2.1 Cs Exam4: Morning Sickness

Front 1

Some degree of nausea with or without vomiting occurs in most pregnancies. It is usually abated by _

What is this referred to as?

Back 1

16-18 weeks (ends in 2nd trimester)

morning sickness

Front 2

There is a lower rate of _among women who experience nausea and vomiting in the first trimester.*

Back 2

miscarriage

Front 3

How do you treat morning sickness?

Back 3

-Pyridoxine (Vit B6) = first line therapy*
may add an antihistamine (doxylamine)

-antemetics (promethazine)

-ginger

-Multivitamins prior to conception

Front 4

What is hyperemesis gravidarum?

Back 4

Intractable nausea and vomiting.
(Inability to retain food and fluid)

--> 5% weight loss & ketonuria

Front 5

What are the physical findings of hyperemesis gravidarum?

Back 5

weight loss, dry and coated tongue and decreased skin turgor.

Orthostatic blood pressures

Front 6

How do you treat hyperemesis gravidarum?

Back 6

Usually symptomatic* (pyridoxine + doxylamine)

Hospital Admission if pt. fails outpatient management.*
-IV fluids, electrolytes, vitamins, antiemetics.*

+ feeding tube if severe

Short period of gut rest followed by reintroduction of oral intake.*

Avoidance of triggers (odor, heat, motion)

Front 7

What are a few drugs used to treat hyperemesis gravidarum?

Back 7

1. pyridoxine - doxylamine (antihistamine) combo
2. Diphenhydramine w/ droperidol

3. Promethazine

Metoclopramide (reglan)
Odansetron (Zofran)

Front 8

Fetal status is generally not adversely affected by vomiting until _

Back 8

persistent maternal weight loss occurs

Rate of IUGR increases and fetal death appears to increase

Front 9

The most vulnerable fetal stage to teratogenic agents is between _

Back 9

3-8 weeks GA, during the period of organogenesis.*

(tetratogenic period- 3 days (day 31) after last period to 71 days after)

Front 10

What are the two main drugs that do not cross the placenta?

Back 10

hepatin and insulin

Front 11

What category is this?

Women studies= no harm

& possibility of fetal harm appears remote
Careful tests in humans have shown no harm.**

Examples?

Back 11

Category A

Folic acid and Vitamin B6
Levothyroxine (Synthroid)

Front 12

What category is this?

Animal studies= no risk + no women studies

OR
animal studies= adverse effect +

women studies= no risk

Examples?

Back 12

B

Diphenhydramine (Benadryl)

Front 13

What category is this?

Animal studies= teratogenic/embryocidal effects + no women studies

OR
no studies are available in either

Should be given only if potential benefit justifies risk.

Examples?

Back 13

C

Carisoprodol (Soma)
Aspirin

Front 14

What category is this?

Women studies= evidence of fetal risk

BUT benefits in certain situations

Back 14

D

Front 15

What category is this?

Animal/Women studies= fetal abnormalities,

*risk clearly outweighs any possible benefits

NEVER used

Back 15

X

Rosuvastatin (Crestor)
Isotretinoin (Accutane)

Front 16

What antimicrobials are contraindicated in pregnancy

Back 16

Tetracycline (brittle bones, yellow teeth)

Flouroquinolones (arthropathies)

Front 17

What antihypertensives are CI in pregnancy?

Back 17

ACE I (dec fetal renal perfusion & death)
ARBs (same as ACE)

loop diuretics (fetal growth restrictions & distress)

Front 18

What are some diabetic agents that are CI in pregnancy?

Back 18

Sulfonureas

Thiazolidinediones

Front 19

What are the anticonvulsants that are CI in pregnany?

Back 19

Phenytoin

Carbamazepine

Front 20

What CI med causes fetal anomalies & death?

Back 20

warfarin--> fetal warfarin syndrome

Front 21

What vaccines are considered 'safe' in pregnancy?

Back 21

dead vaccines

Front 22

Only one attenuated live virus vaccine, the _ is considered safe in pregnancy.

Back 22

oral polio vaccine,

Front 23

_ and _ vaccines are contraindicated during pregnancy.

Back 23

varicella and smallpox vaccines