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Therapeutics > Therapy Of Certain Disorders During Pregnancy > Flashcards

Therapy Of Certain Disorders During Pregnancy Flashcards

1
Q

Physiologic changes in pregnancy begin in the __ trimester and peak during the __ trimester.

A

First; Second

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2
Q

What lowers the concentration of drugs excreted by the kidney during pregnancy?

A

1) Increased plasma volume
2) Increased cardiac output
3) Increased GFR
(All by 30-50%)

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3
Q

Plasma albumin concentration in pregnancy ___(increases/decreases) due to:

A

Decreases; Dilution

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4
Q

Hepatic perfusion in pregnancy __(decreases/increases), which may __(decrease/increase) hepatic extraction of drugs.

A

Increases; increase

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5
Q

What may alter drug absorption in pregnant women (GI)?

A

1) Nausea
2) Vomiting
3) Delayed gastric emptying
4) Increased gastric acid

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6
Q

High levels of ___ in pregnancy may affect hepatic enzyme activity.

A

Estrogen and progesterone

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7
Q

Which diseases have the potential to cause adverse pregnancy consequences?

A

1) Gestational diabetes
2) Gestational hypertension
3) Venous thrombo-embolism

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8
Q

What is the first step for managing constipation during pregnancy?

A

1) Moderate physical exercise
2) Increased dietary intake of fibers and fluids
3) Supplemental fiber and/or stool softener

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9
Q

What are some bulk-forming agents?

A

1) Psyllium
2) Methylcellulose
3) Polycarbophil

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10
Q

Why are bulk-forming agents safe for long-term use?

A

Because they are not absorbed

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11
Q

What are some osmotic laxatives?

A

1) Polyethylene glycol
2) Lactulose
3) Sorbitol

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12
Q

What are some stimulant laxatives?

A

1) Senna
2) Bisacodyl

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13
Q

Which laxatives shouldn’t be used during pregnancy because of electrolyte imbalances?

A

1) Magnesium
2) Sodium salts

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14
Q

Which laxative shouldn’t be used during pregnancy because it stimulates uterine contractions?

A

Castor oil

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15
Q

Which laxative shouldn’t be used during pregnancy because it impairs fat-soluble vitamin (ADEK) absorption, and may cause severe bleeding in the newborn?

A

Mineral oil

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16
Q

What does castor oil cause during pregnancy?

A

Stimulates uterine contractions

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17
Q

Treatment for GERD during pregnancy?

A

1) Lifestyle and diet changes
2) Antacids
3) Sucralfate
4) H2-receptor blockers (ranitidine)

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18
Q

Why is Sodium bicarbonate not a suitable option for GERD during pregnancy?

A

Sodium overload

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19
Q

Why is magnesium trisilicate not a suitable option for GERD during pregnancy?

A

No data available on safety

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20
Q

When does nausea and vomiting of pregnancy begin?

A

Within 4-6 weeks of gestation

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21
Q

When does nausea and vomiting of pregnancy peak?

A

Between weeks 8-12

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22
Q

When does nausea and vomiting of pregnancy resolve?

A

By 16-20 weeks

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23
Q

Treatment for nausea and vomiting of pregnancy?

A

1) Dietary modifications
a) Eating frequent small soft meals
b) Avoiding fatty and spicy meals

2) Ginger

3) Pyridoxine (vitamin B6) and/or antihistamines (doxylamine) are effective and are first-line agents (Pyridoxine - doxylamine)

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24
Q

Why are Metoclopramide and phenothiazines not suitable options for nausea and vomiting during pregnancy?

A

1) Sedation
2) Extrapyramidal adverse
effects (dystonia)

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25
Q

Why is Ondansetron (serotonin 5-HT3 receptor antagonist) not a suitable option for nausea and vomiting during pregnancy?

A

May cause oral clefts

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26
Q

Corticosteroids for nausea and vomiting during pregnancy are reserved for use after the ___ trimester. Why?

A

First; Risk of oral clefts

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27
Q

Gestational diabetes (GDM) is diabetes diagnosed during the:

A

Second and third trimesters

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28
Q

GDM first-line therapy?

A

Nutritional education

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29
Q

What is the drug of choice for GDM and why?

A

Human insulin; does not cross the placenta.

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30
Q

Risks of GDM include:

A

1) Fetal loss
2) Risk of congenital malformations
3) Macrosomia

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31
Q

What are the hypertensive disorders of pregnancy?

A

1) Gestational hypertension

2) Preeclampsia/eclampsia

3) Chronic hypertension

4) Chronic hypertension with superimposed preeclampsia

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32
Q

Treatment of hypertensive disorders of pregnancy?

A

1) Methyldopa
2) Hydralazine
3) Labetelol
4) Magnesium sulfate (when preeclampsia is present)

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33
Q

Preeclampsia develops after:

A

20 weeks of gestation

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34
Q

Preeclampsia consists of:

A

1) Renal failure
2) Maternal morbidity/mortality
3) Preterm delivery
4) Intrauterine growth retardation

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35
Q

Preeclampsia treatment?

A

1) Treatment of hypertension
2) Low-dose aspirin 60-81 mg/day beginning late in the first trimester in women at risk of preeclampsia.

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36
Q

What is the only cure for preeclampsia?

A

Delivery of the placenta

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37
Q

What is eclampsia?

A

Seizures on top of preeclampsia (Medical emergency)

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38
Q

Eclampsia may be prevented by:

A

1) Low dose aspirin
2) Magnesium sulfate

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39
Q

Which drugs should be avoided in eclampsia?

A

1) Diazepam
2) Phenytoin

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40
Q

Treatment of acute Venous Thrombo-embolism (VTE) in pregnancy?

A

Low-molecular-weight heparin (LMWH)

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41
Q

How long should a pregnant woman take LMWH for a VTE?

A

Throughout pregnancy and for 6 weeks after delivery (minimum duration of therapy should be >3 months).

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42
Q

Which drugs should be avoided UNLESS the patient has heparin-induced thrombocytopenia?

A

1) Fondaparinux (synthetic pentasaccharide)
2) Injectable direct thrombin inhibitors (lepirudin, bivalirudin)

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43
Q

Should you give oral agents Dabigatran, Rivaroxaban, or Apixapan for a VTE during pregnancy?

A

No

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44
Q

What is Dabigatran?

A

A direct thrombin inhibitor

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45
Q

What is Rivaroxaban?

A

Direct factor Xa inhibitor

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46
Q

What is Apixaban?

A

Direct factor Xa inhibitor

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47
Q

Why shouldn’t warfarin be given during pregnancy?

A

1) Nasal hypoplasia
2) Stippled epiphysis (chondodysplasia punctata)
3) Limb hypoplasia
4) Eye abnormalities (risk period 6-12 weeks of gestation)
5) CNS anomalies are associated with exposure during 2nd and 3rd trimesters.

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48
Q

High risk women for VTE with prosthetic heart valves should be given:

A

1) LMWH twice daily (or UFH every 12 hours) during pregnancy.

AND

2) Low-dose aspirin of 75-100mg/day.

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49
Q

Unfractionated heparin should be monitored by:

A

aPTT

50
Q

Low molecular weight heparin should be monitored by:

A

Anti-Xa level

51
Q

What are the organisms responsible for UTIs in pregnancy?

A

1) E. Coli
2) Gram (-) rods (Proteus, Klebsiella)
3) Group B Streptococcus

52
Q

The presence of Group B Streptococcus (GBS) in urine indicates:

A

Heavy colonization of the genitourinary tract = increases the risk for GBS infection in the newborn.

53
Q

Treatment of asymptomatic bacteriuria and cystitis is necessary to prevent:

A

Pyelonephritis

54
Q

The most commonly used antibiotics to treat asymptomatic bacteriuria and cystitis are:

A

1) β-lactam antibiotics:
a) Amoxacillin
b) Cephalosporins
2) Nitrofurantoin

55
Q

Nitrofurantoin is not active against:

A

Proteus species

56
Q

Nitrofurantoin should not be used after week __ in patients with G6PD deficiency. Why?

A

37; because of the risk of hemolytic anemia in the newborn.

57
Q

What is Co-trimoxazole?

A

Sulfa-containing drugs

58
Q

Sulfa-containing drugs can contribute to the development of newborn ___, and should be avoided during:

A

Kernicterus; the last week of gestation

59
Q

Trimethoprim is a:

A

Folate antagonist

60
Q

Trimethoprim is contraindicated during the first trimester because:

A

Association with cardiovascular
malformations

61
Q

Fluoroquinolones are containdicated because of:

A

Association with impaired cartilage development

62
Q

Tetracyclines are containdicated because of:

A

Association with deciduous teeth discoloration if given after 5 months of gestation

63
Q

___ is the standard of care for pregnant women with pyelonephritis.

A

Hospitalization

64
Q

Pyelonephritis in pregnancy treatment?

A

1) Parenteral administration of 2nd and 3rd generation cephalosporins (cefuroxime and ceftriaxone)
2) Ampicillin + Gentamicin
3) Ampicillin-sulbactam

65
Q

The total duration of therapy for acute pyelonephritis in pregnancy is:

A

10-14 days

66
Q

Nitrofurantoin should be avoided in pyelonephritis because:

A

It does not achieve therapeutic levels outside urine

67
Q

Bacterial vaginosis in pregnancy treatment?

A

Recommended: Metronidazole

Alternative: Clindamycin

68
Q

Chlamydia in pregnancy treatment?

A

Recommended: Azithromycin

Alternative: Erythromycin

69
Q

Genital herpes in pregnancy treatment?

A

Acyclovir or valacyclovir

70
Q

Gonorrhea in pregnancy treatment?

A

Recommended: Ceftriaxone , treat chlamydial infection concurrently

Alternative: Azithromycin

71
Q

Trichomoniasis in pregnancy treatment?

A

Metronidazole

72
Q

Which drug against protozoa should be avoided during pregnancy?

A

Tinidazole

73
Q

Risks of medications use to the fetus are ___(more/less) than risks of untreated asthma.

A

Less

74
Q

Bronchial asthma treatment in pregnancy?

A

Step 1: Short-acting β2-agonists (SABA) [Albuterol] + Inhalational corticosteroids [Budesonide]

Step 2: Long-acting β2-agonists (LABA) [Salmetrol] + Inhalational corticosteroids [Budesonide]

75
Q

Does seizure frequency change for most pregnant women with epilepsy?

A

No

76
Q

Seizures may become more frequent in pregnant woman because of changes in:

A

1) Maternal hormones
2) Sleep deprivation
3) Medication adherence problems because of fear of teratogenic risk
4) Changes of free serum concentration of antiepileptic drugs

77
Q

Why might there be changes in free serum concentration of antiepileptic drugs in pregnant woman with epilepsy?

A

1) Increased maternal volume of distribution
2) Decreased protein binding from hypoalbuminemia
3) Increased hepatic drug metabolism
4) Increased renal drug clearance

78
Q

The risks of uncontrolled seizures to the infant
are __(greater/less) than those associated with antiseizure drugs.

A

Greater

79
Q

Major malformations are 2-3 times more likely to occur in children born to women taking:

A

Antiseizure drugs

80
Q

Which antiseizure drugs are probably the safest during pregnancy?

A

1) Carbamazepine
2) Lamotrigine
3) Levetiracetam

81
Q

Which antiseizure drugs carry lower risk than valproic acid (VPA)?

A

1) Gabapentin
2) Oxcarbazepine
3) Zonisamide

82
Q

Which antiseizure drugs carry Significant risk?

A

1) Valproic acid
2) Topiramate
3) Phenobarbital

83
Q

Major malformations with valproic acid are:

A

Dose-related

84
Q

Valproic acid during pregnancy can cause:

A

1) Neural tube defects (spina bifida)
2) Facial clefts
3) Cognitive teratogenicity

85
Q

All women taking antiepileptic drugs should receive: (!!)

A

Folic acid supplementation (4-5 mg daily) starting before pregnancy and continuing through the first trimester, and preferably throughout pregnancy.

86
Q

When to avoid or postpone pregnancy?

A

1) Uncontrolled epilepsy
2) Drug-resistant epilepsy
3) Polytherapy
4) High dose ASDs
5) Non-adherence
6) Poor general health

87
Q

Chronic hypertension of pregnancy is defined as:

A

1) Hypertension occurring before 20 weeks of gestation
2) Use of antihypertensive medications before pregnancy
3) Persistence of hypertension beyond 12 weeks postpartum

88
Q

Severe chronic hypertension of pregnancy is:

A

≥160/≥110 mmHg

89
Q

When treating chronic hypertension in pregnant women you should be careful:

A

NOT to compromise utero-placental blood flow. (Lower BP over a period of hours).

90
Q

If there is no end organ damage, antihypertensive drugs may not be used to treat:

A

Non-severe hypertension (<160/<105 mmHg).

91
Q

ACEis, ARBs, renin inhibitors, and mineralocorticoid receptor antagonists should be avoided in pregnancy because:

A

Teratogenicity and toxicity to fetus

92
Q

What is Aliskiren?

A

Renin inhibitor

93
Q

Atenolol should be avoided in pregnancy because:

A

Associated with fetal growth restrictions

94
Q

Hypothyroidism in pregnancy should be treated with:

A

Levothyroxine (larger dose due to increased requirement)

95
Q

Hypothyroidism should be monitored by:

A

TSH level

96
Q

Hyperthyroidism in pregnancy should be treated with:

A

Thionamides:
a) Propylthiouracil (PTU) FIRST TRIMESTER
b) Methimazole REST

97
Q

Iodine 131 (I131) is contraindicated in pregnancy because of:

A

The risk of damage of fetal thyroid

98
Q

Preterm labor occurs between:

A

20-37 weeks of gestation

99
Q

What is a leading cause of infant morbidity and
mortality?

A

Preterm labor

100
Q

What are Tocolytics?

A

Drugs that slow or stop the contractions of a woman’s uterus during pregnancy

101
Q

What are the purposes of tocolytic therapy?

A

1) Postpone delivery to allow for maximal effect of antenatal corticosteroid therapy

2) Allow for transportation of the mother to a facility equipped to deal with high-risk deliveries

3) Prolongation of pregnancy when there are underlying, self limiting conditions that can cause labor (pyelonephritis, abdominal surgery).

102
Q

Tocolytics are not used beyond:

A

34 weeks of gestation

103
Q

Tocolytic agents include:

A

1) β-agonists
2) Magnesium
3) Calcium channel blocker
4) Prostaglandin inhibitors (NSAIDs)

104
Q

Tocolytic agents prolong pregnancy by __ days.

A

2-7

105
Q

Tocolytic agents do not reduce overall rates of:

A

1) Respiratory distress syndrome
2) Neonatal death
3) Preterm delivery

106
Q

What are terbutaline and ritodrine?

A

β2-agonists

107
Q

IV magnesium sulfate has a ____ role:

A

Neuroprotective; it decreases the occurrence of cerebral palsy

108
Q

Maternal adverse effect of IV magnesium sulfate?

A

Pulmonary edema

109
Q

What is Nifedipine?

A

Calcium channel blocker

110
Q

One significant adverse reaction of Nifedipine as a tocolytic is:

A

Hypotension with consequent effect on utero-placental blood flow

111
Q

NSAIDs (Indomethacin) as a tocolytic are associated with:

A

Increased rate of closure of the ductus arteriosus when used after 32 weeks of gestation, for more than 48 hours.

112
Q

Which corticosteroids can be used for fetal lung maturation?

A

1) Betamethasone
2) Dexamethasone
Both for 2 days between 24-34 weeks of gestation

113
Q

Group B Streptococcus (GBS) infection in pregnancy treatment?

A

1) Penicillin G
2) Ampicillin
3) Cefazolin (if penicillin allergy, but no risk of anaphylaxis)
4) Clindamycin or Erythromycin (if penicillin allergy with high risk)
5) Vancomycin (If resistant to #4)

114
Q

Concerns with induction of labor (cervical ripening) are:

A

1) Ineffective labor
2) Hyperstimulation that may adversely affect the fetus

115
Q

Which drugs can be used for cervical ripening?

A

1) Prostaglandin E2 analogs (Dinoprostone)
2) Prostaglandin E1 analog (Misoprostol)
3) Oxytocin (for induction)

116
Q

Prostaglandin E1 analog (Misoprostol) is containdicated in women with previous
___ because of its association with:

A

Uterine scar; uterine rupture

117
Q

The first phase of labor starts from:

A

Onset of labor - Complete cervical dilation.

118
Q

In the first phase of labor, women perceive __ pain because of:

A

Visceral; uterine contractions

119
Q

The second phase of labor is the period between:

A

Complete cervical dilation - Delivery

120
Q

In the second phase of labor, women perceive __ pain because of:

A

Visceral; Perineal stretching

121
Q

Pharmacologic approach to labor pain management:

A

1) Parenteral opioids
2) Epidural analgesia
3) Nitrous oxide (NO)

Therapeutics (23 decks)

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