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49 Cards in this Set
- Front
- Back
Name three medical conditions where women have to continue taking their meds through pregnancy.
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1)epilepsy
2)diabetes 3)HTN |
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TRUE or FALSE: in pregnancy, you take a medicine or you don't. You don't just mess with dosages.
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FALSE-- you may need to alter dosages for pregnant women
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Name three pharmacokinetic parameters pregnancy may alter.
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1)absorption
2)distribution 3)elimination |
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In pregnancy, gastric emptying is *blank* and intestinal transit time is *blank*
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"decreased" and "increased"
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Pregnancy-induced increased pulmonary blood flow, hyperventilation and increased tidal volume will increase absorption of what?
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Inhalants
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The dramatic increase in blood volume seen in pregnancy may lead to what?
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Dilutional hypoalbuminemia
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In what trimester are you most likely to see dilutional hypoalbuminemia?
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Third trimester
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Dilutional hypoalbuminemia may lead to what effect on drugs?
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Decreased drug binding capacity
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Spontaneous abortion and potential teratogenesis are complications of drug use in what trimester?
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First trimester
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Growth retardation, sedation, functional development, altered metabolism and withdrawal are complications of drug use in what trimester?
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Second *and* third trimesters
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What are your concerns for drug use during lactation?
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Similar concerns as second and third trimester
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TRUE or FALSE: birth defects are a common occurrence.
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TRUE
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Name four essential criteria for proof of human teratogenicity.
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1)Proven exposure to agent at critical time in prenatal development
2)Consistent findings by 2 or more epdemiological studies of high quality 3)Careful delineation of clinical cases 4)Rare environmental exposure associated with rare defect |
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Name three helpful but not essential criteria for proof of human teratogenicity.
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1)Teratogenicity in experimental animals
2)Association makes biological sense 3)Proof in an experimental system that agent acts in unadulterated state |
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A highly teratogenic drug is more or less likely to cause birth defects?
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More likely (duh)
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Name three mechanisms by which a drug gets across the placenta.
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1)simple diffusion
2)facilitated diffusion (ex: glucose) 3)active transport (ex: vitamins, amino acids) |
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Which is more likely to cross the placenta: a drug with molecular weight < 600 daltons or a drug with mw > 1000 daltons?
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Drug weighing < 600 daltons
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Which is more likely to cross the placenta: a drug ionized at physiological pH (H20-soluble) or a drug non-ionized at physiologic pH (lipid soluble)?
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Non-ionized (lipid soluble) drugs cross the placenta more effectively
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Higher protein-binding capacity will assist or impede placental crossing?
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Impedes placental crossing
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TRUE or FALSE: dose, synergism with other drugs and duration of exposure have nothing to do with teratogenic potential.
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FALSE
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Name four mechanisms of teratogens
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1)Cell death
2)Mitotic delay 3)Slowing/cessation of differentiation 4)Inhibition of cell migration |
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Controlled studies have demonstrated no fetal risks.
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Category A (ex: vitamins)
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Animal studies indicate no fetal risks but there are no human studies; *OR* adverse effects have been demonstrated in animals but not in well-controlled human studies.
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Category B (ex: penicillin)
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No adequate studies, either animal or human *OR* there are adverse fetal effects in animal studies but no available human data.
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Category C (many drugs taken during pregnancy are in this category)
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Evidence of fetal risk but benefits are thought to outweigh these risks.
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Category D (ex: carbamazepine and phenytoin)
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Proven fetal risk clearly outweighs any benefits
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Category X (ex: the acne medication isotretinoin)
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Name some drugs that make babies un-VIABLE (e.g. proven teratogens)
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1)Valproic acid
2)Isotretinoin 3)Alcohol/ACE-inhibitors 4)Busulfan 5)Lithium 6)Etretinate |
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Name the five features of Fetal Alcohol System
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1)Growth restriction
2)Behavioral disturbances 3)Brain defects 4)Cardiac defects 5)Craniofacial abnormalities |
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Name three points in the framework for describing drugs that are pregnancy-specific.
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1)Maternal considerations
2)Fetal considerations 3)Breast feeding safety |
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Name two antimicrobials given a D rating in pregnancy
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1)Aminoglycosides
2)Tetracycline |
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Name eight antimicrobials given a C rating in pregnancy
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1)Aminoglycosides
2)Aztreonam 3)Chloroquine 4)Fluoroquinolones 5)Imipenem 6)Quinolones 7)Trimethoprim 8)Vancomycin |
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TRUE or FALSE: Women with epilepsy have higher incidence of fetal malformations compared with non-epileptic mothers
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TRUE
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Malformations are more likely in people with decreased activity of *this* enzyme (responsible for elimination of phenytoin and other anticonvulsants)
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Epoxide hydroxylase
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The neural tube closes on what days of embryonic life?
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Days 20-25
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TRUE or FALSE: acetominophen is safe in therapeutic doses for pregnant women.
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TRUE
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NSAIDs may cause what two problems in embryonic development?
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1)Closure of the ductus areteriosus
2)oligohydramnios |
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TRUE or FALSE: narcotics have no significant teratogenesis
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TRUE
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What are three components of lactation you need to consider when prescribing medication?
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1)dose
2)portion excreted in milk 3)amount absorbed by infant |
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TRUE or FALSE: weight-corrected percent of maternal dose ingested by 3-kg newborn and resulting neonatal blood levels are important aspects of lactation to consider when prescribing meds.
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TRUE
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TRUE or FALSE: milk is more acidic then plasma
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TRUE
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High lipid solubility facilitates or impedes solute passage into milk?
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Facilitates
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High molecular weight solutes do or do not cross into milk easily?
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Do not cross easily
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TRUE or FALSE: high protein binding limits passage into milk
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TRUE
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What do bromocriptine, cyclophosphamide, methotrexate, lithium and doxorubicin all have in common?
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All are contraindicated in breastfeeding
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This class of drug is used to prevent preterm birth and includes magnesium sulfate, beta-mimetics and Indocin.
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Tocolytics
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This drug is a labor stimulant
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Oxytocin
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These two drugs are cervical ripening agents
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Prostaglandin E and F2 alpha
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These five drugs are used as uterotonics to prevent postpartum hemorrhage
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1)oxytocin
2)methergine 3)prostaglandin 4)F2 alpha 5)E1 |
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TRUE or FALSE: when considering whether or not to prescribe a drug, trimester is not an issue
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FALSE
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