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28 Cards in this Set

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_promotes smooth muscle relaxation
Progesterone

because of that our lower esophageal sphinctor tone is decreased, leading to reflux
Some degree of nausea with or without vomiting occurs in most pregnancies. It is usually abated by _
16-18 weeks
There is a lower rate of _among women who experience nausea and vomiting in the first trimester.*
miscarriage
How do you treat morning sickness?
symptomatic tx.

Pyridoxine (Vit B6) is first line therapy
may add an antihistamine (doxylamine), or antemetics, or ginger

avoid recumbent position after meals.

Multivitamins prior to conception
What is the first line therapy for morning sickness?
vitamine B6 (pyridoxine)
What is hyperemesis gravidarum?

How often does this occur?
Intractable nausea and vomiting.
Inability to retain food and fluid.

1% of pregnancies,
What are the physical findings of hyperemesis gravidarum?
weight loss, dry and coated tongue and decreased skin turgor.


Orthostatic blood pressures
How do you treat hyperemesis gravidarum?
Usually symptomatic*

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

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

Avoidance of triggers (odor, heat, motion)
What are a few drugs used to treat hyperemesis gravidarum?
pyridoxine - doxylamine (antihistamine) combo

Metoclopramide (reglan)

Odansetron (Zofran)
Fetal status is generally not adversely affected by vomiting until _
persistent maternal weight loss occurs

Rate of IUGR increases and fetal death appears to increase
Substernal discomfort aggravated by meals and the recumbent position is a symptom of _
gastroesophageal reflux
The most vulnerable stage to have nausea and vomiting is between _
3-8 weeks GA, during the period of organogenesis.*
What are the two main drugs that do not cross the placenta?
hepatin and insulin
What category is this?

Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and the possibility of fetal harm appears remote
Careful tests in humans have shown no harm.**

Examples?
Category A

Folic acid and Vitamin B6
Levothyroxine (Synthroid)
What category is this?


Animal studies do not indicate a risk to the fetus; there are no controlled human studies, OR
animal studies do show an adverse effect on the fetus, but well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus
B

Diphenhydramine (Benadryl)
What category is this?

Animal studies have shown the drug to have teratogenic or embryocidal effects, but no controlled studies are available in women, OR
no studies are available in either animals or women
Should be given only if potential benefit justifies risk.
C

Carisoprodol (Soma)
Aspirin
What category is this?

Positive evidence of human fetal risk exists, but benefits in certain situations (e.g., life-threatening situations of serious diseases for which safer drugs cannot be used or are ineffective) may make use of the drug acceptable despite its risks
D
What category is this?

Studies in animals or humans have demonstrated fetal abnormalities, or evidence demonstrates fetal risk based on human experience, or both, and the risk clearly outweighs any possible benefits
X

Rosuvastatin (Crestor)
Isotretinoin (Accutane)
What does tetracycline cause?
yellow-brown discoloration of teeth
What do aminoglycosides cause if given during pregnancy?
ototoxicity (nerve damage to CN VIII)
What antimicrobials are contraindicated in pregnancy
Tetracycline and flouroquinolones
What antihypertensives are CI in pregnancy?
ACE I
ARBs
What are some diabetic agents that are CI in pregnancy?
Sulfonureas, Thiazolidinediones
What are the anticonvulsants that are CI in pregnany?
Phenytoin, Carbamazepine
What vaccines are considered 'safe' in pregnancy?
dead vaccines

Hepatitis A vaccine, Hepatitis B vaccine, influenza, polio (injected), pneumococcal, and meningococcal vaccines are considered safe.
Only one attenuated live virus vaccine, the _ is considered safe in pregnancy.
oral polio vaccine,
_ and _ vaccines are contraindicated during pregnancy.
The varicella and smallpox
Although there are no reported problems with _ vaccine, it is preferred to withhold until postpartum when they are considered safe.
measles, mumps and rubella vaccines (MMR),