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Women's Health - OB > Prescribing in Pregnant Women > Flashcards

Prescribing in Pregnant Women Flashcards

1
Q

Old FDA Pregnancy Category labeling system

A

A: controlled studies show no risk

B: no risk in humans; chance of fetal harm remote

C: risk not excluded; adequate studies lacking; fetal benefits outweigh harm

D: Positive evidence of risk. Studies in humans show fetal risk. Benefit MAY outweigh risk

X: contraindicated

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2
Q

Cons of using old labeling system for pregnancy risk

A
  • often based on animal studies

- does not include adequate info on drug use in lactation

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3
Q

Pregnancy-related physiologic considerations in regards to pharmokinetics

A

Expanded intravascular volume
Increased progesterone activated hepatic metabolism
Increased renal blood flow and GFR
Decreased albumin
Decreased GI motility
Increased thinning of feto-maternal barrier with advancing gestation

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4
Q

What is the critical time when organogenesis to occurs during gestation?

A

first 8 weeks after fertilization (1st trimester)

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5
Q

Most drugs cross the placenta via ________ at a rate directly related to difference between maternal and fetal blood concentrations.

A

simple diffusion

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6
Q

Which types of substances diffuse rapidly into fetal circulation?

A

lipophilic

low molecular weight

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7
Q

Which types of substances do not diffuse into fetal circulation?

A

protein-bound drugs
large molecular weight

(eg. heparin, insulin)

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8
Q

Most drugs enter fetus via what vessel?

A

umbilical vein

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9
Q

Describe how blood gets to fetal systemic circulation from umbilical vein

A

60-80% perfuses liver and rest is shunted to inferior vena cava via ductus venosus

inf vena cava -> right atrium -> shunted to body via foramen ovale and ductus arteriosus to bypass lungs

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10
Q

How is fetal brain tissue different than adults?

A

low myelin content

higher water content

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11
Q

Why are drugs that are originally eliminated by fetus then recirculated?

A

fetus can swallow drug previously eliminated into amniotic fluid

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12
Q

What is the most sensitive time in fetal development for developing malformations? Why?

A

first 8 weeks after fertilization (1st trimester) when organogenesis is occurring

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13
Q

Ways fetus eliminates drugs?

A

Renal excretion

Circulation back through placenta

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14
Q

Which systems are developed earliest and most susceptible to teratogenic effects of drugs and toxins?

A

brain and heart

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15
Q

What are the embryonic and fetal periods? Which is more sensitive phase?

A

Embryonic: fertilization to 8 weeks **more sensitive
Fetal: 8 weeks to birth (wk 38)

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16
Q

Significance of ion trapping in fetus

A

Fetal pH is slightly lower than maternal (7.32 to 7.38), thus most unionized drugs are “ion trapped” to a degree, even in a healthy fetus

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17
Q

What characteristics of drug would minimize fetal exposure?

A 
Low lipid solubility
High protein binding
Lowest dose possible
Short half-life
High molecular weight
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18
Q

methotrexate use during pregnancy

A

Category X

craniofacial deformities, limb deformities

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19
Q

anticonvulsants use during pregnancy

A

Category D

must assess benefit of seizure prevention vs risk of harm to fetus

Magnesium is safe seizure med

20
Q

oral isotretionoin use during pregnancy

A

Category X

causes cleft palate, PTH deficiency, ear and thymus gland abnormalities, CV issues

21
Q

Warfarin effects on fetus

A

Category X

Fetal warfarin syndrome when given in 1st trimester - nasal hypoplasia, hypoplasia of extremities, and developmental retardation

Chondrodysplasia punctata - nasal hypoplasia, bone stippling seen on XR, ophthalmologic abnormalities, and mental retardation

22
Q

Thyroid medication effects on fetus

A

scalp defects (aplasia cutis) in infants and a higher incidence of maternal side effects

23
Q

How is morning sickness treated?

A

Treatment should begin with diet - Carb snacks

Consider Acupressure and acupuncture

Antihistamines (Meclizine, doxylamine, diphenhydramine): decreasing stimulation of vomiting center

Doxylamine (Unisom) is OTC sleep aid
Vitamin B6 with Doxylamine

Ginger (thought to stimulate GI motility and saliva, bile, and gastric sections)

Ondansetron (Zofran)

24
Q

First line treatment for “aches and pains” of pregnancy

A

acetaminophen

25
Q

When can NSAIDs be used in pregnancy?

A

May be used in first trimester ONLY if mother has no h/o GI bleed, ulcer, miscarriage, difficulties conceiving

26
Q

Risk of NSAID use in pregnancy

A

First trimester associated with increased miscarriage risk

Third trimester associated with persistent pulmonary HTN of newborn

27
Q

How to treat constipation in pregnant women?

A

Bulk-forming laxatives are safe -> Psyllium and calcium polycarbophil

Avoid magnesium

28
Q

How to treat GERD in pregnant women?

A

PPIs and H2 antagonists are safe

29
Q

Which antibiotics are safe to use in pregnant women?

A

Penicillins, Azithromycin, Clindamycin, Nitrofurantoin, Sulfa

30
Q

Which vaccines should be avoided in pregnant women?

A

Live vaccines: MMR, small pox, varicella

31
Q

Which antibiotics are NOT safe to use in pregnant women?

A

Erythromycin, Tetracyclines, Streptomycin

32
Q

Which antifungals should be avoided in treating pregnant women?

A

Ketoconazole and griseofulvin

33
Q

Antiparasitic for pregnant women

A

Metronidazole; avoid single dose therapy

Topical permethrin

34
Q

How to treat preexisting HTN in pregnant women?

A

Avoid ACE inhibitors and thiazide diuretics

35
Q

How to treat preexisting depression in pregnant women?

A

If depression not severe and patient agrees, d/c therapy

SSRIs and TCAs are safe

36
Q

How to treat preexisting type 2 diabetes in pregnant women?

A

Insulin preferred over oral agents as doesn’t cross placenta or get into breast milk

Glyburide may be used, but avoid metformin

37
Q

How to treat preexisting allergic rhinitis in pregnant women?

A

Nasal steroids preferred

Avoid decongestants (pseudoephedrine) and 2nd generation antihistamines (cetirizine, loratadine)

38
Q

How to treat preexisting asthma in pregnant women?

A

First line: Beta agonists and inhaled corticosteroids

Use of oral steroids in first trimester have higher risk for clefts

39
Q

Factors to minimize exposure to infant of breast-feeding mother

A 
Lower volume of distribution
High % of maternal protein binding 
High molecular weight
Low pH
More water soluble
40
Q

Examples of specific drugs that are contraindicated during breast feeding

A 
Ergotamine (for migraines)
High dose narcotics
Aminoglycosides and sulfonamides
Combo OCs
Benzodiazepines
41
Q

What hormone stops lactation?

A

estrogen

42
Q

How to prevent acute mastitis?

A 
cool, moist compress
frequent nursing every 2-3 hrs
always start feeding on plugged duct side
Massage toward nipple
Drink plenty of fluids and limit salt
43
Q

How to prevent acute mastitis?

A 
cool, moist compress
frequent nursing every 2-3 hrs
always start feeding on plugged duct side
Massage toward nipple
Drink plenty of fluids and limit salt
44
Q

How to manage candidas of the nipple?

A

Treat infant’s thrush

Gentian violet (OTC) - paint nipple prior to nursing and also transfer to baby’s mouth; stains!

Nystatin drops for baby and nystatin cream for mother

Miconazole or ketoconazole can also be used for the mother

45
Q

How to manage candidas of the nipple?

A

Treat infant’s thrush

Gentian violet (OTC) - paint nipple prior to nursing and also transfer to baby’s mouth; stains!

Nystatin drops for baby and nystatin cream for mother

Miconazole or ketoconazole can also be used for the mother

46
Q

First line anti-hypertensive in pregnant women

A

Methyldopa

Women's Health - OB (5 decks)

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