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PSI Exam > PSI Pharm > Flashcards

PSI Pharm Flashcards

1
Q

Do SSRIs cause autism?

A

SSRI use in pregnancy itself does not increase the risk of autism

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2
Q

Do antipsychotics cause autism?

A

Risk of ASD related to maternal characteristics and not antipsychotic exposure

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3
Q

When is the risk of autism increased?

A

Greater in women with psychiatric disorders who DON’T use SSRIs than in women who do

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4
Q

What should you tell a mother concerned about baby SSRI withdrawal?

A

Poor Neonatal Adaptation: Noted in 25-30% of babies, lasts 1-2 days, no long term sequelae from it

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5
Q

What is the risk of relapse of anorexia in pregnancy?

A

50%

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6
Q

What baby issues are associated with anorexia in pregnancy?

A
  • Prematurity
  • Low birthweight
  • Small for gestational age
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7
Q

What is the correlation between SSRI use and Neonatal Persistent Pulmonary Hypertension?

A

Correlation but not clinically significant

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8
Q

What is the risk of NPPH compared to the relapse of mental health conditions when stopping SSRIs in the 3rd trimester?

A

RISK OF NPPH IS LESS THAN RELAPSE OF MENTAL HEALTH CONDITIONS OF STOPPING SSRI IN 3RD TRIMESTER

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9
Q

What does untreated Perinatal Panic Disorder increase the risk of?

A
  • Preterm delivery
  • Perinatal depression
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10
Q

Should Paroxetine be avoided during pregnancy?

A

Not contraindicated in pregnancy, but not first choice if psychotherapy and other agents are effective

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11
Q

What is unique about Paroxetine regarding pregnancy?

A

Only antidepressant with FDA warning of use in pregnancy
-Increased risk of CV malformation and neonatal withdrawal

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12
Q

What are the risks for perinatal depression?

A
  • Strong family history
  • Current mental health issues
  • 1st pregnancy
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13
Q

What are the protective factors for perinatal depression?

A
  • Treatment with remission of symptoms
  • Good partner support
  • Active involvement in healthcare
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14
Q

Is psychotherapy indicated for perinatal depression?

A

PSYCHOTHERAPY IS STRONGLY RECOMMENDED BY USPSTF

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15
Q

What else can help postpartum depression?

A
  • Estrogen (if out of DVT/PE window and seems hormonally driven)
  • Coordinate with OBGYN
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16
Q

What medication can be used for hyperemesis gravidarum with comorbid anxiety and depression?

A

Mirtazapine (no increased risk of birth defects, may increase preterm labor but confounds not ruled out)

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17
Q

What is the effect of Prazosin during pregnancy?

A

Can decrease placental perfusion and interfere with labor initiation
-weigh risks vs benefits: may be worth it if nightmares affecting sleep

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18
Q

What should be done if a mother experienced sexual trauma and is breastfeeding?

A
  • Educate on normal sensations of breastfeeding
  • Can express milk and then use bottle at first until ready
  • Start with least anxiety provoking situations (day feeding if night causes anxiety)
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19
Q

Does talking about suicide increase the risk of it happening?

A

NO

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20
Q

What is the prevalence of suicide in the postpartum period?

A

1.6-4.5% prevalence
-80% of cases were preventable

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21
Q

leading cause of maternal perinatal mortality?

A

suicide and overdose

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22
Q

What should be checked if a mother feels she can’t adequately take care of herself or her baby?

A
  • Suicidal thoughts
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23
Q

Mother complains of insomnia. What do you do first?

A
  1. figure out WHY not sleeping
  2. sleep hygiene education
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24
Q

Chronic insomnia during pregnancy may increase risk of?

A
  • Gestational DM
  • HTN
  • Preterm birth
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25
Q

What is the best studied Z drug for insomnia?

A

Zolpidem best studied

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26
Q

What is the concern with Melatonin during pregnancy?

A

NOT first line due to concern could later fetal melatonin receptors

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27
Q

Can trazodone be used in pregnancy?

A

okay, but not first line

28
Q

benzodiazepine use in pregnancy and breastfeeding?

A

-not contraindicated
-baby can withdrawal if mom used regularly

29
Q

Does hydroxyzine cause birth defects?

A

No birth defects

30
Q

what do you want to be careful of with Hydroxyzine use in pregnancy?

A

Seizures in baby due to abrupt discontinuation when used long term at high doses

31
Q

What should you screen for if SSRIs make a patient irritable or angry?

A

Bipolar disorder, do Mood Disorder Questionnaire

32
Q

What is the most studied SSRI in the perinatal period?

A

Sertraline; if successful treatment with sertraline in the past, always use this one

33
Q

What should be done for a patient who had to discontinue venlafaxine due to HTN and is irritable and not sleeping?

A

-Goals: minimize risk of preeclampsia, improve sleep and mood irritability
-could reintroduce venlafaxine at low dose to help with withdrawal

34
Q

What medications are at risk of increasing HTN?

A
  • Venlafaxine (RR=1.5)
  • Duloxetine (RR1.04-1.14)
35
Q

When should Depakote be used in pregnancy?

A

ONLY WHEN OTHER MOOD STABILIZERS ARE INEFFECTIVE AND BENEFITS OUTWEIGH RISKS (carries greatest risk for teratogenicity compared to other mood stabilizers)

36
Q

What is the risk of congenital abnormalities with first trimester exposure to lithium?

A

4.6% risk of congenital abnormalities; 1.2% absolute risk of CV abnormalities

37
Q

What should be monitored for with lithium during pregnancy?

A
  • Nephrogenic diabetes insipidus
  • Transient hypothyroidism
  • Transient neonatal toxicity (floppy baby syndrome)
38
Q

What happens to lithium levels during pregnancy?

A

They decrease, dose will likely be increased compared to prepregnancy dose

39
Q

What should be done with lithium dose after delivery?

A

Immediately return to pre-pregnancy dose

40
Q

How do you reduce toxic lithium peaks to the fetus?

A

Divide doses toward end of pregnancy

41
Q

Women with bipolar disorder are substantially more likely to develop postpartum ___

A

Psychosis

42
Q

Does lamotrigine increase risk for neural tube defects, behavioral issues, or cleft palate in infants?

A

NO

43
Q

What happens to lamotrigine levels during pregnancy?

A

Decrease, dose during pregnancy will likely need increased

44
Q

What should be done with lamotrigine dose after birth?

A

Slowly taper back to pre-pregnancy dose to avoid lamotrigine toxicity

45
Q

Are there congenital malformations with Olanzapine use in pregnancy?

A

No

46
Q

What are the risks to the mother with olanzapine use in pregnancy?

A
  • Excessive weight gain
  • Gestational diabetes
47
Q

How much of olanzapine gets into breast milk?

A

0.3-1.1%
-case reports of irritability, tremor insomnia, somnolence

48
Q

What are the risks of cigarette smoking during pregnancy?

A
  • Low birth weight
  • Preterm birth
  • Perinatal loss (miscarriage, stillbirth)
  • SIDS
  • Possible increase in cardiovascular birth defects
49
Q

Does reducing the number of cigarettes during pregnancy help?

A

Not if they are inhaling them more deeply

50
Q

What are the risks associated with Wellbutrin during pregnancy?

A
  • Increased risk of CV abnormalities with first trimester exposure
  • Miscarriage
  • Lowered seizure threshold
  • ADHD in offspring (may be confounded by indication)
  • Fetal cardiac arrythmia and neonatal hyperinsulinism
51
Q

What are the options for smoking cessation during pregnancy?

A
  • Chantix: no birth defects but watch for suicidality in history of depression
  • NRT: gum> patch as patch exposes baby to more nicotine
  • Don’t underestimate counseling/behavior modification!
52
Q

What are the complications of alcohol use in pregnancy?

A
  • Fetal alcohol syndrome (cognitive malformations and impairment)
  • Increased risk of miscarriage, stillbirth, newborn infections
53
Q

What are the non-pharmacologic interventions for alcohol cessation in pregnancy?

A
  • Motivational interviewing
  • Acceptance/mindfulness based interventions
  • Mutual support groups (AA, SMART)
54
Q

What is the risk of naltrexone in pregnancy?

A

Not studied in pregnancy specifically; no difference in congenital abnormalities, stillbirth compared to women using buprenorphine or methadone

55
Q

Is acamprosate safe in pregnancy?

A

yes, no increased risk of congenital abnormalities or low birth weight

56
Q

Should opioid use disorder (OUD) in pregnancy be treated with MAT?

A

Yes; Relapsing pattern of addiction associated with preterm birth, low birth weight, reduced head size, SIDS

57
Q

What should be told to mothers about MAT and infant withdrawal?

A

Withdrawal can be managed in hospital

58
Q

What is the effect of methadone use in pregnancy?

A

Improves outcomes compared to relapsing remitting pattern of addiction

59
Q

What is the effect of buprenorphine use in pregnancy?

A

Crosses placenta less than methadone; less intense infant withdrawal compared to methadone

60
Q

What should be considered with ADHD treatment during pregnancy?

A

Weigh risk of stress and accident risk of untreated ADHD on infant vs being treated

61
Q

What are the risks associated with ADHD stimulants in pregnancy?

A
  • Possible increased risks of preeclampsia
  • Preterm birth
  • Low birth weight
  • Fetal hypoxia
  • Seizures
  • NICU admissions
  • CV malformations (seen with methylphenidate but not amphetamines)
    ***absolute risks appear to be small, confounds were not ruled out, there are no systemic long term studies on neurobehavioral effects on offspring
62
Q

What should mothers be warned about with stimulants in pregnancy?

A

Decreased appetite/weight gain

63
Q

What is the percentage of methylphenidate in breast milk?

A

<1%

64
Q

What is the percentage of amphetamines in breast milk?

A

<2%

65
Q

Is there any adverse effect with breastfeeding while on ADHD medications?

A

No adverse effects with breastfeeding, though limited data

PSI Exam (7 decks)

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