Pharm- class notes 2023 with 100% correct questions and answers

Classic teratogenic period day 31-71 category A drug Controlled studies show no risk to fetus Studies in pregnant women show no risk in any trimester Category B drug No evidence of risk in humans Studies in pregnant women have shown no risk despite animal adverse findings OR animal studies show no risk in absence of human studies Category C drug Risk cannot be ruled out Human studies lacking; fetal risk in animals; use if benefits risks Category D drug Positive evidence of risk Human studies have shown fetal risk; only use if benefits DEFINITELY risks Category X drug Contraindicated in pregnancy Human or animal studies have shown fetal risk that outweighs any possible benefit to patient indication for folic acid supplementation prevention of neural tube defects when should folic acid supplementation be started at least 3 months before conception (400-800mcg) - first 12 weeks (likely throughout pregnancy) Women who have given birth to a child with a neural tube defect or spina bifida should take how much folic acid? 4000mcg daily physiologic cardiovascular changes in pregnancy Heart rate ↑ during pregnancy as a compensatory mechanism to falling systemic vascular resistance Blood pressure falls by about 10% by week 7-8 of gestation, reaches nadir at 24 weeks, and rises to pre-pregnancy values by term hematologic changes in pregnancy Plasma volume ↑ by 10% by week 7 of gestation; plateaus at 45-50% at 32 weeks Pregnancy is a procoagulable state respiratory changes in pregnancy Uterus expands upwards and changes chest shape Oxygen consumption increases renal changes in pregnacy GFR ↑ by end of 1st trimester Resistance to pressor effects of angiotensin II leads to increased extracellular water volume and retention of sodium and water endocrine changes in pregnancy Pregnancy is a state of iodide deficiency Beta-cells undergo hyperplasia and lead to increased insulin secretion Diabetogenic state Pituitary expands during pregnancy and ↑ in size by 135% and prolactin levels ↑ throughout pregnancy major teratogenic malformations Anencephaly Cleft palate Congenital heart disease Mental disabilities incidence of major and minor teratogenic malformations in general populations major 2-3% minor 7-8% drugs w/ proven teratogenicity ACE inhibitors/ARBs Antithyroid drugs Carbamazepime Cyclophosphamide Danazol Isotretinoin Lithium Misoprostol NSAIDs*** available OTC Phenytoin Tetracycline Thalidomide Valproic acid Warfarin Thalidomide tragedy Used as a sedative hypnotic/antiemetic from by pregnant women Led to thousands of malformations Now used for multiple myeloma Nausea and vomiting of pregnancy (NVP) 75-80% of women Symptoms generally begin around week 5 of gestation and cease by week 12 Up to 15% of women will experience persistent symptoms until delivery Only 17% have "morning sickness"; most experience nausea throughout the day Category A NPV Rxs multivitamins pyridoxine (vit B6) doxylamine-pyridoxine diclegis (doxylamine/pyridoxine) Category B NPV Rx Antihistamines (e.g. meclizine, diphenhydramine, dimenhydrinate) metoclopramide ondansetron Category C NVP Rx corticosteroids Phenothiazones (chlorpromaize, prochlorperazine, promethazine) what can a pregnant woman take for HA? acetaminophen (tylenol) NOT NSAID heartburn in pregnancy affects 30-50% Symptomatic GERD can be problematic at anytime during pregnancy, but seems to be more severe in later months of gestation Possible causes include ↓ esophageal sphincter pressure, ↑ abdominal pressure, and abnormal gastric emptying Rxs for heartburn tx in pregnancy antacids (Al, CA, Mg) 1st lline Sucralfate histamine-2 receptor blockers (cimetidine, famotidine, ranitidine) metoclopramide PPI Constipation in pregnancy 11-38% ↑ daily exercise, fluids, and fiber intake are first-line treatments Laxatives should be considered second-line therapies psyllium, bran bulk forming agent for constipation luminal water binding increases stool bulk docusate sodium stool softener for constipation stimulates net secretion of water, NA, Cl, and K and inhibits net absorption of glucose mineral oil lubricant laxative for constipation ↓ surface tension of bowel's contents magnesium citrate, sorbitol, lactulose osmotic laxative for constipation ↑ osmolar tension, resulting ↑ in water collection bisacodyl senna stimulant laxatives for constipation (last line) Stimulates colonic motility and ↓ water absorption from large intestine hemorrhoids in pregnancy 25-35% Topical anesthetics Bulk-forming laxatives Compound corticosteroids plus topical anesthetics Topical corticosteroids what decongestant should be avoided in 1st trimester oral pseudoephedrine decongestants in pregnancy saline spray topical decongestants (avoid oral pseudoephedrine in 1st trimester) antihistamines in pregnancy Both old and new relatively safe 1st generation: diphenhydramine, chlorpheniramine 2nd generation: loratadine, cetirizine, fexofenadine Tx options for cystitis in pregnancy Amoxicillin-clavulanate, cephalexin, nitrofurantoin Tx for empiric therapy for pyelonephritis 3rd generation cephalosporins UTIs in pregnancy Changes in urinary tract during pregnancy predisposes to ↑ incidence of bacteriuria and UTI Must screen for UTI during pregnancy what abx should be avoided in pregnacy tetracylines, fluoroquinolones fluoroquinolone AE in pregnancy relative CI, arthropathy in immature animals Sulfamethoxazole/trimethoprim AE in pregnancy Possible antifolate effects in 1st trimester and may cause kernicterus in 3rd trimester nitrofurantoin AE in pregnancy May cause hemolytic anemia if used at term tetracyline AE in pregnancy can cause tooth discoloration aminoglycosides AE in pregnancy may cause ototoxicity in high doses infections common in pregnancy UTI vaginal yeast infections Rx for Diabetes mellitus in pregnancy Insulin (drug of choice) oral hypoglycemic rx (glycuride, metformin) Isotretinoin AE in pregnancy (accutane) SIGNIFICANT human teratogen! Pregnancy category X Indicated for treatment of cystic acne Females MUST have 2 negative pregnancy tests prior to isotretinoin therapy step 1: mild intermittent Asthma in pregnancy SABA* (e.g. albuterol) as needed If 2x/week, step up to step 2 step 2: mild persistent asthma in pregnancy Daily, low-dose inhaled steroid (e.g. budesonide) Budesonide preferred due to most data available in pregnancy Step 3: moderate persistent asthma in pregnancy LABA* (e.g. salmeterol) + low dose-inhaled corticosteroid Medium dose inhaled steroid Only limited (albeit safe) data exist for combination therapy Salmeterol has been available the longest Step 4: severe persistent asthma LABA + medium-dose inhaled steroid High-dose inhaled steroid Use lowest effective dose Try to stay away from oral steroids Tx for depression in pregnancy SSRI (not paroxetine) Serotonin/ NE reuptake inhibitor (SNRI venlaxafine) Tri-cyclic antidepressants SSRI AE in pregnancy Cardiac birth defects seen with 1st trimester paroxetine use-changed from category C to D Increased neonatal symptoms of withdrawal after birth may be seen Persistent pulmonary hypertension of the newborn Tri-cyclic antidepressant tx for depression in pregnancy w/ most safety data amitriptyline