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56 Cards in this Set

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What are the different trimesters of pregnancy?
1st Trimester: Weeks 1-13.

2nd Trimester: Weeks 14-26.

3rd Trimester: Weeks 27-40

What is the most teratogenic period?
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]

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

When does nausea typically occur in pregnancy?
Between 6-16 weeks

[but can persist up to 20 weeks or beyond]

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

Which is safer Gravol or Gravol Multi-Symptom for Pregnancy?
Gravol regular because Gravol Mult-Symptom contains Willow Bark (which is like ASA)
What drug management would you recommend for a pregnant women with Nausea and Vomitting?
DOC: Doxylamine 10mg/Pyridoxine (Vit B6)10mg [2 tabs qHS; 1 tab qAM; 1 tab in afternoon]
What is "Pregnancy Itch"?
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.

What are the symptoms of Pregnancy Itch ?
1) Intense Itching (worse at night)

2) Dark colored urine

3) Yellow eyes or skin

4) Light coloured bowel movements

What are the risk factors for Pregnancy Itch?
1) Previous history or family history

2) History of liver problems

3) Pregnant with twins

4) Pregnant via IVF

What are the potential complications of Pregnancy Itch?
None for the mother, but increased risk of preterm birth or risk of meconium (fecal matter) in amniotic fluid; risk of fetal death
What drug management would you recommend for a pregnant women suffering from "Pregnancy Itch"?

DOC: Ursodeoxycholic acid (prescription)

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

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

What is another name for Stretch Marks?
Striae gravidarum
What are some causes for Stretch Marks?
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

What are the Signs and Symptoms of Stretch Marks?
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

What are the risk factors for Stretch Marks?
1) Young Maternal Age (<25years)

2) Increased infant birth weight

3) Excessive maternal weight gain during pregnancy

4) Family History

What is the evidence of efficacy for meds used in prevention of Stretch Marks?
Olive Oil, Cocoa butter, Verum, Trofolastin were all found NOT to prevent development of Stretch marks, and did NOT reduce severity of symptoms
What would you recommend for patients suffering from Stretch Marks?
Tretinoin 0.1% cream, Alpha hydroxy acids (e.g Glycolic Acids), Laser therapues and Microdermabrasion. Strivectin and Trilastin
What is the summary of efficacy for the meds used for Stretch Marks?
No consistently effective treatments
What is the summary of efficacy for treatments of Leg Edema in patients?
NSS for lower leg volume difference for compression stockings vs rest.

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

What would you recommend for a cough/cold/rhinitis in pregnant patients?
First Gen Antihistamines and Second Gen Antihistamines
What would you recommend for Constipation in pregnant patients?
DOC is general measures + Bulk forming agents (e.g. Psyllium [Metamucil], Polycarbophil [Prodiem Bulk Therapy Fibre])
What would you recommend for Hemorrhoids in pregnant patients?
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

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

When is Heartburn most common for pregnant patients?
3rd trimester
What meds would you recoomend for management of Heartburn in Pregnancy?
1) Antacids {TUMS, Rolaids}

2) AVOID Magnesium Triscilicate and Sodium Bicarbonate

3) Sucralfate

4) H2RAS

5) PPIs

What are the adverse effects of Caffiene during pregnancy??
Inconclusive [Teratogencity?]
What is the suggested maximum for Caffeine during pregnancy?
What are some common sources of Caffeine?
1) Coffeee

2) Tea,

3) Cola,

4) Chocolate,

5) Medication (Excedrin)

6) Energy Drinks

What are the adverse effects of Alcohol during pregnancy?
Alcohol consumption during pregnancy can harm the fetus, and cause developmental issues.
What are the recommended guidelines for Alcohol during pregnancy?
Not enough evidence to define threshold for low level drinking, therefore advise abstinence as a prudent choice
What is the difference between Materna and PregVit/PregVit Folic 5?
Materna is OTC,

PregVit/PregVit Folic 5 is prescription

"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?
Is a restricted diet beneficial during pregnancy?
No, it assoicated slightly but stastically significant lower mean gestational weight gain
"Breastfed infants with atopic eczema may benefit (decreased severity) from elimination of maternal dietary antigen " True or False?
When does the WHO recommend supplementation of Vitamin A during pregnancy and lactation?
In areas of Endemic Vitamin A deficiency

(e.g. night blindness)

What are the benefits of Vitamin A supplementation?
Reduces maternal anemia, night-blindness, possibly reduces maternal infection.

NO evidence for decreasing maternal or fetal mortality.

What is the dose recommendation for Vit A supplementation during pregnancy and lactation?
5000 - 10,000 IU daily or 200,000 IU weekly
What is the dose recommendation for Calcium supplementation for pregnant and lactation patients?
14-18yrs old: 1300mg-3000mg/day

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

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

What is the dose recommendation for Vit D supplementation in pregnant patients?
600 IU/day - 4000 IU/day
What is the evidence of efficacy for Vit D supplementation in pregnant patients?
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.

What is the RDI for Iron Supplementation in Pregnant patients?
What is the evidence of efficacy for Iron supplementation in pregnant patients?
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
What is the evidence of safety for Iron supplementation in pregnant patients?
More likely to report SE but NSS.

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

What is the daily recommended dose for Zinc supplementation for pregnant patients?
What is the evidence of efficacy for Zinc supplementation in pregnant patients?
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"

What are the issues of Folic Acid deficiency in pregnant patients?
At least 50% of the babies born with serious congenital anomaly can be prevented by folic acid intake
What are risk factors for a pregnancy complicated with neural tube defects?
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)

What is the recommended dosage for pre-conceptional folic acid in patients with no personal health risks, a planned pregnancy?
A diet rich of folate rich foods PLUS multivitamin with folic acid 0.4-1.0mg >2 months preconception continued (until finish breastfeeding)
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) ?
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)
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)?
Recommended to use multivitamins + folic acid 5mg
What are good dietary sources of Folic Acid?
Fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, brussel sprouts and oranges.

[Note: difficult to meet the daily suggested requirements]

What are the possible safety issues with Folic Acid?
1) Possible association with increased incidence of twins

2) Possible association with increased risk of colon cancer

Why does Folic Acid need to be taken BEFORE pregnancy?
Taking folate DURING pregnancy was NOT associated with reducing chance of pre-term births, stilbirths, neonatal deaths and low birthweight