Phar 461 - Pregnancy Wellness

Front 1

What are the different trimesters of pregnancy?

Back 1

1st Trimester: Weeks 1-13.

2nd Trimester: Weeks 14-26.

3rd Trimester: Weeks 27-40

Front 2

What is the most teratogenic period?

Back 2

The first 10 weeks from fertilization; Period of Organogensis.

[Frequency of Neural Tube defects, incidence of deformities that lead to miscarriages is much less after 8-10 weeks]

Front 3

What are the key points for using OTC meds in Pregnancy? (5)

Back 3

1) Use nondrug measures when possible

2) Select single entity products

3) Limit exposure as much as possible (use lowest effective dose, aim for shortest duration possible)

4) Refer to MD if OTC products fail within specified time period or symptoms progress

Front 4

When does nausea typically occur in pregnancy?

Back 4

Between 6-16 weeks

[but can persist up to 20 weeks or beyond]

Front 5

What are some non-drug measures for managing nausea in pregnancy?

Back 5

1) Eat biscuits while in bed

2) Don’t drink while having meals

3) Avoid noxious smells

4) eat smaller meals

5) Take folic acid alone or multivitamins without iron

Front 6

Which is safer Gravol or Gravol Multi-Symptom for Pregnancy?

Back 6

Gravol regular because Gravol Mult-Symptom contains Willow Bark (which is like ASA)

Front 7

What drug management would you recommend for a pregnant women with Nausea and Vomitting?

Back 7

DOC: Doxylamine 10mg/Pyridoxine (Vit B6)10mg [2 tabs qHS; 1 tab qAM; 1 tab in afternoon]

Front 8

What is "Pregnancy Itch"?

Back 8

Obsteric Cholestasis: A liver disorder in pregnancy.

Where bile acids accumulate in the liver resulting in increased amounts in the blood.

Usually occurring in the 3rd trimester.

Front 9

What are the symptoms of Pregnancy Itch ?

Back 9

1) Intense Itching (worse at night)

2) Dark colored urine

3) Yellow eyes or skin

4) Light coloured bowel movements

Front 10

What are the risk factors for Pregnancy Itch?

Back 10

1) Previous history or family history

2) History of liver problems

3) Pregnant with twins

4) Pregnant via IVF

Front 11

What are the potential complications of Pregnancy Itch?

Back 11

None for the mother, but increased risk of preterm birth or risk of meconium (fecal matter) in amniotic fluid; risk of fetal death

Front 12

What drug management would you recommend for a pregnant women suffering from "Pregnancy Itch"?

Back 12

REFER TO PHYSICIAN;

DOC: Ursodeoxycholic acid (prescription)

Front 13

What is the evidence of efficacy for the meds recommended for Pregnancy Itch?

Back 13

Ursodeoxycholic acid

(improves pruritis; fewer pre-term births (RR 0.4)

Front 14

What is another name for Stretch Marks?

Back 14

Striae gravidarum

Front 15

What are some causes for Stretch Marks?

Back 15

1) Mechanical Stretching (pregnancy, Obesity)

2) Normal Growth (Puberty)

3) Infection (causing a release of a toxin that damages tissues)

4) Increased levels of body steroid hormones that has catabolic effect on fibroblasts

5) Genetic Factors

6) Immunosuppression

Front 16

What are the Signs and Symptoms of Stretch Marks?

Back 16

May appear on Abdomen, Breasts, Hips, Thighs and Buttocks.

Initially appeared as slightly raised pink red linear bands; may itch and the length increases and colour deepens to purple and then matures into white flat lines

Front 17

What are the risk factors for Stretch Marks?

Back 17

1) Young Maternal Age (<25years)

2) Increased infant birth weight

3) Excessive maternal weight gain during pregnancy

4) Family History

Front 18

What is the evidence of efficacy for meds used in prevention of Stretch Marks?

Back 18

Olive Oil, Cocoa butter, Verum, Trofolastin were all found NOT to prevent development of Stretch marks, and did NOT reduce severity of symptoms

Front 19

What would you recommend for patients suffering from Stretch Marks?

Back 19

Tretinoin 0.1% cream, Alpha hydroxy acids (e.g Glycolic Acids), Laser therapues and Microdermabrasion. Strivectin and Trilastin

Front 20

What is the summary of efficacy for the meds used for Stretch Marks?

Back 20

No consistently effective treatments

Front 21

What is the summary of efficacy for treatments of Leg Edema in patients?

Back 21

NSS for lower leg volume difference for compression stockings vs rest.

Statistically Significant for Reflexology vs rest; reduced leg edema symptoms.

Front 22

What would you recommend for a cough/cold/rhinitis in pregnant patients?

Back 22

First Gen Antihistamines and Second Gen Antihistamines

Front 23

What would you recommend for Constipation in pregnant patients?

Back 23

DOC is general measures + Bulk forming agents (e.g. Psyllium [Metamucil], Polycarbophil [Prodiem Bulk Therapy Fibre])

Front 24

What would you recommend for Hemorrhoids in pregnant patients?

Back 24

Anesthetics (Pramoxine, benzocain, cinchocaine) used to relive pain, itch, irritation of anal canal and perianal area.

Vasoconstrcitors (Epinephrine, Naphazoline, Phenylephrine) are used to relief of engorged tissues.

Anusol is Cryotherapy to shrink blood vessels and sooth tissues

Front 25

What would you recommend for a Pregnant patient for pain management?

Back 25

DOC: Acetaminophen [potentially more risk of preterm birth with pre-eclampsia]

2nd Line: Ibuprofen (ONLY IN 2nd Trimester] [ASA generally not recommended 3rd trimester: Codeine: should not be used in the 3rd trimester]

Front 26

When is Heartburn most common for pregnant patients?

Back 26

3rd trimester

Front 27

What meds would you recoomend for management of Heartburn in Pregnancy?

Back 27

1) Antacids {TUMS, Rolaids}

2) AVOID Magnesium Triscilicate and Sodium Bicarbonate

3) Sucralfate

4) H2RAS

5) PPIs

Front 28

What are the adverse effects of Caffiene during pregnancy??

Back 28

Inconclusive [Teratogencity?]

Front 29

What is the suggested maximum for Caffeine during pregnancy?

Back 29

300mg/day

Front 30

What are some common sources of Caffeine?

Back 30

1) Coffeee

2) Tea,

3) Cola,

4) Chocolate,

5) Medication (Excedrin)

6) Energy Drinks

Front 31

What are the adverse effects of Alcohol during pregnancy?

Back 31

Alcohol consumption during pregnancy can harm the fetus, and cause developmental issues.

Front 32

What are the recommended guidelines for Alcohol during pregnancy?

Back 32

Not enough evidence to define threshold for low level drinking, therefore advise abstinence as a prudent choice

Front 33

What is the difference between Materna and PregVit/PregVit Folic 5?

Back 33

Materna is OTC,

PregVit/PregVit Folic 5 is prescription

Front 34

"There is likely no protective effect of antigen avoidance on the incidence of Atopic eczema during the first 18 months of life" True or False?

Back 34

TRUE

Front 35

Is a restricted diet beneficial during pregnancy?

Back 35

No, it assoicated slightly but stastically significant lower mean gestational weight gain

Front 36

"Breastfed infants with atopic eczema may benefit (decreased severity) from elimination of maternal dietary antigen " True or False?

Back 36

TRUE

Front 37

When does the WHO recommend supplementation of Vitamin A during pregnancy and lactation?

Back 37

In areas of Endemic Vitamin A deficiency

(e.g. night blindness)

Front 38

What are the benefits of Vitamin A supplementation?

Back 38

Reduces maternal anemia, night-blindness, possibly reduces maternal infection.

NO evidence for decreasing maternal or fetal mortality.

Front 39

What is the dose recommendation for Vit A supplementation during pregnancy and lactation?

Back 39

5000 - 10,000 IU daily or 200,000 IU weekly

Front 40

What is the dose recommendation for Calcium supplementation for pregnant and lactation patients?

Back 40

14-18yrs old: 1300mg-3000mg/day

19-50yrs old: 1000mg-2500mg/day

Front 41

What is the evidence of efficacy for Calcium supplementation in pregnancy patients?

Back 41

At least 1g calcium daily (1.5-2g/day); decreases risk of hypertension, pre-eclampsia, pre-term birth, maternal death and serious morbidity.

Also INCREASES HELLP syndrome.

Front 42

What is the dose recommendation for Vit D supplementation in pregnant patients?

Back 42

600 IU/day - 4000 IU/day

Front 43

What is the evidence of efficacy for Vit D supplementation in pregnant patients?

Back 43

While there is evidence that 2000-4000 IU/daily intakes of Vit D will have higher serum 25(OH)D concentration compared to 400 IU/day in women.

BUT there is NO clinical outcome data to support a change to these higher amounts at this time.

Front 44

What is the RDI for Iron Supplementation in Pregnant patients?

Back 44

27mg/day

Front 45

What is the evidence of efficacy for Iron supplementation in pregnant patients?

Back 45

Cochrane review shows that varied doses of Elemental Iron in pregnant patients were less likely to have low birthweight babies, maternal anemia at birth, iron deficiency anemia at birth

Front 46

What is the evidence of safety for Iron supplementation in pregnant patients?

Back 46

More likely to report SE but NSS.

SE appeared to be more likely at doses >60mg elemental iron/day

Front 47

What is the daily recommended dose for Zinc supplementation for pregnant patients?

Back 47

15mg/day

Front 48

What is the evidence of efficacy for Zinc supplementation in pregnant patients?

Back 48

With 15-90mg/day vs placebo. In studies there was a reduction in relative risk of pre-term birth, no evidence of other benefits.

"There might be more benefit from improving nutritional status rather than supplementing with Zinc"

Front 49

What are the issues of Folic Acid deficiency in pregnant patients?

Back 49

At least 50% of the babies born with serious congenital anomaly can be prevented by folic acid intake

Front 50

What are risk factors for a pregnancy complicated with neural tube defects?

Back 50

1) Previous fetus or child with NTD

2) 1st, 2nd, 3rd relation with NTD

3) Pre-existing maternal diabetes as well as IDDM

4) Epilepsy with Valproic acid or Carbamazepine for seizure control

5) Use of Folic acid antagonists (i.e. methotrexate)

Front 51

What is the recommended dosage for pre-conceptional folic acid in patients with no personal health risks, a planned pregnancy?

Back 51

A diet rich of folate rich foods PLUS multivitamin with folic acid 0.4-1.0mg >2 months preconception continued (until finish breastfeeding)

Front 52

What is the recommended dosage for pre-conceptional folic acid in patients with health risks (epilepsy, IDDM, BMI>35, family history of neural tube defect, high risk ethnic groups (e.g.Sikh) ?

Back 52

Folate supplemented diet PLUS multivitamins with 5mg folic acid beginning >3 months prior to conception and continue until 10-12 weeks post conception; then continue with multivitamin with folic acid 0.4-1.0mg (until finished breastfeeding)

Front 53

What is the recommended dosage for pre-conceptional folic acid in patients with poor medication compliance and lifestyle issues (poor diet, inconsistent birth control, possible teratogenic substance use)?

Back 53

Recommended to use multivitamins + folic acid 5mg

Front 54

What are good dietary sources of Folic Acid?

Back 54

Fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, brussel sprouts and oranges.

[Note: difficult to meet the daily suggested requirements]

Front 55

What are the possible safety issues with Folic Acid?

Back 55

1) Possible association with increased incidence of twins

2) Possible association with increased risk of colon cancer

Front 56

Why does Folic Acid need to be taken BEFORE pregnancy?

Back 56

Taking folate DURING pregnancy was NOT associated with reducing chance of pre-term births, stilbirths, neonatal deaths and low birthweight