prego and conditions Flashcards
T/F: is using medication during pregnancy common
true
what are the most common medications pregnant women take
antibiotics
promethazine
what is the primary goal for medication use in pregnant women
prevention of birth defects due to medications
pregnancy is measured from ____ first day of ____menstrual period
first
last
the first trimester is the most critical period for drug exposure because why
major organs are developing
what is a teratogen
substance that causes a birth defect or malformation in an exposed embryo/fetus
what is teratogeniticty
ability of teratogen to produce congenital abnormalities
some examples of known teratogens
ace inhibitors
anticonvulsants
isotretinoin
lithium
thalidomide
warfarin
tetracycline
what is category A
-safest
-studies fail to demonstrate risk in 1st trimester
what is category B
animal studies have not demonstrated a fetal risk but NO controlled studies in prego women or animals show AE but safe in humans
what is category C
animal studies show AE, no studies in women or no animal/human studies
what is category D
evidence of positive fetal harm but benefit might outweigh risk
what is category X
risk clearly outweigh benefits, contraindicated
why is the ABCD category not used anymore
-confusing
-unable to keep up with changing data
-when prescribing, it was more based on category and not understanding what it actually meant
what are the goals of PLLR
provide better counseling to pregnant women and nursing mothers who need to take medication
is cutaneous blood flow increased or decreased
increased
does blood volume increase or decrease at term
increases–up to 50%
why does hemoglobin slightly decrease during pregnancy
because of extra volume
what supplement requirements increase during pregnancy especially later half
iron
SBP drops by how much during pregnancy
5-10 mmHg
what kind of blood flow is slower in pregnancy
venous
-leg edema, varicose veins
residual volume is decreased due to elevated diaphragm because
baby is pressing on diaphragm and lungs cant expand
does kidney size increase or decrease
increase
-gfr increases
nausea/vomiting may do what to drug absorption
decrease
gi motility decreases may do what to drug absorption
increase it
body fat increases, what does that lead to
VD of lipid soluble drugs is increased
albumin decreases, what happens to VD
increases
placenta is the _____ barrier between ____ and ____ circulation
lipid
fetal
maternal
what does the placenta produce to maintain pregnancy
progesterone
the placenta is rich in
blood vessels
the placenta supplies what
oxygen
what kind of substances cross the membrane easier
fat soluble bc of lipid barrier
what kind of drugs (non-ionized or ionized) cross easier
non-ionized
do low or large MW drugs cross easier
low
*drugs w MW <500 will cross placenta
*drugs w MW >1000 do NOT cross
what is the 2nd most prevalent congenital anomaly
neural tube defects
* spina bifida and anencephaly
neural tube defects are from failure of what
neural tube closing
-closure occurs in 1st month of prego
what is the cause of neural tube defects
folic acid deficiency
methotrexate
exposure to cig smoke
T/F: folic acid should be recommended for ALL women of reproductive age
true
how much folic acid should be taken daily
400-800 mcg
for maximal benefit, when should you start taking folic acid
1 month before to through 3 month after conception
what kind of women are considered high risk to where they need to take folic acid
previously affected pregnancy
taking anticonvulsants
how much folic acid should be taken if at high risk
4 mg daily in the months surrounding conception or throughout pregnancy
what kind of vaccines should be avoided during pregnancy
live
*varicella, HPV, MMR
what is a vaccination that is recommended for all prego ppl
tdap–for each pregnancy btw 27-36 wks
bc baby is not protected from pertussis
caffeine should limited to how much when preconception planning
<200 mg before and during pregnancy
tobacco can cause what
preterm birth, low birth wt, spontaneous abortion
what can obesity cause during pregnancy
neural tube defects
preterm delivery
diabetes
hypertension
C section
if normal weight, how much kcal is recommended
100-300 kcal
if constipation is untreated, it can lead to what
hemmorhoids
what is nonpharm for constipation
high fiber foods
fluids
exercise
what is 1st line for pharm tx for constipation
fiber supplements
stool softners
what is acceptable for short term use in constipation
peg
mg/sodium salts
senna
what is CI in constipation
castor oil
mineral oil
bc it causes uterine contractions
what can you do if you get hemorrhoids
sitz bath
avoid constipation
avoid sitting for long period of time
what is CI for hemorrhoids
topical anesthetics and steroids
GERD usually happens when in pregnancy
later half
what is nonpharm for GERD
small freq meals
avoid food before bed
elevate head of bed
what is 1st line for GERD
anatacids
sucralfate
what is 2nd line for GERD
famotidine
PPI (lansoprazole, pantoprazole, rabeprazole is/was cat b)
metoclopramide (cat B)
when should you stop acid suppression agent
after pregnancy or when dyspepsia improves
when does nausea/vomiting usually happen
1st trimester
what is the cause of N/V
unknown but thought to due to hCG and estrogen
what is hyperemesis gravidarum
unrelenting vomiting
-may need iv fluids, hospitalization
what may reduce incidence of N/V 3 mo prior to conception
prenatal vitamins
what are some non pharm things to do with N/V
eat freq,small meals
bland foods
high protein foods
drink, chilled tart drinks (ginger ale)
what non pharm should be avoided with N/V
fatty and spic meals
foods with odors
empty stomach
what is the first line for n/v
vitamin b6
-can do b6 + doxylamine
-metoclopramide
what else can be used for n/v if needed
ondansetron (cat B)
-not approved for use of n/v in preg
-watch qtc
what is gestational diabetes mellitus
glucose intolerance during 2nd or 3rd tri
what are some consequences from GDM
fetal loss
increased risk of major malformations
fetal macrosomia
what conditions increase risk for GDM
> 25
obesity
family hx of dm
previous infant >9 lb
race (african american, hispanic, asian, native)
what is the goal AIc and when should they be screened
6-7%
24-28 wks
the two step screening for GDM is: screening with __ hr, __ g glucose test
1 hr
50 g
the one step screening for GDM: NO screening, __ hr, __g glucose test
2 hr
75 g
non pharm is 1st line for GDM, what is the tx
diet
daily blood glucose monitoring–REQUIRED
what is the pharm tx for GDM
insulin (reg, nph, levemir, humalog)
oral agents–dont control sugars as well as insulin– glyburide (c), metformin (b)
-other agents not recommended as 1st line
generally, BP tends to ____ in pregnancy
decrease
gestational hypertension (w/o proteinuria) usually develops when
after 20 wks
what is the values that can diagnosis gestational hypertension
average diastolic >90
2 readings in same arm
what is considered severe for gestational hypertension
S: >160, D: >110
what values are shown to consider tx for gest hypertension
> 150/100
what are the goal values for gest hypertension
S: 130-150
D: 80-100
what is preeclampsia
gestational hypertension w proteinuria
what is preeclampsia the leading cause of
fetal complications (low wt, fetal growth restriction, preemie, stillbirth)
what are some maternal complications with preeclampsia
renal failure
seizures
death
what are some risk factors for preeclampsia
very old or young
multiple gestation
chronic htn
previous hx of preeclampsia
first baby
obese
tobacco
what are some other signs and sx of preeclampsia
edema
n/v
headache
mental status change
blurred vision
tachycardia
what high risk populations should use prevention for preeclampsia
previous mod/sev preeclampsia
multifetal gest
renal
autoimmune disease
diabetes
chronic htn
what is the preventive tx for preeclampsia
low dose aspirin AFTER 12 wk gestation
what is the only cure of preeclampsia
delivery of placenta (tx of choice if 37+ wk gestation)
what kind of tx should be inititated if preeclampsia is becoming severe
antihypertensive
anticonvulsive
when should antihypertensive therapy be inititated
if > 150/100 mmHg
what is the first line for antihypertensive therapy
iv labetolol
what is second line for antihypertensive therapy
oral sustained release nifedpine
what is the med for anticonvulsant therapy
iv mag sulfate
what is considered chronic hypertension
> 140/90
present before prego or diagnosed before wk 20
what are some meds used for chronic hypertension
methyldopa (mild-slow)
beta blocker–labetolol (freq use)
calcium channel blockers (nifedipine and verampamil)
what beta blocker should be avoided for chronic hypertension
atenolol
what is not recommended for chronic hypertension
ace inhibitors
arbs
diuretics can be continued if taking ____ to pregnancy
prior
for venous thromboembolism, what med is contraindicated
warfarin
what is used for prevention in at risk pt/treatment
low molecular wt heparin
enoxaprin
what is used for prevention in at risk pt/treatment
low molecular wt heparin
enoxaparin
what kind of headaches are most common during pregnancy
tension, migraine
the headaches during pregnancy are associated to fluctuations in what
estrogen
what is non pharm for headaches
ice packs
rest
what are pharm options for headaches
apap
can add caffeine (under 200mg)
butalbital
what should be avoided for headaches
aspirin
nsaids during 1st and 3rd tri
triptans
opioids
iron deficiency anemia increases risk of what
preterm delivery
low birth weight
what is iron needed for
fetus/placenta
increased RBCs
is the babys iron affected by iron deficiency
NO
what is the treatment for iron deficiency anemia
30-60 mg iron daily
PLUS folic acid
for all otc products, you should wait until when to use them
2nd tri
what are some otc products to avoid during preg
asipirin
bismuth
nsaids
cough syrup
oral decongestant
combo otc
for asthma, what beta agonist (short or long acting) should be avoided–can use if needed
short acting
minimize using preg
corticosteroids for asthma should be avoided when
1st tri (oral)
inhaled is ok at low doses (budenoside preferred)
should anti epileptics be withdrawn due to teratogenic risk
NO
can therapy be changed for epileptic use once preg is confirmed
no
-can precipitate seizures
anti epileptics can decrease what levels
folate
what can be used for mood disorder
TCA (good)
SSRI (used but some concerns)
what are good SSRIs to use
sertraline
citalopram
escitalopram
what SSRIs should be avoided
fluoxetine
paroxetine
typical antipsychotics are ok to use during pregnancy, what are some examples
chlorpromazine
haloperidol
perphenazine
even though lithium is a known teratogen, it is the drug of choice for what
bipolar disorder
thyroid disorder is considered when you have
TSH lower than normal
-should be monitored every 4-6 wks
for thyroid disorder, what med is considered safe
levothyroxine
