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gu/repro > prego and conditions > Flashcards

prego and conditions Flashcards

1
Q

T/F: is using medication during pregnancy common

A

true

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2
Q

what are the most common medications pregnant women take

A

antibiotics
promethazine

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3
Q

what is the primary goal for medication use in pregnant women

A

prevention of birth defects due to medications

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4
Q

pregnancy is measured from ____ first day of ____menstrual period

A

first
last

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5
Q

the first trimester is the most critical period for drug exposure because why

A

major organs are developing

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6
Q

what is a teratogen

A

substance that causes a birth defect or malformation in an exposed embryo/fetus

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7
Q

what is teratogeniticty

A

ability of teratogen to produce congenital abnormalities

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8
Q

some examples of known teratogens

A

ace inhibitors
anticonvulsants
isotretinoin
lithium
thalidomide
warfarin
tetracycline

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9
Q

what is category A

A

-safest
-studies fail to demonstrate risk in 1st trimester

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10
Q

what is category B

A

animal studies have not demonstrated a fetal risk but NO controlled studies in prego women or animals show AE but safe in humans

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11
Q

what is category C

A

animal studies show AE, no studies in women or no animal/human studies

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12
Q

what is category D

A

evidence of positive fetal harm but benefit might outweigh risk

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13
Q

what is category X

A

risk clearly outweigh benefits, contraindicated

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14
Q

why is the ABCD category not used anymore

A

-confusing
-unable to keep up with changing data
-when prescribing, it was more based on category and not understanding what it actually meant

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15
Q

what are the goals of PLLR

A

provide better counseling to pregnant women and nursing mothers who need to take medication

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16
Q

is cutaneous blood flow increased or decreased

A

increased

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17
Q

does blood volume increase or decrease at term

A

increases–up to 50%

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18
Q

why does hemoglobin slightly decrease during pregnancy

A

because of extra volume

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19
Q

what supplement requirements increase during pregnancy especially later half

A

iron

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20
Q

SBP drops by how much during pregnancy

A

5-10 mmHg

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21
Q

what kind of blood flow is slower in pregnancy

A

venous
-leg edema, varicose veins

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22
Q

residual volume is decreased due to elevated diaphragm because

A

baby is pressing on diaphragm and lungs cant expand

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23
Q

does kidney size increase or decrease

A

increase
-gfr increases

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24
Q

nausea/vomiting may do what to drug absorption

A

decrease

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25
Q

gi motility decreases may do what to drug absorption

A

increase it

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26
Q

body fat increases, what does that lead to

A

VD of lipid soluble drugs is increased

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27
Q

albumin decreases, what happens to VD

A

increases

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28
Q

placenta is the _____ barrier between ____ and ____ circulation

A

lipid
fetal
maternal

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29
Q

what does the placenta produce to maintain pregnancy

A

progesterone

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30
Q

the placenta is rich in

A

blood vessels

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31
Q

the placenta supplies what

A

oxygen

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32
Q

what kind of substances cross the membrane easier

A

fat soluble bc of lipid barrier

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33
Q

what kind of drugs (non-ionized or ionized) cross easier

A

non-ionized

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34
Q

do low or large MW drugs cross easier

A

low
*drugs w MW <500 will cross placenta
*drugs w MW >1000 do NOT cross

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35
Q

what is the 2nd most prevalent congenital anomaly

A

neural tube defects
* spina bifida and anencephaly

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36
Q

neural tube defects are from failure of what

A

neural tube closing
-closure occurs in 1st month of prego

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37
Q

what is the cause of neural tube defects

A

folic acid deficiency
methotrexate
exposure to cig smoke

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38
Q

T/F: folic acid should be recommended for ALL women of reproductive age

A

true

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39
Q

how much folic acid should be taken daily

A

400-800 mcg

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40
Q

for maximal benefit, when should you start taking folic acid

A

1 month before to through 3 month after conception

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41
Q

what kind of women are considered high risk to where they need to take folic acid

A

previously affected pregnancy
taking anticonvulsants

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42
Q

how much folic acid should be taken if at high risk

A

4 mg daily in the months surrounding conception or throughout pregnancy

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43
Q

what kind of vaccines should be avoided during pregnancy

A

live
*varicella, HPV, MMR

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44
Q

what is a vaccination that is recommended for all prego ppl

A

tdap–for each pregnancy btw 27-36 wks
bc baby is not protected from pertussis

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45
Q

caffeine should limited to how much when preconception planning

A

<200 mg before and during pregnancy

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46
Q

tobacco can cause what

A

preterm birth, low birth wt, spontaneous abortion

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47
Q

what can obesity cause during pregnancy

A

neural tube defects
preterm delivery
diabetes
hypertension
C section

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48
Q

if normal weight, how much kcal is recommended

A

100-300 kcal

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49
Q

if constipation is untreated, it can lead to what

A

hemmorhoids

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50
Q

what is nonpharm for constipation

A

high fiber foods
fluids
exercise

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51
Q

what is 1st line for pharm tx for constipation

A

fiber supplements
stool softners

52
Q

what is acceptable for short term use in constipation

A

peg
mg/sodium salts
senna

53
Q

what is CI in constipation

A

castor oil
mineral oil
bc it causes uterine contractions

54
Q

what can you do if you get hemorrhoids

A

sitz bath
avoid constipation
avoid sitting for long period of time

55
Q

what is CI for hemorrhoids

A

topical anesthetics and steroids

56
Q

GERD usually happens when in pregnancy

A

later half

57
Q

what is nonpharm for GERD

A

small freq meals
avoid food before bed
elevate head of bed

58
Q

what is 1st line for GERD

A

anatacids
sucralfate

59
Q

what is 2nd line for GERD

A

famotidine
PPI (lansoprazole, pantoprazole, rabeprazole is/was cat b)
metoclopramide (cat B)

60
Q

when should you stop acid suppression agent

A

after pregnancy or when dyspepsia improves

61
Q

when does nausea/vomiting usually happen

A

1st trimester

62
Q

what is the cause of N/V

A

unknown but thought to due to hCG and estrogen

63
Q

what is hyperemesis gravidarum

A

unrelenting vomiting
-may need iv fluids, hospitalization

64
Q

what may reduce incidence of N/V 3 mo prior to conception

A

prenatal vitamins

65
Q

what are some non pharm things to do with N/V

A

eat freq,small meals
bland foods
high protein foods
drink, chilled tart drinks (ginger ale)

66
Q

what non pharm should be avoided with N/V

A

fatty and spic meals
foods with odors
empty stomach

67
Q

what is the first line for n/v

A

vitamin b6
-can do b6 + doxylamine
-metoclopramide

68
Q

what else can be used for n/v if needed

A

ondansetron (cat B)
-not approved for use of n/v in preg
-watch qtc

69
Q

what is gestational diabetes mellitus

A

glucose intolerance during 2nd or 3rd tri

70
Q

what are some consequences from GDM

A

fetal loss
increased risk of major malformations
fetal macrosomia

71
Q

what conditions increase risk for GDM

A

> 25
obesity
family hx of dm
previous infant >9 lb
race (african american, hispanic, asian, native)

72
Q

what is the goal AIc and when should they be screened

A

6-7%
24-28 wks

73
Q

the two step screening for GDM is: screening with __ hr, __ g glucose test

A

1 hr
50 g

74
Q

the one step screening for GDM: NO screening, __ hr, __g glucose test

A

2 hr
75 g

75
Q

non pharm is 1st line for GDM, what is the tx

A

diet
daily blood glucose monitoring–REQUIRED

76
Q

what is the pharm tx for GDM

A

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

77
Q

generally, BP tends to ____ in pregnancy

A

decrease

78
Q

gestational hypertension (w/o proteinuria) usually develops when

A

after 20 wks

79
Q

what is the values that can diagnosis gestational hypertension

A

average diastolic >90
2 readings in same arm

80
Q

what is considered severe for gestational hypertension

A

S: >160, D: >110

81
Q

what values are shown to consider tx for gest hypertension

A

> 150/100

82
Q

what are the goal values for gest hypertension

A

S: 130-150
D: 80-100

83
Q

what is preeclampsia

A

gestational hypertension w proteinuria

84
Q

what is preeclampsia the leading cause of

A

fetal complications (low wt, fetal growth restriction, preemie, stillbirth)

85
Q

what are some maternal complications with preeclampsia

A

renal failure
seizures
death

86
Q

what are some risk factors for preeclampsia

A

very old or young
multiple gestation
chronic htn
previous hx of preeclampsia
first baby
obese
tobacco

87
Q

what are some other signs and sx of preeclampsia

A

edema
n/v
headache
mental status change
blurred vision
tachycardia

88
Q

what high risk populations should use prevention for preeclampsia

A

previous mod/sev preeclampsia
multifetal gest
renal
autoimmune disease
diabetes
chronic htn

89
Q

what is the preventive tx for preeclampsia

A

low dose aspirin AFTER 12 wk gestation

90
Q

what is the only cure of preeclampsia

A

delivery of placenta (tx of choice if 37+ wk gestation)

91
Q

what kind of tx should be inititated if preeclampsia is becoming severe

A

antihypertensive
anticonvulsive

92
Q

when should antihypertensive therapy be inititated

A

if > 150/100 mmHg

93
Q

what is the first line for antihypertensive therapy

A

iv labetolol

94
Q

what is second line for antihypertensive therapy

A

oral sustained release nifedpine

95
Q

what is the med for anticonvulsant therapy

A

iv mag sulfate

96
Q

what is considered chronic hypertension

A

> 140/90
present before prego or diagnosed before wk 20

97
Q

what are some meds used for chronic hypertension

A

methyldopa (mild-slow)
beta blocker–labetolol (freq use)
calcium channel blockers (nifedipine and verampamil)

98
Q

what beta blocker should be avoided for chronic hypertension

A

atenolol

99
Q

what is not recommended for chronic hypertension

A

ace inhibitors
arbs

100
Q

diuretics can be continued if taking ____ to pregnancy

A

prior

101
Q

for venous thromboembolism, what med is contraindicated

A

warfarin

102
Q

what is used for prevention in at risk pt/treatment

A

low molecular wt heparin
enoxaprin

103
Q

what is used for prevention in at risk pt/treatment

A

low molecular wt heparin
enoxaparin

104
Q

what kind of headaches are most common during pregnancy

A

tension, migraine

105
Q

the headaches during pregnancy are associated to fluctuations in what

A

estrogen

106
Q

what is non pharm for headaches

A

ice packs
rest

107
Q

what are pharm options for headaches

A

apap
can add caffeine (under 200mg)
butalbital

108
Q

what should be avoided for headaches

A

aspirin
nsaids during 1st and 3rd tri
triptans
opioids

109
Q

iron deficiency anemia increases risk of what

A

preterm delivery
low birth weight

110
Q

what is iron needed for

A

fetus/placenta
increased RBCs

111
Q

is the babys iron affected by iron deficiency

A

NO

112
Q

what is the treatment for iron deficiency anemia

A

30-60 mg iron daily
PLUS folic acid

113
Q

for all otc products, you should wait until when to use them

A

2nd tri

114
Q

what are some otc products to avoid during preg

A

asipirin
bismuth
nsaids
cough syrup
oral decongestant
combo otc

115
Q

for asthma, what beta agonist (short or long acting) should be avoided–can use if needed

A

short acting
minimize using preg

116
Q

corticosteroids for asthma should be avoided when

A

1st tri (oral)
inhaled is ok at low doses (budenoside preferred)

117
Q

should anti epileptics be withdrawn due to teratogenic risk

A

NO

118
Q

can therapy be changed for epileptic use once preg is confirmed

A

no
-can precipitate seizures

119
Q

anti epileptics can decrease what levels

A

folate

120
Q

what can be used for mood disorder

A

TCA (good)
SSRI (used but some concerns)

121
Q

what are good SSRIs to use

A

sertraline
citalopram
escitalopram

122
Q

what SSRIs should be avoided

A

fluoxetine
paroxetine

123
Q

typical antipsychotics are ok to use during pregnancy, what are some examples

A

chlorpromazine
haloperidol
perphenazine

124
Q

even though lithium is a known teratogen, it is the drug of choice for what

A

bipolar disorder

125
Q

thyroid disorder is considered when you have

A

TSH lower than normal
-should be monitored every 4-6 wks

126
Q

for thyroid disorder, what med is considered safe

A

levothyroxine

gu/repro (5 decks)

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