Term
| What does folic acid help prevent and what is the recommended dose for a woman planning to get pregnant? |
|
Definition
| Helps prevent Neural tube defects. Dose is 400 mcg QD for at least 3 months. |
|
|
Term
| What are the most common neural tube defects (NTDs)? |
|
Definition
|
|
Term
| What is the difference between the embryonic period and the fetal period? |
|
Definition
| The embryonic period is 2-8 weeks after fertilization when most body structures are formed. Fetal period is from 8 weeks after fertilization till pregnancy reaches term (~40 weeks after the last mentrual period). |
|
|
Term
| Approximately __% of embryos survive past two weeks after fertilization. |
|
Definition
|
|
Term
| Babies born before how many weeks typically can't survive? |
|
Definition
|
|
Term
| Any babies born < ____ weeks are considered high risk. |
|
Definition
|
|
Term
| When is prenatal genetic testing indicated? |
|
Definition
| Family history, sibling with severe birth defect, women with at least 2 miscarriages, and women greater than 34 yo. Can do chorionic villus sampling or amniocentesis. |
|
|
Term
| What is the FDA approved abortion (medical)? |
|
Definition
| Mifepristone 600 mg PO followed about 48 hours later by misoprostol 400 mcg po |
|
|
Term
| What are the two main abortifacients and their MOAs? |
|
Definition
| Mifepristone: Progesterone receptor antagonist. Misoprostol: Prostaglandin E1 analogue. |
|
|
Term
| What do you need to monitor with abortifacients? |
|
Definition
| With Mifepristone or Misoprostol you need to monitor for infection and bleeding. be careful with patients who are already prone to infection or to bleeding. |
|
|
Term
| What happens to Vd and to albumin in a pregnant woman's body? |
|
Definition
| Vd goes up, albumin binding capacity goes down |
|
|
Term
| What happens to absorption in a pregnant womans body? |
|
Definition
| Reduced GI motility, increased gastric pH and nausea/vomiting can all affect absorption. |
|
|
Term
| What 3 things are altered with excretion in a pregnant woman's body? |
|
Definition
| Decreased biliary excretion, increased maternal plasma volume and cardiac output, increased renal blood flow, and GFR |
|
|
Term
| What are the factors that influence drug transfer between mother and baby? |
|
Definition
| Lipid solubility, electrical charge, molecular weight, and degree of protein binding |
|
|
Term
| Drugs would be considered a ________ factor in causing birth defects, and can also be teratogenic. |
|
Definition
|
|
Term
| What happens to zygote if exposed to drugs <2 weeks after fertilization? |
|
Definition
| No effect or zygote dies. During embryonic period, may critically influence organ development and cause structural anomalies, and fetal peiord is less likely to cause malformation but may influence functioning/behavior. |
|
|
Term
| What does category B mean for teratogenicity in pregnancy? |
|
Definition
| Category B does not mean the drug is unsafe, it just means that there is no human data. Many drugs are category B and still used in pregnancy. Usually for this category, the benefits outweigh the risks. |
|
|
Term
| Contraception - no studies show that they cause fetal harm. Still listed as a category __ in the United States |
|
Definition
|
|
Term
| What FDA category are Androgens, ACE-Inhibitors, antineoplastics, and coumadin in? |
|
Definition
| ACE-inhibitors, antineoplastics, and coumadin are in D. Androgens (testosterone) are in X. |
|
|
Term
| Name some category D drugs. |
|
Definition
| Iodides, PTU, Methimazole, Lithium, Phenytoin, Tetracyclines, and Valproic acid. |
|
|
Term
| What are the 4 Category X drugs that are known teratogens? |
|
Definition
| Androgens, vitamin A (>18,000 IU/day), Thalidomide, and Retinoids, |
|
|
Term
| What is the safest drug for treating bipolar disorder during pregnancy? |
|
Definition
|
|
Term
| What are some GI disorders during pregnancy? |
|
Definition
| Hemorrhoids, GI upset, nausea, acute pain, Also HA, allergies, cough/cold, infectious disease, and anemia are common. |
|
|
Term
| What is first line for constipation during pregnancy? |
|
Definition
| Fiber supplements or docusate sodium |
|
|
Term
| What is second line for constipation in pregnancy and what drugs are NOT recommended? |
|
Definition
| Bisacodyl, lactulose, and sorbitol are second line. Senna (3rd line), mineral oil and caster oil are all generally not recommended. |
|
|
Term
| What do women experience nausea and vomiting during pregnancy? |
|
Definition
| Elevated HcG, estrogen, progesterone, prostaglandin E2, thyroid hormones, H. pylori seropositivity, abnormal peristalsis, and psychosocial factors |
|
|
Term
| What is GERD during pregnancy generally caused by? |
|
Definition
| Decreased LES tone, and increased intragastric pressure |
|
|
Term
| What is first line to treat GERD in pregnancy? |
|
Definition
| Calcium antacids (Al and Mg ok too, but NOT bicarb), choose based on stool (constipation vs diarrhea). H2RAs and sucralafate are 2nd line. Avoid Na bicarb and Mg trisilicate. |
|
|
Term
| How do you treat hemorrhoids during pregnancy? |
|
Definition
| Increase dietary fiber, increase fluid, sitz batch, and skin protectants. AVOID topical anesthetics or steoids. |
|
|
Term
| What is the safest drug for acute pain during pregnancy? |
|
Definition
| Acetominophen. NSAIDS are only ok early in pregnancy in small doses!! Given in third trimester can close the PDA prematurely and kill baby. |
|
|
Term
| What do you treat vasomotor rhinitis (allergies) in 2nd trimester with? |
|
Definition
| Chloripheniramine. Can also use claritin and zyrtec (cat. B). Sudafed is OK for a short period of time. Budesonide and beclomethasone are preferred as nasal sprays. |
|
|
Term
| What is first line for cough symptoms during pregnancy? Cold symptoms? |
|
Definition
| Cough- only WATER (other meds are category C at best). Cold- try saline nasal sprays, then topical decongestants, then oral decongestants if necessary |
|
|
Term
| When does the mother and baby get antibiotics if the mother is positive for a group B strep UTI? |
|
Definition
| They both get antibiotics in labor or after. |
|
|
Term
| How do you treat a pregnant woman's UTI? |
|
Definition
| Macrobid (nitrofurantoin) x 7-10 days, or cephalexin as next choice for 7-10 days. AVOID bactrim, tetracyclines, and fluoroquinolones. |
|
|
Term
| How do you treat Syphilis in a pregnant woman? |
|
Definition
| Treat with PCN, even if allergy bc it crosses the placenta. Desisitize if allergic. |
|
|
Term
| What STD do doctors perform C sections to avoid giving to the baby? |
|
Definition
|
|
Term
| Why do babys have goopy eyes after being born? |
|
Definition
| The nurse puts Erythromycin gel on their eyes so the baby doesn't get the conjunctivitis in their eyes |
|
|
Term
| What makes preeclampsia severe? |
|
Definition
| If SBP >160 or DBP>110, proteinuria, oliguria, visual disturbances, pulmonary edema/cyanosis, epigastric pain, elevated LFTs, thrombocytopenia, and fetal growth restriction |
|
|
Term
| How do you prevent and treat preeclampsia? |
|
Definition
| Nothing is recommended to prevent it. Watch closely and deliver early if necessary. Preeclampsia is high blood pressures before 28 weeks gestation. To treat (if DBP>110), give IV hydralazine/labetolol, or pO nifedipine. Magnesium given for seizure prevention and treatment. |
|
|
Term
| Once a pt has a seizure during pregnancy (after high bp), what do they have? |
|
Definition
| Eclampsia and you must then treat teh seizures with magnesium sulfate bolus then maintenance drip. can also give phenytoin. Then generally deliver post seizure to protect mother. |
|
|
Term
| What antihypertensive meds are contraindicated during pregnancy? |
|
Definition
| ACE-inhibitors, ARBs, and atenolol. |
|
|
Term
| If a pregnant patient comes in to the pharmacy with a prescription for Lisinopril, what do you do? |
|
Definition
| Call the doctor and recommend a switch to Methyldopa or labetalol. ACE, ARBs and atenolol are contraindictaed during pregnancy! |
|
|
Term
| What drug treatment should you provide to a pregnant woman with Asthma? |
|
Definition
| Continue current ICS (inhaled corticosteroid and rescue therapy but avoid initiating long acting bronchodilators or other meds. |
|
|
Term
| What makes a women low risk for gestational DM to the point where she doesn't need to be screened? |
|
Definition
| <25 yo, caucasian, BMI<25, no history of abnormal glucose tolerance, no previous GDM, and no dm in first degree relative. |
|
|
Term
| What is the glucose tolerance test? |
|
Definition
| A 50 g, 1 hour oral glucose administration without regar to last meal. Diagnose GDM with a threshold of 140 mg/dL has 10% less sensitivity than 130 mg/dL but fewer false-positive results. either threshold is acceptable. |
|
|
Term
| How do you treat gestational diabetes? |
|
Definition
| Medical nutrition therapy followed by insulin, metformin, or both. Moderate caloric restriction can also be used if obese, but don't want to restrict to much. |
|
|
Term
| How much do requirements for thyroid therapy in a hypothyroidic pregnant patient increase during pregnancy? |
|
Definition
| 25-50 % during pregnancy- treat with thyroid replacement therapy |
|
|
Term
| T/F Medication change to phenobarbital is NO longer recommended for seizure disorders during pregnancy. |
|
Definition
|
|
Term
| A woman has a ________ rate of VTE (venous thromboembolism) during the last 20 weeks of pregnancy and a much ________ risk post-partum. |
|
Definition
| constant rate- much higher risk post-partum |
|
|
Term
| What do you prophylax with in a woman with a single VTE? recurrent VTE? |
|
Definition
| UFH or LMWH for prophylaxis a single single VTE. Therapeutic doses of UFH or LMWH in women with recurrent VTE. (Heparin[Lovenox] used- Avoid Warfarin/Coumadin!) |
|
|
Term
| How do you prevent losing a baby when the mother is Rh-negative (and the baby is positive)? |
|
Definition
| At 28 weeks gestation, within 72 hours after delivery of an Rh positive newborn, after a first trimester pregnancy loss, and after an invasive procedure. - give Rho (D) Immune Globulin |
|
|
Term
|
Definition
| Cervical changes and uterine contractions before 37 weeks gestation. |
|
|
Term
|
Definition
| Used to postpone delivery. Generally for administration of antenatal corticosteroids or transportation of mother to facility equipped for high-risk deliveries. Do not use if infection, fetal distress, severe preeclampsia, vaginal bleeding, or maternal hemodynamic instability |
|
|
Term
| Why would we want to give a woman antenatal corticosteroids? |
|
Definition
| They are given to the pregnant mother to open up airways and help produce surfactant and develop the lungs of the newborn. |
|
|
Term
| What drugs are used to inhibit labor? |
|
Definition
| Tocolytics include Calcium channel blockers (Nifedipine), B-adrenergic agents (Terbutraline), Magnesium, and NSAIDS(indomethacin) |
|
|
Term
| What tocolytic causes "floppy baby"? |
|
Definition
|
|
Term
| What Tocolytics have higher incidence of Side effects? |
|
Definition
| Terbutaline (B-adrenergic agent), and NSAIDS (premature ductus closure) |
|
|
Term
| What tocolytics have few or rare side effects? |
|
Definition
| Nifedipine (Ca channel blocker), Magnesium |
|
|
Term
| What medications are used as antenatal corticosteroids? |
|
Definition
| Betamethasone 12 mg IM Qd x 2 c days. Or Dexamethasone 6 mg IM Q12 hours for 4 doses |
|
|
Term
| When do you cover for group B strep? |
|
Definition
| If rectal culture is positive, previous neonate with GBS infection, or women presenting in labor with no screening info and a fever, <37 weeks gestation. If baby is born before 35 weeks, you don't know their GBS status |
|
|
Term
| How do you cover Group B strep (to prevent infections in newborns)? |
|
Definition
Penicillin or Ampicillin 2 g IV. If pt has PN allergy but it wasn’t anaphylaxis, recommend sulfazalin- if they did have anaphylaxis- then give clindamycin (if infection was clindamycin sensitive) if wasn’t’ clinda sensitive or culture was unknown- give VANCO.
They no longer recommend erythromycin. |
|
|
Term
| What are the indications for cervical ripening (labor induction)? |
|
Definition
| Post datism (>42 weeks gestation), suspected fetal growth retardation, maternal HTN (preeclampsia), PROM, social factors, Bishop score <6 (cervical dilation, cervical effacement, station of baby's head, consistency of cervix, and position of cervix). Oxytocin is most commonly used agent after cervical ripening. |
|
|
Term
| What is given to reduce maternal blood loss? |
|
Definition
| IM oxytocin, methylergonovine or both are used to reduce maternal blood loss during a postpartum hemorrhage. |
|
|
Term
| What do you give to treat mastitis? |
|
Definition
| Mastitis= infection of breast tissue. Treat with anti-staph penicillins, cephalosporins x 10-14 days |
|
|
Term
| Does metoclopramide increase milk production? |
|
Definition
| YES Metoclopramide increases milk production |
|
|
Term
| What are some substances that decrease milk production? |
|
Definition
| Nicotine, estrogen, bromocriptine, MAOIs, and more |
|
|
Term
| What are some medications that increase milk production? |
|
Definition
| Metoclopramide, antipsychotics, domperidone, oxytocin, and alcohol |
|
|
Term
| What types of medications do you want to choose for a breastfeeding mother? |
|
Definition
| Meds with short half-life, high protein binding, poor oral absorption, and low lipid solubility |
|
|
Term
| What are the categories of medication safety during lactation? |
|
Definition
| L1 (safest) to L5 (contraindicated) |
|
|
Term
| What are some contraindicated medications during lactation? |
|
Definition
| Amphetamines, lithium, antineoplastics, bromocriptine, ergotamine, nicotine, and drugs of abuse. |
|
|
Term
| What medications are considered safe during lactation? |
|
Definition
| Alcohol (in moderation), analgesics, anticonvulsants, antibiotics, caffeine (in moderation), laxatives, and insulin |
|
|
Term
Sexual arousal activates release of neurotransmitters; mainly _______and ______from nerve terminals in the penis |
|
Definition
| acetylcholine and nitric oxide (NO) |
|
|
Term
| What are the two main components required for erection? |
|
Definition
| NO production and smooth muscle cell relaxation |
|
|
Term
| How does NO work to cause erection? |
|
Definition
NO produced by endothelial cell moves over to the neighboring SMC and can activate opening of K+ channels and hyperpolarize SMC (relaxes them), and it can also bind the heme-moeity in guanylyl cyclase, activating the enzyme and also relaxing the SMCs. |
|
|
Term
| Sildenafil, Vardenafil, and Tadalafil are ______ inhibitors of _________. |
|
Definition
| reversible inhibitors of phosphodiesterase (PDE) |
|
|
Term
| How can visual disturbances occur with boner pills? |
|
Definition
| Sildenafil, Vardenafil, and Tadalafil all affect PDE-6, which is rods and cones (in the eyes), which can cause visual disturbances including color problems (red and green) |
|
|
Term
| What is the mechanism and adverse effects of Phosphodiesterase 5 inhibitors |
|
Definition
| Mechanism: Increase smooth muscle cell cGMP and activates protein kinase G (PKG). ADR include priapism, visual disturbances, and interact with vasodilators |
|
|
Term
| What are some conditions that can affect the prostate? |
|
Definition
| Inflammation (infection or aseptic), benign enlargement (BPH), or tumors. |
|
|
Term
| What is the difference between hyperplasia and hypertrophy? |
|
Definition
| Hypertrophy is tissue expansion due to increase in cell size. Hyperplasia is tissue expansion due to increase number of cells. |
|
|
Term
|
Definition
| Benign prostatic hyperplasia is very common in males over 50 yo. It is characterized by hyperplasia (increased number of cells) of both stromal and epithelial cells in the prostate. |
|
|
Term
| How does testosterone affect stromal cells? |
|
Definition
| Testosterone can enter a stromal cell and be reduced by 5a-reductase type 2 which changes it into DHT. DHT then triggers growth factors in stromal cells and diffuses over to the neighboring epithelial cells and has effect on its growth factors as well. DHT is the main androgen in the prostate. |
|
|
Term
| What is prostate hyperplasia due to? |
|
Definition
| Prostate hyperplasia= increased number of both stromal and epithelial cells. it is due to an imbalance between cell proliferation and cell death. |
|
|
Term
| What two classes of drugs treat BPH? |
|
Definition
| a1-adrenergic antagonists and 5a-reductase inhibitors |
|
|
Term
| What drugs treat only the symptoms of BPH? |
|
Definition
| a1-adrenergic antagonists (Terazosin, Doxazosin, Tamsulosin, Alfuzosin, and Silodosin) |
|
|
Term
| What drugs actually reduce the size of the prostate to treat BPH? |
|
Definition
| 5a-reductase inhibitors do this (Dutasteride and Finasteride). They block the conversion of testosterone to DHT (stops tissue proliferation) |
|
|
Term
| What are some side effects of 5a-reductase inhibitors? |
|
Definition
| Sexual dysfunction, impotence, teratogenic effects |
|
|
Term
| What is the mechanism for a1-adrenergic antagonists? |
|
Definition
| Relaxes prostatic and urethral smooth muscle. ADR include postural hypotension, and QT prolongation. |
|
|
Term
| What are some common causes of low testosterone in males? |
|
Definition
| Klinefelter's syndrome (XXY syndrome), uncorrected cryptorchidism (presence of one or both undescended testes), chronic disease (HIV, COPD, end stage renal disease), hyperprolactinemia, medications, aging, and alcoholism. |
|
|
Term
| What are the benefits of androgen replacement therapy? |
|
Definition
| Anabolic and androgenic effects (muscle, bone, libido). May elevate mood, help maintain bone mass, red cell count and muscle mass, may help with ED and increase libido; may also improve cognitive ability. |
|
|
Term
| What are some adverse effects of androgen replacement therapy? |
|
Definition
| Potentiates BPH and prostate cancer, erythrocytosis (high RBCs), hepatic dysfunction (increase bilirubin and hepatic enzymes+ causes edema and Na retention), hepatic malignancy (teratogenic), oily skin and acne, worsens sleep apnea, may lower HDL and increase LDL, and very harmful to fetal development (shouldn't be around pregnant women). |
|
|
Term
| The effects of testosterone and DHT are mediated through the ______ receptor. |
|
Definition
| androgen receptor- like all steroid hormone receptors, has DNA and hormone binding domains- mutations in the receptor can cause androgen insensitivity |
|
|
