Pregnancy & Lactation

Question 1

3 things to look for in prenatal supplement

Answer 1

folate (1 mg)
calcium (1000-1300mg)
iron (27-30mg)

Question 2

vaccine recommendations during pregnancy (3)

Answer 2

1. inactivated flu before end of october
2. Tdap between weeks 27-36
3. COVID-19

Question 3

vaccines to AVOID in pregnancy (6)

Answer 3

1. varicella
2. mmr
3. live flu (nasal)
4. yellow fever
5. typhoid fever
6. HPV

Question 4

teratogenic drugs (7)

Answer 4

1. warfarin
2. methotrexate
3. lithium
4. lisinopril
5. alcohol
6. statins
7. isotretinoin

Question 5

Pregnancy’s effect on pharmacokinetic parameters: absorption

Answer 5

SLOWER rate but increased extent of absorption due to decreased GI motility

Question 6

Pregnancy’s effect on pharmacokinetic parameters: distribution

Answer 6

Increased Vd due to increased mass
Decreased protein binding

Question 7

Pregnancy’s effect on pharmacokinetic parameters: metabolism

Answer 7

Increased CYP3A4 activity
Decreased CYP2C19 activity

Question 8

Pregnancy’s effect on pharmacokinetic parameters: excretion

Answer 8

Increased renal and hepatic blood flow, and CrCl

Question 9

Diabetes medication during pregnancy

Answer 9

Recommended: insulin
Not recommended: metformin, glyburide, victoza

Question 10

HTN medication during pregnancy: PREFERRED

Answer 10

-amlodipine
-nifedipine
-labetalol
-HCTZ
-hydralazine
-methyldopa

Question 11

HTN medication during pregnancy: AVOID

Answer 11

-ACE inhibitors: lisinopril (“-pril”)
-ARBs: Valsartan (“-sartan”)

Question 12

1st line pharmacological option for nausea + vomiting during pregnancy

Answer 12

pyridoxine
pyridoxine + doxylamine

Question 13

1st line pharmacological option for heartburn during pregnancy

Answer 13

antacids (i.e. magnesium hydroxide, calcium carbonate)

Question 14

1st line pharmacological option for constipation during pregnancy

Answer 14

osmotic laxatives: polyethylene glycol, lactulose

Question 15

1st line pharmacological option for pain, fever, headache during pregnancy

Answer 15

acetaminophen
AVOID: NSAIDS after 32 weeks

Question 16

1st line antibiotic use during pregnancy

Answer 16

cephalexin
penicillin or ampicillin

Question 17

antibiotics to AVOID during pregnancy

Answer 17

1. sulfamethoxazole trimethoprim
2. doxycycline
3. ciprofloxacin/levofloxacin

Question 18

1st line treatment of gestational diabetes

Answer 18

insulin

Question 19

1st line treatment of thromboembolism (blood clot)

Answer 19

nonpharm option first
AVOID WARFARIN

Question 20

treatment of severe preeclampsia

Answer 20

IV:
-hydralazine
-labetalol
-nifedipine
PO:
-nitroprusside

Question 21

treatment of seizures during pregnancy**

Answer 21

magnesium sulfate 4-6 g IV bolus

Question 22

HELLP syndrome symptoms

Answer 22

1. hemolysis
2. elevated liver enzymes
3. low platelet countes

Question 23

HELLP syndrome treatment options

Answer 23

1. platelets
2. corticosteroids

Question 24

1st line treatment of Group B strep during pregnancy

Answer 24

Penicillin G or Ampicillin

Question 25

medication for prevention of preterm labor

Answer 25

progesterone 200mg vaginally or 250mg IM

Question 26

treatment of premature membrane rupture

Answer 26

1. corticosteroids (i.e. dexamethasone, betamethasone) 2. antibiotics (i.e. penicillin, cefazolin) 3. tocolytics (i.e. nifedipine, indomethacin, terbutaline, magnesium) 4. magnesium sulfate

Question 27

Characteristics of drugs that will have high concentration in breastmilk (3)

Answer 27

1. lipid soluble (breastmilk high in fat) 2. small molecular weight 3. low protein binding/can reach high maternal plasma levels

Question 28

RID < 2%

Answer 28

minimal transfer to breastmilk

Question 29

RID 2-5%

Answer 29

small amount of transfer to breastmilk

Question 30

RID 5-10%

Answer 30

moderate amount of transfer to breastmilk

Question 31

RID > 10%

Answer 31

large amount of transfer to milk, risk of effects to infants exist