QUIZ 6

Question 1

What drugs may require dose adjustment d/t differences in volume of distribution?

Answer 1

• antiepileptics

- antibiotics

Question 2

What occurs embryologically from conception to 31 days?

Answer 2

development of head and CNS

Question 3

What occurs embryologically from 31 to 71 days?

Answer 3

growth development of palate and ears

Question 4

What occurs embryologically from 71 days to term?

Answer 4

internal organ development and growth

Question 5

What are typical effects of teratogens?

Answer 5

• restricted growth or death of fetus
• carcinogenesis
• malformation in organ structure or function

Question 6

What are pharmacokinetic principles to consider?

Answer 6

1) protein binding
2) T 1/2: shorter > longer
3) volume of distribution: high = distributed in greater concentrations
4) pKa = pH
5) bioavailability = how much in blood stream
6) IV = most active
7) IM/SubQ
8) PO - must account for GI

Question 7

What are lactation risk categories?

Answer 7

L1: safe; not PO bioavailable 
L2
L3: +/- data
L4: maybe benefits > risks; no alternatives 
L5: CONTRAINDICATED

Question 8

What are medication properties to consider in lactation?

Answer 8

1) PO bioavailability
2) milk/plasma ratio: if >1, drug concentrates in milk
3) molecular weight
4) protein binding
5) T 1/2

Question 9

What makes a medication preferable for breastfeeding?

Answer 9

• low PO bioavailability
• low milk/plasma ratio (<1)
• high molecular weight
• high protein binding
• short T 1/2 (take AFTER breastfeeding)

Question 10

What makes a medication not preferable for breastfeeding?

Answer 10

• high milk/plasma ratio (>1)
• low molecular weight (MW<200)
• low protein binding
• long T 1/2 *avoid extended release

Question 11

After which date must drugs have the new label?

Answer 11

July 1, 2015

Question 12

What happens to drugs approved on or after June 30, 2001?

Answer 12

3 years to change labeling

Question 13

What occurs to drugs approved prior to June 30, 2001?

Answer 13

Pregnancy category removed; no other changes mandatory

Question 14

What were the old pregnancy labeling subcategories?

Answer 14

8. 1 pregnancy
9. 2 labor and delivery
10. 3 nursing mothers

Question 15

What are the new pregnancy labeling subcategories?

Answer 15

8. 1 pregnancy AND L&D
9. 2 lactation
10. 3 females and males of reproductive potential

Question 16

What does the new 8.1 category include?

Answer 16

1) pregnancy exposure registry and contact information
2) risk summary: risk of adverse developmental outcomes
3) clinical considerations: risk/benefit counseling
4) data: human and animal

Question 17

What does the new 8.2 category include?

Answer 17

1) risk summary: effect on child, milk production, and presence of drug in milk
2) clinical considerations
3) data

Question 18

What does the new 8.3 category include?

Answer 18

1) need for pregnancy testing
2) contraception recommendations
3) effect on fertility

Question 19

What is the role of the HCP?

Answer 19

1) evaluate and recommend
2) decide
3) document

Question 20

What of the mother’s hx should be considered?

Answer 20

1) med list
2) disease states
3) drug-drug interactions

Question 21

What of the infant’s medical hx should be considered?

Answer 21

1) GA at delivery
2) acuity of care
3) IUGR
4) volume of feedings

Question 22

What characterizes hyperemesis?

Answer 22

1) dehydration
2) ketonuria
3) >5% weight loss

Question 23

What are non-pharm tx of N/V?

Answer 23

• avoid foods/odors
• eating small, frequent meals
• carb rich foods
• separate liquids from solids
• ginger for N, not V

Question 24

What is pharm tx for N/V?

Answer 24

doxylamine + pyridoxine = Cat A

treat w/ B6 first; add unisom if B6 alone does not work

*odansetron can be considered if first line tx not effective

Question 25

What are non-pharm tx for migraines?

Answer 25

• healthy lifestyle
• behavioral tx
• mind/body (e.g. yoga, meditation)
• PT, acupuncture

Question 26

What are pharm tx for migraines?

Answer 26

acetaminophen - lowest dose for shortest amount of time

Question 27

What is not recommended for migraines?

Answer 27

1) avoid NSAIDs (i.e. ibuprofen)
2) opioids not first line
3) triptans = limited info
4) dihydroergotamine and valproic acid = CONTRAINDICATED

Question 28

What is nutrition therapy?

Answer 28

• nutrition counseling and plan

- moderate exercise plan

Question 29

What glucose levels indicate pharm tx?

Answer 29

FBG >95
1h PPG >130-140
2h PPG >120

Question 30

What is first line tx for GDM?

Answer 30

insulin

NPH + short acting (e.g. aspart, lispro,

Question 31

How can insulin be calculated?

Answer 31

0.7u/kg/day x pre-pregnancy weight

Question 32

What are herbal galactagogues?

Answer 32

• fenugreek
• blessed thistle (little data)
• alfalfa (no data)

Question 33

What are rx galactagogues?

Answer 33

1) metoclopramide
2) domperidone
3) sulpiride

Question 34

What is the preferable tx of opioid use?

Answer 34

opioid agonist pharmacotherapy (i.e. methadone) > medically supervised withdrawal

Question 35

What are the benefits of methadone in pregnancy?

Answer 35

• prevention of withdrawal in mother and baby

- reduced rate of relapse

Question 36

T or F: methadone is contraindicated in breastfeeding

Answer 36

FALSE

Question 37

What are the 5 As of smoking cessation?

Answer 37

1) ask about smoking status
2) advise pt about quitting
3) assess willingness to quit
4) assist pt in quitting
5) arrange f/u

Question 38

What is non-pharm tx of depression?

Answer 38

• bright light therapy
• acupuncture
• exercise/yoga
• family/couples therapy
• peer support
• massage

Question 39

What is the first line agent for depression?

Answer 39

sertraline (Zoloft) = SSRI

Question 40

What are pharm tx for asymptomatic bacteriuria/cystitis?

Answer 40

• nitrofurantoin (Macrobid) *avoid in first tri!
• amoxicillin
• cephalexin (Keflex)