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36 Cards in this Set
- Front
- Back
Medication related factors that elevate the level of drug transfer
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High lipophilicity,
Low ionization, Low maternal protein binding, Low molecular weight.... The opposite of these would have trouble passing placenta |
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Agents that exhibit teratogencity effects in 2nd and 3rd trimesters
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Tetracycline and NSAIDs
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Some known tertogens during organogenesis include:
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Chemotherapy agents, certain sex hormones, lithium (may be better than CBZ or others), warfarin, antiepileptic agents, thalidomide, retinoids
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How much folic acid is recommended for women during pregnancy? How about for a woman with a previous pregnancy complicated y neural tube defect?
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400 mcg/day; 4 mg/day for previous complication
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Whats the window of opportunity to start folic acid?
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Neural tube closes within the first four weeks of pregnancy
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What are nicotine patchesranked in pregnancy
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Nicotine by itself is less of a threat than smoking
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How should constipation be treated in pregnancy?
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First approach is diet hydration and exercise. Fiber, stool softeners, MoM, Mag cit, lactulose, PEG, and sorbitol can be considered..
Castor Oil and Mineral Oil should be avoided |
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GERD treatments in pregnancy
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–non-pharmacological interventions
include small, frequent meals, caffeine reduction, no bedtime meals, elevation of the head of the bed. Most of the common calcium, aluminum, or magnesium oral antacids, sucralfate, ranitidine and cimetidine are considered safe. Sodium bicarbonate should be avoided. Metoclopramide has been used in pregnancy. Less is known about lansoprazole and omeprazole. |
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Hemorrhoid treatment in pregnancy
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Topical anesthetics, asatringents, fiber, fluids, sitz baths
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N/V treatment in pregnancy
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smaller, frequent meals and
accupressure may be helpful. Antihistamines (e.g. doxylamine), vitamins (pyridoxine), phenothiazines, metoclopramide, ondansetron, and ginger have been used. |
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Gestational Diabetes treatment
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Nutrition, exercise, insulin is drug of choice; glyburide may be consideredl metfomin may also be reasonabe alternative
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Hypertension Treatment in pregnancy drugs
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Methyldopa, labetolol, CCB; ACE-I should be avoided due to renal toxicities
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Migraine/HA treatment in pregnancy
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APAP, NSAIDs (avoid at term), caffeine; Narcotics (narcotic analgesics are considered safe) and benzos are not indicated (can only be used if absolutely necessary)
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What BB can be used as preventative therapy for migraine in pregnancy?
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Propranolol
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Can ASA and indomethacin be used for migraine treatment in pregnancy?
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No; they're potent prostaglandin inhibitors (associatied with premature closure of ductus arteriosis)
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Can sumatriptan, ergotamine, dihydroergotamine be used for migraine treatment in pregnancy
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Sumatriptan is controversial for migraine abortive therapy; ergotamine and dihydroergotamine should be avoided
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What Abx are C/I in Pregnancy
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Fluoroquinolones and tetracyclines
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When is nitrofurantoin used in pregnancy
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Not in late pregnanc; should not be used after 37 weeks in patients with glucose 6 phosphate dehydrogenase deficiency due to concern about hemolytic anemia in the newborn
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What can sulfa containing drugs cause if given at term?
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Kernicterus
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When should trimethoprim be avoided in pregnancy?
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It's a folate antagonist and should be avoided in first trimester
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Treatment of Chlamydia?
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Azithromycin 1 g or Amoxicillin 500 mg TID x7 days
Erythromycin base or ethylsuccinate is an alternative treatment. |
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Why should erythromycin estolate be avoided in pregnancy?
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Due to potential for hepatotoxicity
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Women with primary outbreak during pregnancy should be treated with?
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Acyclovir
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Women with first episode infection of genital herpes or outbreak at the time of delivery should..
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Have a cesarean section
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What are the most effective treatments for allergic rhinitis in pregnancy?
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Beclomethasone, budesonide
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First line antihistamines for pregnancy?
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Chlorpheniramine and hydroxyzine
Nasal cromolyn appears safe |
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Preferred inhaled corticosteroid during pregnancy for asthma?
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Budesonide
Other inhaled corticosteroids may also be considered if effective before pregnancy. |
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Are long acting beta agonists considered safe in pregnancy?
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yes
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In epilepsy during pregnancy, what strength of folic acid should be given?
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4-5 mg daily before pregnancy and through first trimester, and vitamin K during last month of gestation
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What should you do for drugs in women with epilespy and pregnant?
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Use monotherapy with drug that has controlled SZ most effectively
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What are the most common depression medication used in pregnancy?
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SSRI
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Adverse outcomes from SSRI in pregnancy?
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Neonatal persisitent pulmonary HTN. withdrawal effect in newborn (irritability and difficulties with feeding and breathing), and increased risk for cardiac defects (paroxetine)
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Does the pregnancy category (A,B,C,D,X) apply to lactation as well?
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Nope.
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If a drug is highly protein bound in maternal circulatory system, is it going to pass through lactation to the baby?
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Not as likely
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If mom is taking a short acting drug TID when should she take it?
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Right after breast feeding..
That way the breast milk will have lower levels of drug when breast feeding |
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Should you use short or long acting forms in breast feeding moms?
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Short acting
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