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SUM'20 - Advanced Principles > Week 3 pregnancy & lactation (everything) > Flashcards

Week 3 pregnancy & lactation (everything) Flashcards

1
Q

***Physiological changes of pregnancy may alter drug disposition and effect through:

A

Indirect and Direct effects

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2
Q

**example of a DIRECT physiological change

A

Direct Effects - ex. Placental transfer

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3
Q

*** Even after delivery drugs may affect

A

breastfeeding

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4
Q

*** example of a INDIRECT physiological change

A

Indirect Effects - Changes in placental and uterine function

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5
Q

Pregnant women in U.S. average 4.2 medications (study from 2006-2008)
97% take at least

A

1 medication

30.5% of the 97% take at least 5 medications

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6
Q

Most common medications taken during pregnancy

A

Antiemetics
Antibiotics
Analgesics

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7
Q

*most common medications taken during pregnancy; at least 10% taking drugs with long term effects on CNS

A

Antidepressants
Anticonvulsants
Antipsychotics

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8
Q

**concerns of medications during pregnancy:

A

Teratogenicity Effects ( not only congenital abnormalities but non-birth development such as puberty) **

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9
Q

Teratogenicity Effects of medications results

examples

A

Fetal Loss
Congenital Malformation
Fetal Growth Restriction
Preterm Labor

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10
Q

Genetic difference responsible for

A

some variations in genetic response

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11
Q

Pregnancy does not obviously modify

A

pharmacogenetic

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12
Q

Obstetric conditions are related to

A

complex genetic factors

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13
Q

**Metabolism of codeine to morphine greatly affected by

A

polymorphisms ( means “many form” and it occurs when we have many classes that are related to each other by inheritance) **

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14
Q

* exam Recently recognized mothers who are ultra-rapid metabolizers of codeine may transfer morphine

A

through breast milk to cause neonatal CNS depression and even death

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15
Q

Major physiologic changes during pregnancy alter drug disposition

A

Absorption and Uptake

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16
Q

physiologic changes in pregnancy alter Oral absorption and bioavailability

A

not usually affected by pregnancy

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17
Q

physiologic changes in pregnancy alter Intestinal motility

A

decreases

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18
Q

physiologic changes in pregnancy on gastric emptying

A

Gastric emptying only delayed during labor or administration of opioids

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19
Q

physiologic changes in pregnancy on FRC

A

Reduced FRC (functional residual capacity)

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20
Q

physiologic changes in pregnancy on minute ventilation:

A

Increased minute ventilation

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21
Q

increased minute ventilation increases pulmonary uptake of:

A

increases pulmonary uptake of inhalation anesthetic agents

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22
Q

renal blood flow increases what percent

A

60-80%

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23
Q

GFR increases what percent

A

50%

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24
Q

If a drug is excreted unchanged by the kidneys - how do we adjust the dose

A

increase the dose

due to increased GFR - renal BF increases 60-80%

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25
Q

if a drug is metabolized by the liver - what must we do to the dose

A

increase or decrease depending on metabolic pathway involved

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26
Q

bioavailability- the fraction of an administered drug that reaches systemic circulation- how is this changed in pregnancy

A

not usually changed significantly

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27
Q

physiologic changes of pregnancy will affect individual drugs depending on what?

A

their physicochemical characteristics (physical and chemical) and metabolic pathways

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28
Q

**exam during pregnancy what three drugs do you increase metabolism of?

A

phenytoin
morphine
midazolam

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29
Q

**exam - during pregnancy what two drugs do you decreases metabolism of

A

caffeine

theophylline.

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30
Q

**exam- name the drug used for mild analgesic and antipyretic during pregnancy.

does it have a teratogenic risk associated with this drug?

A

There is no know teratogenic risk associated with the use of ACETAMINOPHEN

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31
Q

**exam-

what analgesic drug do we avoid in the third trimester?

A

Aspirin

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32
Q

**exam-
why do we avoid aspirin in the third trimester of pregnancy?
name 3 injuries that occur

A

Renal injury
Oligohydramnios
Intrauterine constriction of the ductus arteriosus

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33
Q

**exam

what do we know about opioids and their teratogenic risk

A

NO teratogenic risk!

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34
Q

**exam-
tramadol has analgesic effects from weak opioid activity and inhibition of serotonin and norepinephrine uptake- when do we avoid it and why>

A

early pregnancy- associated with high number of spontaneous abortions

avoid during first trimester

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35
Q

Describe Ebsteins anomaly-

A

is a rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn’t formed properly.

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36
Q

**exam- lithium therapy has a small increased risk for what two condition

A

cardiac defects- especially ebsteins anomaly

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37
Q

**exam what specific diuretic should be avoided

A

spironolactone

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38
Q

**which antihypertensive drugs are safe during pregnancy

A

methyldopa
labetalol
calcium entry blocking agents
hydralazine

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39
Q

**which respiratory drug is not recommended? I checked it was withdrawn with US market!

A

Zileuton

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40
Q

**name the preferred short acting beta 2 receptor agonist

A

albuterol

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41
Q

**name the preferred long acting beta 2 adrenergic agonist

A

salmeterol

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42
Q

**pregnant women have 5 times the normal risk for what condition

A

venous thromboembolism and thrombosis and is a significant cause of maternal death

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43
Q

**do heparins cross the placenta

A

NO

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44
Q

**what is the preferred anticoagulant to give mothers

A

low molecular weight heparin
preferred over
unfractionated heparin

easy to administer and does not require monitoring

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45
Q

**LMWH is less likely to cause what condition

A

HIT- heparin induced thrombocytopenia

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46
Q

why isn’t rivaroxaban and dagibatran recommended

A

it crosses the placenta

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47
Q

**what does the american college of obstetricians and gynecologists recommend for the initial drug for nausea

A

B6-pyridoxine

with or w/o doxylamine

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48
Q

**what medication has been used for refractory vomiting during pregnancy

A

ondansetron (5-hydroxytryptamine receptor antagonist)

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49
Q

**there is debate over which anti-diabetic should be first line drug choice. what medications are considered safe (3)

A

insulin
metformin
glyburide

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50
Q

**what anti-infective drug is considered safe but some recommend avoiding during first trimester

A

metronidazole

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51
Q

**what is the first line anti infective drug used pregnant women

A

penicillins and cephalosporins

52
Q

**where should pregnant women avoid traveling

A

malaria endemic areas

53
Q

**if a pregant women travels to malaria endemic area what meds can be used

A

chloroquine

mefloquine

54
Q

**what are the effects of caffeine

A

no evidence of teratogenic affects in humans

55
Q

**what are the effects of cannabis

A

no effects- but dont take it because of the adverse effects of smoking

56
Q

**what are the risks of nicotine replacement- e cigarettes and vaping

A

unknown

57
Q

**HIGHLY teratogenic drug

A

thalidomide, ribavirin, isotretinoin, acitretin, valproate

58
Q

highly teratogenic drugs additional recommendations

A

So high risk of teratogenic- use two forms of BC

59
Q

do anticonvulsants cross the placenta

A

yes- all of them

60
Q

do the offspring of anti epileptic patients has a propensity to develop epilopsy

A

yes

61
Q

fetal anticonvulsant syndrome refers to

A

the board orofacial, cardiovascular and digital malformations

62
Q

fetal hydantoin syndrome

A

craniofacial abnormalities, and limb abnormalities

63
Q

fetal carbamazepine associated with

A

spinal bifidia

64
Q

fetal barbital syndrome associated with

A

decreased intellectual and cognitive development of neonates

65
Q

fetal valproate syndrome

A

epicentral folds, shallow orbits, hypertelorism low ears flat nasal bridge

66
Q

total body water increases

A

8%

67
Q

intravascular volume increases what percent

A

Intravascular volume increases by 40% thus,

68
Q

what type of drugs have increase volume of distribution

A

hydrophilic drugs- neuromuscular blockers

69
Q

*** what drug has the highest teratogenic risk?

A

valproate

followed by:
Phenytoin
Phenobarbitone
Topiramate

70
Q

anesthetic drugs do they go to the breast milk

A

no

71
Q

ketamine give or avoid

A

avoid- do not give postoperative infusion of drugs

72
Q

what diabetic drug should be used with caution while breast feeding

A

metformin- use with caution

73
Q

sulfonamides are they safe while breast feeding

A

no

74
Q

amiodarone while breastfeeding can cause what complications

A

iodine release- thyroid dysfunction.

75
Q

phenobarbital and diazepam

A

can accumulate in the baby coming from breast milk.

76
Q

intravascular volume increases by what %?

A

40%

77
Q

*** due to the increased intravascular volume during pregnancy, hydrophilic drugs (such as NMB) have an increased:

A

volume of distribution ***

78
Q

** body fat increases during pregnancy. given large vol of distribution what does this also impact?

A

lipophilic drug protein binding **

79
Q

plasma albumin concentration is reduced about 70% – what does this mean?

A

less protein binding locations

  • increased concentrations of free drugs
80
Q

increased concentrations of free drug (not pr bound) is offset by

A

increased clearance (GFR)

81
Q

*** Total (free bound) concentration of a drug will decrease and we may need to

A

reset therapeutic target range lower to compensate **

82
Q

*** these two drugs require monitoring and modification of dose b/c of changes in pr-binding:

A

Theophylline ***

Phenytoin

83
Q

first trimester exposure to diazepam increase the R/O

A 
cleft lip (with or w/o cleft palate)
neural tube defects
intestinal atresia
limb defects
84
Q

perinatal use of diazepam has been associated with:

A

hypotonia
hypothermia
resp. depression

85
Q

overall, it appears risks are small but benzo’s should only be used in the first trimester if the perceived benefit offsets the possible

A

teratogenic risks

86
Q

*** what drug has the highest teratogenic risk?

A

valproate

followed by:
Phenytoin
Phenobarbitone
Topiramate

87
Q

the most common serious neurologic problem during pregnancy

A

epilepsy

88
Q

this type of antidepressant does not appear to be associated w/ congenital abnormalities or neurodevelopmental problems

A

tricyclics

89
Q

this type of antidepressant should be avoided in pregnancy

A

maoi’s

90
Q

this type of antidepressant cross the placenta to varying degrees

A

SSRIs

91
Q

As a class, SSRI’s increase the rate of :

A

cardiac malformations and risk complications

92
Q

antipsychotic drugs are generally not associated w/:

A

increased congenital malformations

93
Q

***is labetalol safe in pregnancy?

typical dose?

A

yes

5-10mg

94
Q

*** ACE and ARBs’ safe in pregnancy?

A

should not be given

-can result in: 
fetal RF and oligohydramnios
fetal limb contractures
craniofacial deformities
pulmonary hypoplasia
95
Q

*** Amiodarone safe or not during pregnancy?

A

safe - most often the agent used

96
Q

-maternal asthma is common in pregnancy.

have B2 adrenergic receptor agonist and corticosteroids been associated with congenital malformations?

A

no!

97
Q

montelukast and zafirlukast

A

are considered safe

98
Q

zileuton is

A

not recommended

99
Q

theophylline and aminophylline have no

A

adverse fetal effects

100
Q

rivaroxaban and the thrombin inhibitor dabigatran (pradaxa)

A

are not recommended

they cross the placenta

101
Q

pregnancy is a hypercoagulable state b/c of relative increases in many:

A

coag factors and increased venous stasis

102
Q

pregnant women have 5x the normal risk for

A

VTE —> significant cause of maternal death

103
Q

***postoperative infusions of what drug is best to be avoided due to limited safety data

A

ketamine**

depression clinics - not for PD

104
Q

** LMWH is preferred over:

A

unfractionated heparin b/c it is easy to administer** and does not req monitoring **

105
Q

phenobarbital and diazepam in infants are considered safe… but what should we be aware of

A

in infants elimination could be slower and they could accumulate

106
Q

the shorter half life of UFH means that it is easier to

A

reverse

107
Q

warfarin is a vitamin K antagonist that can cause an:

A

embryopathy, especially in 1st trimester

108
Q

fondaparinux and argatroban (direct thrombin inhibitors) appear to be

A

safe in pregnancy

109
Q

** short therm us of aminoglycosides is acceptable but what should be avoided b/c of risk for congenital deafness after 1st trimester?

A

streptomycin

110
Q

sulphonamides and nitrofurantoin are safe but avoid

A

sulfamethoxazole during the first trimester

111
Q

Tetracyclines should not be administered after what week of pregnancy? Why?

A

5th week

-teeth darkening

112
Q

these drugs are so high risk that two forms of Birth Control are recommended when taking:

A 
Thalidomide
Ribavirin
Isotretinoin
Acitretin
Valproate

TRIAV

113
Q

only a few types of drugs are strongly contraindicated during breastfeeding, these are:

A

cytotoxic and immunosuppressive drugs

114
Q

drugs may also affect lactation and some are used therapeutically for

A

this purpose

to improve/reduce lactation

115
Q

drugs that increase the secretion of ____ can stimulate milk production.

A

prolactin

116
Q

Transfer of drugs to breast milk occurs mainly by

A

passive diffusion

117
Q

the rate of passive transfer into breast milk depends on what elements:

A
  1. lipid solubility
  2. molecular wt
  3. degree of ionization
  4. protein binding
118
Q

Amount of drug in breast milk is a variable fraction of the

A

maternal concentration

119
Q

what is it that we generally have no concern regarding transfer of in breast milk?

A

anesthetic drugs

120
Q

postoperative infusions of what drug is best to be avoided due to limited safety data

A

ketamine

121
Q

_____ do not transfer well to breast milk

A

LA’s

122
Q

phenobarbital and diazepam in infants are considered safe… but what should we be aware of

A

in infants elimination could be slower and they could accumulate

123
Q

** Iodine released during its metabolism may cause

A

thyroid dysfunction **

124
Q

** this antidiabetic should be used with CAUTION while nursing preterm infants and neonates

A

metformin

125
Q

** during breastfeeding, sulfonamides should be avoided due to:

A

displacement of bilirubin from binding sites

SUM'20 - Advanced Principles (16 decks)

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