Pregnancy and Medications

Question 1

Pregnancy Categories and what they mean

Answer 1

A - safe
B - fine to use
C - caution, but not absolute no, adverse effects on animal fetus but no adequate studies in humans
D - adverse effects proven, flashing red
X - known abnormalities or fetal death, absolute no

Question 2

Benzodiazepine category and safety?

Answer 2

category D

concern for withdrawal and dependence issues for mom and baby

Question 3

Lactation safety rating

Answer 3

L1-5

Question 4

verapamil can cause ____ in men

Answer 4

oligospermia

Question 5

Effects based on timing of exposure

Answer 5

1. conception - fetal abortion
2. first trimester (12 weeks) - physical malformation
3. later in pregnancy: functional and behavioral abnormalities (CNS)

Question 6

when does placental transport of maternal substrates established?

Answer 6

~5th week of fetal life

Question 7

factors that determine drug ability to cross placenta

Answer 7

1. molecular weight
2. lipid solubility
3. protein binding

Question 8

N/V treatment

Answer 8

First line: avoid foods/meds that trigger N/V
Second line: IV fluid and electrolyte replacement
Third line: doxylamine-pyridoxine (A), zofran (B), can also use promethazine

Question 9

side effect of doxylamine

Answer 9

sedation

Question 10

side effects of zofran

Answer 10

headache

prolonged QT interval if used long-term

Question 11

pharm treatment of hyperemesis gravidarum

Answer 11

1. vit B6 / pyridoxine (A)
2. doxylamine / unisome (A)
3. promethazine /phenergan (C)
4. dramamine / dimenhydrinate (B)
5. Reglan / metoclopramide (B)

Question 12

serious side effect of reglan

Answer 12

tardive dyskinesia

Question 13

when do you start aspirin for pre-eclampsia

Answer 13

new onset hypertensive pt with risk factors for pre-eclampsia
81 mg between weeks 12-16, continue until week 36

Question 14

High risk factors for pre-eclampsia (need 1 and elevated BP to start aspirin)

Answer 14

1. previous pre-eclampsia
2. diabetes, 1 or 2
3. CKD
4. multi-gestational pregnancy
5. hx of chronic HTN
6. autoimmune disease

Question 15

moderate risk factors for pre-eclampsia (need 2 and elevated BP to start aspirin)

Answer 15

1. obesity
2. family hx
3. age >35
4. previous pregnancy w/ low birth weight or small for gestational age infant

Question 16

BP that they start to treat during pregnancy

Answer 16

160/100

Question 17

treatment for HTN in pregnant pt

Answer 17

1. First line: Labetalol (C)
2. Methyldopa (B) only good for mild HTN
3. metoprolol succinate

Question 18

acute management of severe HTN

Answer 18

Hydralazine / Apresoline (IV) - category C

Question 19

HTN meds CI in pregnancy

Answer 19

ACE inhibitors, ARBs

Question 20

poor glycemic control during pregnancy can result in these complications for the baby

Answer 20

1. large birth weight
2. preterm labor
3. hypoglycemia shortly following delivery (b/c insulin production high)
4. increased risk for diabetes later in life

Question 21

treatment for diabetes

Answer 21

First line: insulin (B)

Second line: glyburide / DiaBeta (C) or Metformin (B)

Question 22

MOA and indications for metformin

Answer 22

helps body more efficiently utilize insulin that is already in body, helps with insulin resistance
Type II DM, pre-diabetes, PCOS

Question 23

treatment of depression in pregnant patients

Answer 23

First-line: SSRIs (sertraline/zoloft, lexapro, citalopram)
in combo with CBT
can also use SNRI (effexor), ECT

Question 24

Drugs CI in pregnancy

Answer 24

Aspirin
NSAIDs (1st trimester C and 2-3rd trimester D)
ACE inhibitors
ARBs
Valproic Acid
Statins
Ergotamine, Dihydroergotamine
Isotetrinoin

Question 25

medication that's good for allergies and sleep that is safe to use

Answer 25

doxylamine (A)

Question 26

headache medications ok to use

Answer 26

acetaminophen