
Nicotine

Phenobarbital, Primidone
Statins
Tetracyclines

44
Q

Common drugs that may decrease milk production

A

-Estrogen
-Pseudoephedrine
-Clomiphene (used to induce ovulation)
-Ergot derivatives (bromocriptine,
cabergoline, ergotamine)

45
Q

How are Lactation disorders treated?

A

1st line: non-pharmacological treatment

2nd line:metoclopramide: but
GI distress, extrapyramidal symptoms (can’t sit still, parkinson-like symptoms), methemoglobinemia in infants -> mostly not recommended

46
Q

What is the treatment for Mastitis?

A

infected mammary gland
-1st line: dicloxacillin
alternative: cephalexin
add ibuprofen (not contraindicated in breastfeeding)

47
Q

What is the treatment for Nipple candidiasis?

A

1st line:
topical micanozole or clotrimazole
applied to the nipples after each feeding
+
oral nystatin for infant’s mouth (it passed from the mom to the baby)

48
Q

Which hormone drops significantly after delivery?

A

Progesterone by 85%
more severe -> postpartum depression

Endo/Eye/Derm - Women/Men (30 decks)

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