Y2B2 Pharm- Pregnancy And Lactation

Front 1

In relation to what happens to the mother during pregnancy, which one is wrong:

a) Reduction in intestinal motility
b) Increase in gastric emptying time
c) Decrease in gastric acidity
d) increase in albumin concentrations
E) Expansion of plasma volume
F) Increase in renal blood flow
G) Increased cardiac output

Back 1

D) the albumin concentrations do NOT increase. They in fact decrease during pregnancy.

Front 2

what is the purpose of the placenta for the fetus?

Back 2

transfer of nutrients, gaseous exchange, excretion and respiration

Front 3

what does the fetoplacental unit function as in the fetal-maternal communication system?

Back 3

endocrine portion

Front 4

what does the substantial increase in total body water and plasma volume during pregnancy cause?

Back 4

increase distribution of drugs into water compartments.

Front 5

what may cause an increase in free drug concentrations in the pregnant woman?

Back 5

decrease in plasma albumin which is accompanies by reduced binding to plasma albumin.

Front 6

why does alcohol abuse during pregnancy lead to alcohol problems in children in utero?

Back 6

lower concentrations of monamine oxidase, alcohol dehydrogenase, and aldehyde dehydrogenase.

Front 7

what process is substantially reduced or absent in the fetus that can cause grey baby syndrome?

Back 7

glucoronidation

Front 8

when do infant hepatic levels of P450 reach the the same level as adults?

Back 8

6-12 months

Front 9

why is the amniotic fluid a potential source of drug acting on the fetus?

Back 9

agents excreted by fetal kidney into amniotic fluid may be swallowed by the fetus and reabsorbed by the GI tract. Therefore, the drug stays in the system.

Front 10

when does organogenesis in the fetus occur? why is this important?

Back 10

days 18-60--> this is when you want to avoid giving Mom some drugs that may have teratogenic effects,

Front 11

what is the best anti-HTN drug used in pregnancy?

Back 11

methyldopa

Front 12

what drug may be used for emergency reduction in BP for pregnant women not responding to methyldopa?

Back 12

parenteral hydralazine

Front 13

what drugs may be used in acute situations for pregnant HTN?

Back 13

sublingual nifedipine

Front 14

what two drugs (besides methyldopa) used in pregnancy women reduce blood pressure effectively w/o reflex tachycardia?

Back 14

nifedipine and labetalol

Front 15

what drug category is contraindicated for HTN in pregnancy? which category should be avoided, but isn't necessarily contraindicated? why?

Back 15

contraindicated: ACE-I --> may cause neonatal renal failure
avoid: adrenergic beta blockers--> may cause fetal growth retardation

Front 16

If you are on B-blockers or ace inhibitors, how long should you be off the drug before trying to get pregnant?

Back 16

4-6 weeks

Front 17

what is the least toxic drug for epilepsy in pregnancy? what should you avoid in anti-epileptics?

Back 17

low dose phenobarbital--> avoid

Front 18

if you are on an anti-epileptic, how long should you be off the drug before trying to get pregnant?

Back 18

4-6 weeks

Front 19

what anti-seizure drug (s) are CI in pregnancy?

Back 19

ALL OF THEM... esp phenytoin and valcroic acid

Front 20

what is the DOC for diabetes in pregnancy?

Back 20

insulin

Front 21

when do you commence tx in a pregnant diabetic?

Back 21

fasting plasma glucose > 95 mg/dl and/or HbA1C >7%

Front 22

what drugs should be avoided for diabetes in pregnancy?

Back 22

all oral hypoglycemic agents

Front 23

what condition involving amniotic fluid can cause diabetes in pregnancy?

Back 23

polyhydramnios-- 14% of pts w/ polyhydramnios develop diabetes.

Front 24

what is the most common pathogen to blame for UTI in pregnancy?

Back 24

e. coli

Front 25

how do you tx acute cystitis in UTI pregnancy?

Back 25

cephalexin: 7-10 days

Front 26

how do you tx acute pylonephritis in UTI pregnancy?

Back 26

cefazolin + gentamicin - 10-14 days

Front 27

how do you tx N/V?

Back 27

dietary modifications, multivitamins, pyridoxine, cyanocobalamin, phenothiazines and metaclopramide.

Front 28

what are the CI associated w/ anti-emetic drugs?

Back 28

NONE. none of the anti-emetic drugs are CI

Front 29

what is the difference between a category B and C drug?

Back 29

Category C-- for some reason seems to be more concerning than category B even though there has not been shown to be harmful to fetus.

Front 30

which category should not be used during pregnancy?

Back 30

Category X

Front 31

what is the "all or none" period? what is the result of teratogenicity during this period?

Back 31

time from conception until implantation.
-insults to embryo are likely to result in death and miscarriage.

Front 32

exposure of emryos to teratogens during the preimplantation stage usually does not cause congenital malformations, unless?

Back 32

the agent persists

Front 33

what period has the maximum sensitivity to teratogenicity? why?

Back 33

embryonic period (day 18-60 after conception), d/t rapid tissue differentiation (damage is irreparable)

Front 34

what three drugs have the most pronounced teratogenic effects during embryonic period?

Back 34

cocaine, alcohol, and metamphetamine

Front 35

what does a child w/ fetal alcohol syndrome look like? how much must the mother drink in order to cause this?

Back 35

looks: microcephaly, developmental delay, low nasal bridge, cleft palate, thin upper lip

chronic daily ingestion of at least 2 g alcohol/kg

Front 36

what can you find in the newborn's meconium that proves fetal alcohol syndrome?

Back 36

Fatty acid ethyl esters

Front 37

use of ACE-I in late pregnancy has been associated w/ what fetal issues?

Back 37

fetal toxicity-intrauterine renal insufficiency, neonatal hypotension, oliguria, renal failure and hyperkalemia.

Front 38

what effect does coumadin anticoagulants have on the fetus? when is it the most teratogenic?

Back 38

fetal warfarin syndrome--> nasal hypoplasia, Interuterine growth retardation, CNS damage, eye defects hearing loss.

critcal period btwn: 6-9 weeks of gestation

Front 39

what teratogenic effects can phenytoin cause?

Back 39

fetal hydantoin syndrome-craniofacial dysmorphology-cleft lip, cleft palate. Nail hypoplasia, growth retardation, mental deficiency and cardiac defects.

Front 40

first trimester exposure to valproate causes what types of defects?

Back 40

neural tube defects.


also high forehead, low nasal bridge, short nose, cardiovascular defects...

Front 41

what teratogenic effects does cocaine have on the fetus?

Back 41

abruptio placentae, prematurity, fetal death, decreased birth weight, limb defects, urinary tract malformation, and reduced neurodevelopmental performance.

Front 42

what does snorting cocaine cause on appearance?

Back 42

nasal drip, collapse or perforation of nasal septum

Front 43

what is the main cause of death during pregnancy?

Back 43

cocaine + alcohol which causes spontaneous abortion and placenta abruptio

Front 44

the transfer of drugs into breast milk is influence by what?

Back 44

protein binding, solubility and ionization

Front 45

what two drugs don't transfer into breast milk?

Back 45

heparin and insulin

Front 46

what is the M/P cut-ff for safe use of drugs during lactation?

Back 46

10%

Front 47

what two drugs have a 1/2 life of 40 days and high infant exposure that should be avoided?

Back 47

lithium and amiodarone

Front 48

what three types of drugs are CI in breastfeeding?

Back 48

cytotoxic agents, gold salts and immunosuppressives.

Front 49

what are ways to reduce exposure of breast milk to toxins?

Back 49

1) find an agent that doesn't cross readily into breast milk
2) lower toxicity
3) alt route of admin
4) admin well b4 or well after breastfeeding
5) utilized serum and urine monitoring of drug concentrations
6) delay tx until weaning has occurred