Imported: Repro_Test 1: Schriefer_Drug Therapy In Pregnancy

Front 1

what effect does placental blood flow have on placental drug transfer?

Back 1

Increased drug delivery to placental membranes as blood flow increases

Front 2

what effect does molecular size of a drug have on placental drug transfer?

Back 2

Decreased transfer of drug across placental membrane as molecular size increases

Front 3

what effect does the Lipid solubility of drug have on placental drug transfer?

Back 3

Increased transfer of drug across placental membrane as lipid solubility increases

Front 4

what effect does pKa have on placental drug transfer? (basic and acidic)

Back 4

basic: Increased ion trapping on fetal side

acidic: Decreased ion trapping on fetal side

Front 5

in babies, discuss the development of Phase I and II metabolism and the effect on drugs

Back 5

phase I-->develops faster-->adds small groups (can sometimes deactivate a drug)

phase II-->slower-->glucuronate (would clear drug, but doesn't mature til after birth)

Front 6

if you want to see some basic principles of teratogenesis, flip the card and reveal your destiny

Back 6

Susceptibility to teratogens depends on the genotype of the fetus

Susceptibility to teratogens varies with the developmental stage at the time of exposure

Teratogenic effects are dose dependent (so give lowest effective dose)

Teratogenic effects are seen at a fraction of the dose affecting the mother

A variety of teratogens may produce the same malformations; a single teratogen may produce a variety of malformations

Front 7

Drugs thought to have significant risk can be classified into 3 categories.. what are they?

Back 7

Known teratogens which should be avoided entirely (Category X)

Drugs thought to have small teratogenic risk – value of drug must be balanced against risk to fetus. Must consider patient’s wishes and health (Category D)

Drugs with suggested but unproven risk – may be used cautiously if benefit outweighs risk ( Category C)

Front 8

Describe Category A for fetal drug exposure

Back 8

Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of a risk in later trimesters), and the possibility of fetal harm appears remote

Front 9

Describe Category B for fetal drug exposure

Back 9

Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Front 10

Testosterone, estradiol, alcohol, and cigarettes are examples of drugs that fall in what category?

Back 10

X

known teratogens

(estrogen and testosterone fall in this category because they will effect the fetus of an opposite sex)

Front 11

Phenytoin, warfarin, diazapam, MTx, are examples of drugs that fall in what category?

Back 11

D

There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk

Front 12

Glipazide, codein, promethazine, gentamicin, hydralazine, and predinsone are examples of drugs that fall in what category?

Back 12

C

Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

Front 13

Cimetidine, insulin, Ibuprofen, acetaminophen, cephalosporins, penicillins are examples of drugs that fall in what category?

Back 13

B

Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Front 14

folic Acid, viatmin B12/6, ferrous sulfate are examples of drugs that fall in what category?

Back 14

A

Controlled studies in women fail to demonstrate a risk to the fetus in the first trimester (and there is no evidence of a risk in later trimesters), and the possibility of fetal harm appears remote

Front 15

Best analgesic drug choice for a preggo woman?

*

Back 15

Acetaminophen

(NSAIDs increase risk of miscarriage)

Front 16

with respect to anemia, what do you want to give a pt for prevention? for treatment?

Back 16

Prevention – oral ferrous sulphate 200 mg daily

Treatment – oral ferrous sulphate 200 mg 3x daily and folic acid 5 mg daily

Front 17

tx for nausea and vomiting associated with morning sickness?

Back 17

Vitamin B6

Front 18

tx for preeeclampsia?

Back 18

treat with bed rest and sedate with phenobarbital, if necessary

Aspirin effects on platelets decrease clotting and increase placental perfusion – may decrease likelihood of hypertension

Front 19

tx for eclampsia?

Back 19

– bed rest,

magnesium sulfate, ** (category A drug)

and hydralizine (if diastolic BP above 100; to prevent stroke). Labetalol is an alternative

Front 20

what is given for prevention of neural tube defects?

Back 20

Folic acid

Front 21

What is Paroxetine? what do you have to think about?

Back 21

it is an SSRI

SSRIs, SNRIs previously thought to be safe. This may not be true; particularly paroxetine.

About 10% of women suffer depression during pregnancy

Front 22

What effect does chloral hydrate have on a baby when breast feeding?

Back 22

May cause drowsiness if fed at peak concentration in milk

Front 23

What effect does Chloramphenicol have on a baby when breast feeding?

Back 23

Concentrations too low to cause gray baby syndrome; possibility of bone marrow suppression does exist; recommend not taking chloramphenicol while breast feeding

Front 24

What effect does Diazepam have on a baby when breast feeding?

Back 24

Will cause sedation in breast-fed infants; accumulation can occur in newborns

Front 25

What effect does Heroin have on a baby when breast feeding?

Back 25

Enters breast milk and can prolong neonatal opioid dependence

Front 26

What effect does Iodine (radioactive) have on a baby when breast feeding?

Back 26

Enters milk in quantities sufficient to cause thyroid suppression in infants

Front 27

What effect does Lithium have on a baby when breast feeding?

Back 27

Avoid breast feeding

Front 28

What effect does Methadone
have on a baby when breast feeding?

Back 28

(see heroin) Under close physician supervision, breast feeding can be continued. Signs of opiate withdrawal in the infant may occur if mother stops taking methadone or stops breast feeding abruptly

Front 29

What effect does Propylthiouracil
have on a baby when breast feeding?

Back 29

Can suppress thyroid function in infant