Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Endocrine Module > Teratogenesis, Pregnancy, and Postpartum Issues > Flashcards

Teratogenesis, Pregnancy, and Postpartum Issues Flashcards

1
Q

What factors influence teratogenic potential?

A
  1. Duration of Use
  2. Susceptibility of Fetus
  3. Placental Transfer
  4. Timing of Exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the mechanism of Placental Transfer?

A

Passive Diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What factors influence rate and extent of passive diffusion?

A
  1. MW
  2. Protein Binding
  3. Lipid Solubility
  4. Ionization
  5. Concentration Gradient
  6. Uterine Blood Flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In terms of MW, what are the sizes that cross and do not cross the placenta?

A

<500 daltons, readily cross
>1000 daltons, do not cross in significant amounts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do highly protein bound drugs cross the placenta?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ionized or Unionized drugs cross the placenta?

A

Unionized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The Pre-Embyronic Stage is 0-14 days after fertilization, what is the teratogen effect?

A

Teratogen exposure produces ALL or NOTHING effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The Embryonic Stage is 14-56 days, what is the teratogen effect?

A

MOST Susceptible = MAJOR structural anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The Fetal Stage is 57 days - term, what is the teratogen effect?

A

Anomalies more likely to involve growth and functional aspects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the limitations of the OLD FDA Categories?

A

Derived from animal data
No distinction between drugs in the same class
Majority in Category C
Lacks informative data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the REVISED FDA labeling include?

A
  1. Removed letter category
  2. Pregnancy Subsection
  3. Lactation Subsection
  4. Females and Males of Reproductive Subsection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are agents to avoid DURING pregnancy?

A
  1. ACE/ARBs/Renin Inhibitors
  2. DOACs
  3. Isotretinoin
  4. NSAIDs
  5. Retinoids
  6. Thalidomide
  7. Trimethoprim
  8. Valproic Acid
  9. Warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the concern with Thalidomide and does it have a REMs?

A

Contraindicated in Pregnancy
YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the requirements for the REMS of Thalidomide?

A
  1. Prescription filled <7 days and no more than a 4-week supply at one time
  2. Patients required to use contraceptive measures
  3. Females must have neg pregnancy test within 24 hrs prior to starting treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the concern with Lenalidomide and does it have a REMs?

A

Contraindicated in pregnancy
YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the concern with Retinoids?

A

Contraindicated in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is the greatest risk for Retinoids?

A

At 4-7 weeks gestation and risk persists after stopping therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the contraception requirement for Isotretinoin?

A

Contraception 1 month following DC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the contraception requirement for Acitretin (Soriatane)?

A

Contraception for 3 years following DC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the iPLEDGE Program?

A

REMs for Isotretinoin, requires all patients, prescribers, pharmacists, and wholesale distributors to register

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

For iPLEDGE patients must complete an informed consent with pick prescription within?

A

30 days for men and women who cannot get pregnant
7 days for women of childbearing potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

For females of childbearing potential, iPLEDGE requires what?

A

2 negative pregnancy tests before starting, negative pregnancy test every month, and use of 2 forms of contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Can you donate blood while taking Isotretinoin?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does the dating of pregnancy (gestation) work?

A

Gestation age refers to age of fetus beginning the first days of the last menstrual period which is ~2 weeks prior to fertilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Prematurity is defined as?

A

<37 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Late Pretrerm is defined as?

A

34-36 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Gravidity (G) means what?

A

Number of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Parity (P) means what?

A

Number of pregnancies that exceed 20 weeks of gestation and outcome of each pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the PK changes in pregnancy?

A
  1. Delayed gastric emptying, INCREASED gastric pH
  2. Decreased motility
  3. Increased total body water
  4. Increased body fat
  5. Increased cardiac output
  6. Increased GFR
  7. Decreased plasma albumin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Increase in gastric pH causes what?

A

Increase availability of acid-labile drugs or decrease availability for drugs that require acidic environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Decrease gastric emptying causes what?

A

Delay time to peak concentration after admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Decrease in GI motility causes what?

A

Increased absorption of enteral meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Increase in total body water causes what?

A

Increase volume of distribution for hydrophilic meds = increase dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Increase body fat causes what?

A

Increase volume of distribution for lipophilic meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Increase cardiac output causes what?

A

Increase hepatic blood flow = increase hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Increase GFR causes what?

A

Increase clearance of renal eliminated drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Decrease plasma albumin causes what?

A

Increase free drug for drugs that are highly protein bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What Vitamins and Supplements should be taken?

A
  1. Pre-Natal Multi-Vitamin
  2. Iron
  3. Folate
  4. Calcium/Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the minimum amount of iron that should be taken?

A

30 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What amount of iron is recommended during pregnancy?

A

30 mg/day
60-120 if iron deficiency anemia is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What amount of iron is recommended in prenatal vitamin?

A

30-90 mg of elemental iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the recommended amount of folate for all women of child-bearing age?

A

0.4 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the recommend amount of folate for women during pregnancy?

A

0.8 mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the recommend amount of folate in prenatal vitamins?

A

0.8-1 mg of folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the recommend amount of calcium and vitamin D for pregnancy?

A

1000 mg of calcium and 600 IU of vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When is dietary modifications recommended to treat diabetes in pregnant women?

A

Type 2 DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the first line choice treatment of type 1 and 2 diabetes in pregnant women?

A

Insulin, does not cross placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

If insulin is not used in Type 2 DM, what oral agents are recommended?

A

First Line: Metformin
Second Line; Glyburide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the concern with Glyburide in pregnant women?

A

May result in more neonatal hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is chronic hypertension defined as in pregnancy?

A

Diagnosed before pregnancy or before 20 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the treatment for Mild-Mod Hypertension 140-149/90-108 mmHg?

A

Watch and Wait
Decrease salt, protein, stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the treatment for CHRONIC Severe Hypertension >160/100 mmHg?

A

1st Lne: Labetalol PO or Nifedipine ER PO
2nd/3rd Line: Methyldopa PO or HCTZ PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the goal BP for CHRONIC Severe Hypertension?

A

120-159/80-106 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the treatment for ACUTE Severe Hypertension >160/100 mmHg?

A

Hydralazine IV, Labetalol IV, Nifedipine IM
Start within 60 mins, not one is 1st line, if one doesn’t work at max dose move on to the next

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When do you avoid ACE/ARBs in pregnancy?

A

2nd/3rd, with concern in the first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When do you avoid MRAs in pregnancy?

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the FDA box warning for ACE/ARBs?

A

DC use as soon as possible once pregnancy is detected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the drug of choice for asthma that is a beta agonist?

A

Albuterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the drug of choice for asthma that is an inhaled corticosteroid?

A

Budesonide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the drug of choice for asthma that is a long-acting beta agonist?

A

Salmeterol/Formoterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the anti-epileptic agents?

A

Valproic Acid, Phenytoin, Phenobarbital, Carbamazepine, and Topiramate

62
Q

What does Valproic Acid cause?

A

Neural tube defects
Facial Cleft

63
Q

What does Phenytoin cause?

A

Cleft palate
Limb defects

64
Q

What does Phenobarbital cause?

A

Cardiac malformations

65
Q

What does Carbamazepine cause?

A

Cleft palate

66
Q

What does Topiramate cause?

A

Cleft palate

67
Q

How do you manage epilepsy when pregnant?

A

Monotherapy at lowest effective dose, AVOID valproic acid, phenobarbital, and phenytoin if possible

68
Q

What is the recommended folate supplementation for patients with epilepsy?

A

1 mg/day for w/epilepsy
4 mg/day for patients on carbamazepine or valproic acid

69
Q

When is nonpharmacologic psychotherapy appropriate treatment for depression in pregnant women?

A

Effective for most with mild to moderate depression

70
Q

What is the drug of choice for depression in pregnancy?

A

SSRIs are drug of choice
Sertaline and Fluoxetine
AVOID paroxetine and citalopram

71
Q

What is the alternative drug for depression in pregnancy?

A

Tricyclic Antidepressants
Desipramine and Nortiptyline

72
Q

What are the neonatal effects of SSRIs?

A

Persistent Pulmonary Hypertension of the newborn
Poor neonatal adjustment syndrome

73
Q

What are the pregnancy-induced conditions?

A
  1. N/V
  2. Constipation
  3. GERD
  4. Gestational Diabetes
  5. Gestational HTN
  6. Preeclampsia
  7. Thromboembolism
74
Q

What is the treatment goal for N/V (hyperemesis gravid arum)?

A

Decrease symptom severity and frequency, prevent and treat complications, and minimize potential fetal effects

75
Q

What is the treatment algorithm for N/V?

A
  1. Dietary Changes
  2. Vitamin B6 and Doxylamine
  3. Add Dimenhydrinate, Diphenhydramine, Promethazine, or Prochlorperazine
  4. Add Metoclopramide or Ondansetron
  5. Add Chlorpromazine or Methylprednisolone

Add On: Ginger Extract

76
Q

What are the precautions of Promethazine second line drug for N/V?

A

Dystonia, sedation, extrapyramidal reactions

77
Q

What are the precautions of Prochlorperazine second line drug for N/V?

A

Dystonia, sedation, extrapyramidal reactions

78
Q

What are the precautions of Metoclopramide second line drug for N/V?

A

Caution with use at < 10 weeks gestation, prolong QT interval

79
Q

What are the precautions of Ondansetron third line drug for N/V?

A

Caution with use at < 10 weeks gestation, prolong QT interval

80
Q

What are the precautions for Pyridoxine/Doxylamine (Diclegis) combination for N/V?

A

Delayed release tablet, sedation

81
Q

What are the precautions for Pyridoxine/Doxylamine (Bonjesta) combination for N/V?

A

Extended release tablet, sedation

82
Q

What is the first line option for N/V?

A

Pyridoxine

83
Q

What are the OTC meds for N/V?

A

Diphenhydramine, Doxylamine, Meclizine, Pyridoxine, and Ginger

84
Q

What is first line therapy for constipation in pregnancy?

A

Nonpharmacologic, dietary changes

85
Q

What are the first line agents for constipation in pregnancy?

A

Antacids, H2 Antagonists, and PPI

86
Q

What are the Antacids, and which one is most recommended?

A

Calcium Carbonate (most)
Aluminum Hydroxide (least)
Magnesium Hydroxide

87
Q

What are the H2 Antagonists, and which one is most recommended?

A

Ranitidine (no)
Famotidine (most)
Cimetidine (avoid)

88
Q

What are the PPIs and which one is most recommended?

A

Lansoprazole
Omeprazole (most)
Pantoprazole

89
Q

What drugs should be avoided in constipation with pregnancy?

A

Antidiarrheal/Antisecretory Bismuth Subsalicylate and Antacid Sodium Bicarb

90
Q

Why do you avoid Bismuth Subsalicylate?

A

Closure of ductus arterious

91
Q

Why do you avoid Sodium Bicarbonate?

A

Maternal/Fetal metabolic alkalosis

92
Q

What are the risk factors for Gestational Diabetes?

A
  1. Age >25
  2. Overweight
  3. Ethnic group with high incidence DM
  4. FH of DM
  5. History of abnormal glucose test
93
Q

When should screening with oral glucose tolerance test OGTT occur?

A

24-48 weeks gestation

94
Q

What is the drug of choice for gestational diabetes?

95
Q

What is the alternative oral agent for gestational diabetes?

96
Q

What is the classification for Gestational Hypertension?

A

Increase BP SBP>140 mmHg or DBP> 90 mmHg, after 20 weeks gestation

97
Q

What is Preeclampsia?

A

Increase BP with proteinuria, Increase BP with thrombocytopenia, renal/hepatic insufficiency, pulmonary edema, or new onset headache

98
Q

What is Eclampsia?

A

Tonic clonic seizures with preeclampsia

99
Q

Is Eclampsia a medical emergency?

A

YES, requires intubation to protect airway, seizures can occur antepartum, intrapartum, or postpartum

100
Q

What are the HELLP Complications for Preeclampsia?

A

H: Hemolysis
E: Elevated L: Liver Function tests
L: Low P: Platelets

101
Q

What are the risk factors for Preeclampsia?

A
  1. Chronic HTN
  2. Chronic Renal Disease
  3. Maternal Age >40
  4. Multiple Gestation
  5. Preeclampsia in a previous pregnancy
  6. Gestational diabetes or diabetes
  7. Obesity
102
Q

Management of Severe Preeclampsia applies to what patients?

A
  1. BP <160 SBP or >110 DBP on two occasions 4 hours apart
  2. Thrombocytopenia
  3. Impaired hepatic function
  4. Renal insufficiency
  5. Pulmonary edema
  6. New onset HA/or visual disturbances
103
Q

What should be used to manage BP in Severe Preeclampsia?

A

IV Labetalol or Hydralazine

104
Q

What should be used to manage Seizure Prevention in Severe Preeclampsia?

A

Magnesium Sulfate

105
Q

What is the goal range for magnesium concentration for prevention of eclampsia?

106
Q

What can be used for prevention of preeclampsia?

A

Low dose ASA may be used after 12 weeks of pregnancy for women at high risk for preeclampsia

107
Q

How does the ASA dose change for patients with Type 1 or 2 DM?

A

100-150 mg/day

108
Q

What is the preferred treatment for Thromboembolism in Pregnancy?

109
Q

What is the alternative first line treatment for Thromboembolism in Pregnancy?

110
Q

When can Warfarin be used in pregnancy?

A

TERATOGEN, avoid unless used in women with mechanical heart valves (teratogenic risk decrease with doses <5mg)

111
Q

Drug of Choice for Pain in Pregnancy?

A

Acetaminophen

112
Q

Alternative Choice for Pain in Pregnancy?

A

NSAIDs, avoid in 1st/2nd trimester

113
Q

Drug of Choice for Allergies in Pregnancy?

A

Chlorpheniramine or Intranasal Corticosteroids

114
Q

Alternative Choice for Allergies in Pregnancy?

A

Diphenhydramine, Loratadine, and Cetirizine

115
Q

Drug of Choice for Cough/Congestion in Pregnancy?

A

Oxymetazoline (nasal)
Pseudoephedrine (oral)
Dextromethorphan

116
Q

Alternative Choice for Cough/Congestion in Pregnancy?

A

Guaifenesin, avoid due to congenital effects

117
Q

Drug of Choice for UTI in Pregnancy?

A

Amoxicillin-Clavulanta or Nitrofurantoin

118
Q

Alternative Choice for UTI in Pregnancy?

A

Cephalexin
Bactrim (avoid in 2nd/3rd trimester)

119
Q

Drug of Choice for Diarrhea in Pregnancy?

A

Stool bulking

120
Q

Alternative Choice for Diarrhea in Pregnancy?

A

Loperamide, use sparingly

121
Q

What is defined as preterm labor?

A

Cervical dilation and/or uterine contractions at <37 weeks gestation

122
Q

What are Tocolytic Agents used for?

A

Postpone delivery long enough (up to 38 hours) to allow for: administration of antenatal corticosteroids or transport of mother

123
Q

What is the tocolytic beta agonist?

A

Terbutaline, not ideal due to hypotension, arrhythmias, and hyperkalemia

124
Q

What is the tocolytic CCB?

A

Nifedipine, predominant agent
May cause hypotension

125
Q

What is the tocolytic NSAID?

A

Indomethacin, predominant agent
May cause premature closure of ductus arterioles

126
Q

What is the tocolytic magnesium?

A

Magnesium Sulfate, limited efficacy

127
Q

What are the antenatal steroids that are utilized to accelerate fetal lung maturation?

A

Betamethasone or Dexamethasone

128
Q

When is Betamethasone 12 mg IM or Dexamethasone 6 mg IM recommended?

A

Risk for delivery >24 to <34 weeks
Risk for delivery at >34 to <37 weeks with no previous course

129
Q

What are the Cervical Ripening Agents?

A

Misoprostol (intravaginal/oral)
Dinoprostone (intravaginal/intracervical)

130
Q

Dinoprostone Gel (prepidil) is what route?

A

Intracervical

131
Q

Dinoprostone Vaginal (Cervidil) is what route?

A

Intravaginal

132
Q

What drug stimulates/induces labor?

133
Q

How does drug excrete into breast milk?

A

Passive Diffusion

134
Q

Maternal Serum Concentration in relation to breast milk

A

High maternal concentration = greater passive diffusion into milk

135
Q

Lipid Solubility in relation to breast milk

A

Higher lipid solubility = greater transfer into milk

136
Q

Protein Binding in relation to breast milk

A

Higher protein bound = less transfer into breast milk

137
Q

Ionization in relation to breast milk

A

Unionized = greater transfer into milk

138
Q

Molecular Weight in relation to breast milk

A

Low MW = greater transfer into milk

139
Q

Acid/Base in relation to breast milk

A

Weak bases can be ionized when in breast milk

140
Q

What drugs are contraindicated or use with caution in lactation?

A
  1. Bromocriptine
  2. Chemotherapy
  3. Codeine
  4. Cyclophosphamide
  5. Cyclosporine
  6. Iodine
  7. Lithium Carbonate
  8. Methotrexate
  9. Radiopharmaceutical
  10. Tetracyclines
141
Q

What are acceptable meds for pain with lactation?

A

Acetaminophen or Ibuprofen
NOT ASA

142
Q

What are acceptable meds for allergies with lactation?

A

Loratadine or Diphenhydramine
Can dry up milk supply

143
Q

What are acceptable meds for cough/congestion with lactation?

A

Nasal Decongestants or Dextromethorphan
NOT Psuedoephedrine

144
Q

What are acceptable meds for heartburn/reflux with lactation?

A

Antacids/Famotidine/Pantoprazole
NOT bismuth subsalicylate or cimetidine

145
Q

What are acceptable meds for constipation with lactation?

A

Bulking Agents, Docusate, Bisacodyl, PEG
NOT Senna

146
Q

What are acceptable meds for diarrhea with lactation?

A

Bulking Agents or Loperamide
NOT bismuth subsalicylate

147
Q

What medications can cause low milk production?

A
  1. Bromocriptine
  2. Estrogen Containing contraceptive
  3. Oral Decongestants
  4. Antihistamines
  5. Nicotine
  6. Diuretics
148
Q

What is a pharmacologic therapy for low milk production?

A

Metoclopramide

149
Q

What is the management for Mastitis?

A
  1. Antibiotics for 10-14 days (cephalexin)
  2. Anti-Inflammatory Medications for Pain (ibuprofen)
  3. Nonpharmacologic Therapy
150
Q

What is pharmacologic therapy for postpartum depression with lactation?

A

Sertraline First Line
Paroxetine or Nortriptyline Second Line
Fluoxetine CAUTION

Endocrine Module (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions