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Pharm Fall > Pregnancy & Lactation > Flashcards

Pregnancy & Lactation Flashcards

1
Q

What will happen to drugs that are renal cleared during pregnancy?

A

The concentration of renal cleared drugs will decrease cut to the increased maternal plasma volume, cardiac output, and GFR increase by 30-50%

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2
Q

What will happen to fat soluble drugs during pregnancy?

A
  1. Distribution of fat soluble drugs may increase
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3
Q

What will happen to drugs that highly bind to proteins in the blood during pregnancy?

A

Increase in distribution of drugs that are highly protein bound (unbound drugs do not change much in concentration)

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4
Q

What effect does nausea, vomiting and delayed gastric emptying have on drugs during pregnancy?

A
  • Alters the absorption of drugs
  • Increased gastric pH will affect absorption of weak acids and bases
  • Increased estrogen/progesterone may result in enhanced elimination or accumulation of some drugs
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5
Q

What chemical properties may influence the rate of transfer of drugs across the placenta?

A
  • Lipid solubility
  • Electrical change
  • Molecular weight
  • Degree of protein binding of the drug
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6
Q

What could happen in the first two weeks after conception if exposed to a teratogen?

A

The “all or nothing” effect. Either the embryo will be destroyed or the embryo will not have any problems at all

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7
Q

What could happen to an embryo if it is exposed to teratogens between 18 and 60 days of pregnancy?

A

This is the period of organogensis and exposure to teratogen could lead to structural anomalies.
Other problems are: growth retardation, CNS abnormalities and death

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8
Q

Medications associated with teratogenic effects

A
  • Chemo drugs (methotrexate, cyclophosphamide)
  • Sex hormones diethylstilbesterol)
  • Lithium
  • Retinoids
  • Thalidomide
  • Certain anti-epileptics
  • Coumarin derivatives (coumadin)
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9
Q

Category A drugs

A

These drugs have no risk to the fetus in any trimester

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10
Q

Category B drugs

A

Animal studies have shown these drugs have no effect on the fetus but they have not been tested on humans

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11
Q

Category C drugs

A

Animal studies have shown these drugs have an adverse effect on the fetus. No studies done on humans but benefits might outweigh potential risk in certain situations.

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12
Q

Category D drugs

A

Animal studies have shown these drugs have an adverse effect on the fetus. No studies done on humans but benefits might outweigh potential risk in certain situations.

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13
Q

Category X drugs

A

Do not use these drugs in pregnancy. Evidence of fetal abnormalities or risk have been found.

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14
Q

What are the pregnancy induced conditions? (9)

A
  • Constipation
  • GERD
  • N&V
  • Gestational diabetes
  • HTN
  • Thyroid abnormalities
  • Thromboembolism
  • UTI
  • Allergic Rhinitis
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15
Q

Tx for Constipation

A
  • Light exercise
  • Dietary fiber
  • Fluids
  • Supplemental fiber/stool softener if needed
  • Can also use osmotic laxatives (polyethylene glycol, lactulose, sorbitol, magnesium and sodium salts)
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16
Q

What should you avoid with constipation?

A

Castor oil and mineral oil

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17
Q

Tx of GERD

A
  • Antacids
  • Aluminum
  • Calcium
  • Magnesium preparations
  • Sucralfate
  • H2 blockers (famotidine, ranitidine) are safest.
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18
Q

What should you avoid with GERD?

A
  • Sodium bicarbonate

- Magnesium trisilicate

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19
Q

Tx of N&V

A
  • Frequent, small, bland meals
  • Avoid fatty foods
  • Pyridoxine (Vit B6)
  • Antihistamines (doxylamine)
  • Acupressure at point P6 on velar aspect of the wrist
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20
Q

Tx of Gestational Diabetes

A
  • Daily self monitoring required
  • Insulin therapy
  • Alternatives to insulin: glyburide and metformin (not as well studied as glyburide)
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21
Q

At what glucose levels do you need to start treating gestational diabetes?

A

FPG- below 90-99
1Hr postprandial- </= 140
2Hr postprandial- below 120-127

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22
Q

Tx of HTN

A
  • Calcium 1 g/day
  • Magnesium sulfate is recommended to prevent eclampsia
  • Methyldopa, labetalol and CCB are commonly used
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23
Q

What should you avoid in the treatment of HTN during pregnancy?

A
  • ACE
  • ARB
  • renin inhibitors
  • Diazepem
  • Phenytoin
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24
Q

What thyroid abnormality can happen to pregnant women?

A

During pregnancy, there is an increase in thyroid hormone secretion so some women get postpartum thyroiditis

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25
Q

How do you treat postpartum throiditits?

A
  • Most of the time it resolve spontaneously

- Propanolol/labetolol provide symptomatic relief of adrenergic symptoms

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26
Q

Tx of thromboembolism during pregnancy

A
  • Unfractionated heparin

- LMWH (preferred)

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27
Q

How long should you tx thromboembolism during pregnancy?

A

Should be continued throughout pregnancy and for 6 weeks after delivery

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28
Q

Should you take warfarin for thromboembolism during pregnancy?

A

NO. Don’t do it.

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29
Q

Tx of UTI during pregnancy

A
  • Cephalexin (usually stick with cephalosporins)

- Nitrofurantoin (not active against proteus species)

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30
Q

What is contraindicated for Tx of UTIs during pregnancy?

A
  • Sulfa drugs (bacterium)
  • fluoroquinolones
  • tetracycline
31
Q

First line tx for allergic rhinitis during pregnancy

A
  • intranasal corticosteroids
  • nasal cromolyn
  • 1st generation antihistamines
32
Q

What is contraindicated in the tx of allergic rhinitis during pregnancy?

A

Oral decongestants like sudafed

33
Q

Purpose of tacolytic agents

A

To postpone delivery long enough to allow for the maximum effect of antenatal steroid administration

34
Q

Examples of tacolytic agents

A
  • Beta agonists
  • Magnesium
  • Ca channel blocker
  • NSAIDS
35
Q

Example of beta agonist

A

Terbutaline 250-500mg SQ q3-4hrs

36
Q

Beta agonist side effects

A

Higher incidence of maternal side effects:

  • hypokalemia
  • arrhythmias
  • hyperglycemia
  • hypotension
  • Pulmonary edema
37
Q

Example of CCB

A

Nifadipine

38
Q

CCB side effects

A
  • Fewer side effects compared to magnesium and beta agonist
  • Hypotensive effect
  • Change in uteroplacental blood flow
39
Q

Example of NSAIDS

A

Indomethacin

40
Q

NSAID side effects

A

Increased rate of premature constriction of the ductus arterioles in infants

41
Q

Antenatal Corticosteroid Purpose

A

For fetal lung maturation to prevent RDS

42
Q

Dosing of antenatal corticosteroids

A

Betamethasone 12mg IM q24hrs for 2 doses
or
Dexamethasone 6mg IM q12hrs for 4 doses
(given to pregnant mom between 26 and 34 weeks)

43
Q

What happens to the cervix in the last few weeks of pregnancy?

A

Softens and thins to facilitate labor

44
Q

What hormones regulate cervical ripening and labor induction?

A

Prostaglandins E2 and F2, they increase callagenase activity in the cervix leading to thinning and softening

45
Q

What are the most common indications for induction?

A
  • Postdatism (beyond 42 wks)

- Pregnancy induced HTN (80%)

46
Q

Labor Induction Medications

A
  • Postaglandin E1 analogs
  • Prostaglandin E2 analog
  • Anti-progesterone agent
  • oxytocin
47
Q

Prostaglandin E1 Analog examples

A

Dinoprostone (prepidil gel or cervidil vaginal insert)

48
Q

What must you do when giving a prostaglandin E1 analog?

A

Pt must be attached to a fetal heart rate monitor for the duration of cervidil use and 15 minutes after its removal

49
Q

Prostaglandin E2 analog

A

Misoprostol

50
Q

Side effects of Misoprostol

A
  • Uterine hyperstimulation

- meconium stained amniotic fluid

51
Q

When is misoprotol contraindicated?

A

Women with a previous uterine scar because of its a/w uterine rupture

52
Q

Anti-progesterone agent example

A

Mifepristone

53
Q

Oxytocin

A
  • Most commonly used labor induction agent

- Effective in low dose and high dose

54
Q

Epidural Analgesics

A
  • Used for pain
  • Fentanyl
  • Bupivacine
55
Q

Patient controlled epidural analgesics

A
  • Patient controls the amount and timing of anesthetic

- Results in lower total dose of local anesthetic

56
Q

Regional anesthesia side effects

A
  • Hypotension
  • Pruritis
  • Inability to void
57
Q

Epidural side effects

A
  • prolongation of 1st and 2nd stages of labor
  • higher number of instrumental deliveries
  • maternal fever
58
Q

Factors affecting drug transfer from maternal blood to breast milk

A
  • degree of protein binding in maternal plasma
  • molecular weight
  • lipid solubility
  • maternal plasma concentration
  • drug half life
  • drug pH
59
Q

What is one of the most significant factors in the drug transfer to breast milk?

A

Degree of protein binding in maternal plasma proteins.

***Highly bound medications transfer in low amounts

60
Q

Low molecular weight drugs

A

Passively diffuse into breast milk. However larger molecules are not likely to transfer in large amounts

61
Q

Lipid solubility of drugs

A

Higher lipid solubility increases the likely hood of transfer into the breast milk

62
Q

What type of drugs are the best for lactating mothers?

A

Drugs with lower oral bioavailability and lower lipid solubility

63
Q

When should a lactating mother take medication?

A
  • Try to increase the interval of when you take the drug to when you feed as much as possible
  • Immediately after breast feeding
64
Q

What can a lactating mother do during short term drug therapy?

A

Pump and dump if the medication is not compatible with breast feeding

65
Q

Mastitis

A

Inflammation of the breast (infectious or non-infectious)

66
Q

What is the most common cause of milk stasis?

A

mastitis

67
Q

S/S of mastitis

A
  • breast tenderness
  • redness
  • warmth
  • flu like symptoms
68
Q

Risk factors for mastitis

A
  • breast engorgement
  • plugged milk ducts
  • cracked nipples
69
Q

What bacteria is the most common cause of infectious mastitis?

A

Staph. Aureus

70
Q

Tx of mastitis

A

10-14 day antibiotic such as penicillinase resistant penicillins(dicloxacillin) or cephalosporins (cephalexin) and continue breast feeding or pump if you can

71
Q

Tx of postpartum depression

A
  • First line tx is sertraline

- Paroxetine and nortriptylline are considered second line tx

72
Q

Non pharmacologic tx of relactation

A

Nipple stimulation:

  • infants nursing
  • mechanical pump
  • hand
73
Q

Parmalogix tx of relactation

A

Metoclopramide stimulates prolactin secretion. Only used if non pharacologic options aren’t effective. (10mg PO 3x daily for 7 to 14 days)

74
Q

First line pharmacologic tx of relactation

A

Fenugreek (herbal supplement)

Pharm Fall (12 decks)

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