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D&T3 Exam 1 > Pregnancy Drugs > Flashcards

Pregnancy Drugs Flashcards

1
Q

Teratogens

A

Chemical or physical event which can induce fetal malformations

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2
Q

Teratogens

Examples

A

DES

Thalidomide

Bendectin

Fetal alcohol syndrome

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3
Q

Teratogens

Diethylstilbestrol

A

No steroidal estrogen (initially for prevention of premature birth)

Clear cell adenocarcinoma of vagina of offspring

Transplacental

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4
Q

Only known transplacental carcinogen

A

Diethylstilbestrol

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5
Q

Teratogens

Bendecin

A

For n/v during pregnancy

No evidence to support teratogenic

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6
Q

Teratogens

Thalidomide

A

Sedative/hypnotic for n/v

Amelia, phocomelia and altered facial and ear development (limb abnormalities)

Now chemotherapy

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7
Q

Teratogen

During fetogenesis

A

Typically gonadal or nervous system abnormalities

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8
Q

MC etiology of developmental defects

A

Unknown

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9
Q

Inc in pregnancy

Distribution

A

Inc plasma volume and total body water

Dec albumin (inc fraction of drugs)

Inc biotransformation and GFR

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10
Q

Chemicals pass through placenta by

A

Passive diffusion

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11
Q

Nutrients pass placenta via

A

Active transport

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12
Q

pregnancy category X

A

Thalidomide

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13
Q

Most drugs used in practice category

A

B and C

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14
Q

Drugs to avoid in early pregnancy

A

Antineoplastic (methotrexate): congenital defects
Tetracyclines: teeth and bone growth
Warfarin: congenital defects
Systemic retinoids: craniofacial, CV (for acne)

Theoretical
Antibiotics, sulfonylureas
General anesthesia

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15
Q

Drugs to avoid late in pregnancy

A

Benzodiazepines: floppy infants
Oral anticoagulants
Thiazide diuretic: thrombocytopenia (inc bleed risk)
Aspirin: kernicterus, hemorrhage

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16
Q

Special considerations

Drugs in pregnancy

A

Antibiotics: risk-benefit

Tetracyclines: teeth discoloration, hepatic toxicity
Streptomycin: ototoxicity in fetus

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17
Q

Common infxns during pregnancy

A

UTI-nitrofurantoin, penicillins, Bactrim

Common cold

Bacterial vaginosis: metronidazole

Vaginal candidiasis-topical azoles

Sinusitis: Bactrim, penicillins, azithromycin

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18
Q

Common medical problems during pregnancy

A

Anemia: physiologic and iron deficiency::folic acid deficiency

Iron or folic acid: leads to n/constipation: use min amount

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19
Q

Drugs in pregnancy

Hyperthyroidism

A

Avoid radioactive iodine

Carbimazole, methimazole, propythiouricil: must treat because hyperthyroidism deadly to fetus

Surgery best

Avoid breast feeding

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20
Q

Drugs in pregnancy

DM

Preexisting

A

Insulin req inc. switch from oral hypoglycemic to insulin

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21
Q

Drugs in pregnancy

DM

Gestational diabetes

A

Utilize human insulin

Don’t use hypoglycemic may cause teratogenesis an ad fetal hypoglycemia but metformin and glyburide are used

22
Q

Drugs in pregnancy

Pre-eclampsia hypertension

A

Develops after 20 wks. HELLP syndrome ass

Only tx is delivery

23
Q

Medical care. During pregnancy

Pre-eclamptic hypertension

Drug tx

A

May use hydralazine for rapid results or methyldopa or labetalol

Avoid nitroprusside, ace inhibitors, arb’s and diuretics

24
Q

Chronic hypertension and pregnancy

A

Methyldopa DOC

Alt: hydralazine, b-blockers, ca channel blockers

Avoid ace inhibitors/arbs, lonidine, reserpine, clonidine, diuretics

Tx: preeclampsia: delivery

25
Q

Anticoagulation and pregnancy

Indications

A

DVT, prosthetic cardiac valve, recurrent fetal loss

26
Q

Anticoagulation and pregnancy

Use

A

Heparin (low molecular weight doesn’t have to be IV)-doesnt cross placenta

Stop 2-3 wks before delivery.

Avoid warfarin

27
Q

Epilepsy

Antiepileptics

A

All teratogenic

Narrow therapeutic index (since albumin dec w pregnancy)

Monotherapy with low dose

28
Q

Epilepsy

Phenytoin

A

10% fetal hydantoin syndrome: cardiac malformations, gu defects, craniofacial

29
Q

Epilepsy

Carbamazepine

A

Neural tube defects

30
Q

Epilepsy

Valproic acid

A

Neural tube defects

31
Q

Epilepsy

Supplementation

A

With folic acid. Bump to 4 mg/day

32
Q

Asthma

A

MC respiratory condition of pregnancy

33
Q

Asthma

Ass

A

With preterm labor and low birth weight

34
Q

Asthma

Tx

A

Avoid triggers

Short acting b-sympathomimetics for acute exacerbation (albuterol or terbutaline)

35
Q

Asthma

Inhaled glucocorticoids

A

First line (betamethasone, fluticasone) no evidence of teratogenesis

36
Q

Asthma

Systemic glucocorticoids

A

Prednisone: maybe for severe exacerbation (if chance of death and need ventilator)

5x inc risk of cleft palate

Use late in pregnancy, use for organ rejection

37
Q

Asthma

Leukotriene inhibitors

A

Could be safe

3rd line agents

38
Q

N/v

Tx

A

Only if severe

39
Q

Asthma

Hyperemesis gravidarium

A

Severe form

Hospitalization

40
Q

Asthma

Tx

A

Non drug first (ginger, small freq meals, pyridoxine)

Ondansetron (med)

41
Q

Depression

tx

A

SSRI thought to be safe but may be teratogenic

Sertraline is safest

42
Q

Depression

Paxil

A

Cardiac defects (RR 50%)

43
Q

depression

A

Ass with PPHN (persistent pulmonary hypertension of the newborn), inc 5-6x

44
Q

Fetal alcohol syndrome

A

Totally preventable

Malformations: up to 32%

45
Q

FAS

Characteristics

A

Small birth weight

Small head

Epicanthic folds

Small, widely spaced eyes

Flat midface

Short upturned nos

Smooth wide philtrum

Thin upper lip and underdeveloped jaw

46
Q

Tobacco use

A

Most important modifiable risk

47
Q

Tobacco abuse

Ass

A

Premature labor, low birth weight, inc fetal loss

48
Q

Tobacco abuse

Narcotic withdrawal

A

Babies born to opiate addicted mothers are physically addicted

Tx: treat to prevent withdrawal

49
Q

Signs of narcotic withdrawal

A

Inc irritability, high pitched cry

Tremor, frantic first sucking

Inc respirations and stools, sneezing

Yawning, vomiting and fever

No consensus on management

50
Q

Breast feeding

A

Dose to infant 1-2% of moms

D&T3 Exam 1 (19 decks)

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