RxPrep Drug Use in Pregnancy & Lactation

human chorionic gonadotropin

What does hCG stand for?

positive hCG

What lab result is used to confirm pregnancy?

first

In what trimester of pregnancy is the embryo most susceptible to birth defects caused by teratogens?

true

True or False: Teratogenic drugs should be discontinued prior to pregnancy, if possible.

American College of Obstetricians and Gynecologists

Who publishes guidelines for safe and effective drug use in conditions impacting women, including pregnancy?

behavioral intervention

What is a safe and sometimes effective strategy for prenatal smoking cessation?

neural tube defect

What birth defect is caused by folate deficiency?

400

Adults should consume ________ mcg of dietary folate equivalents per day.

increase; 600

During pregnancy, folate requirements (decrease/increase) to ________ mcg of dietary folate equivalents per day.

1000; 600

Pregnant women require ________ mg/day of calcium and ________ IU/day of vitamin D.

a

Which old pregnancy category referred to no risk?

a) A

b) B

c) C

d) D

e) X

b

Which old pregnancy category referred to animal studies not demonstrating fetal risk?

a) A

b) B

c) C

d) D

e) X

c

Which old pregnancy category referred to animal studies showing harm to the fetus but no well-controlled studies in pregnant women, meaning use was only indicated if the potential benefit outweighed the risk?

a) A

b) B

c) C

d) D

e) X

d

Which old pregnancy category referred to positive evidence of risk to the human fetus but the benefits may outweigh the risk with life-threatening or serious diseases?

a) A

b) B

c) C

d) D

e) X

e

Which old pregnancy category referred to use in pregnancy as contraindicated?

a) A

b) B

c) C

d) D

e) X

adverse developmental outcomes

According to the updated pregnancy sections in package inserts, a pregnancy risk summary is required for all medications that includes the risk of ________ based on human and animal data and the drug's pharmacology.

lactation

The ________ section of the package insert includes whether the drug/metabolites are present in human milk.

females & males of reproductive potential

The ________ section of the package insert includes any effects on fertility and requirements for pregnancy test and contraception.

flu, Tdap

What 2 immunizations are routinely recommended for pregnant patients?

each pregnancy

How often do pregnant women need to receive a Tdap vaccine?

REMS

Some drugs with significant teratogenic risk have ________ requirements due to potential harm to the fetus.

isotretinoin, topical retinoids

What 2 acne drugs/classes are teratogens?

quinolones, tetracyclines

What 2 antibiotic classes are teratogens?

warfarin

What anticoagulant is a teratogen?

RAAS inhibitors, statins

What 2 cardiovascular drug classes are teratogens?

contraceptives, Duavee, estradiol, megestrol, progesterone, raloxifene, testosterone

What 7 hormones are teratogens?

dihydroergotamine, ergotamine

What 2 migraine drugs are teratogens?

hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, valproic acid, weight loss drugs

What 11 drugs/classes are teratogens?

false

True or False: Not all teratogens are considered hazardous drugs.

National Institute for Occupational Safety and Health

Who determined teratogens should be considered hazardous drugs?

Briggs' Drugs in Pregnancy and Lactation

What is an example of a resource that should be used when prescribing/dispensing medications to pregnant women?

preeclampsia

complication of pregnancy that presents with elevated blood pressure and evidence of organ damage, most often to the kidneys or liver

low-dose aspirin

To prevent preeclampsia, ACOG and ADA guidelines recommend adding daily ________ at the end of the first trimester of pregnancy for women at risk for preeclampsia.

type 1 or 2 diabetes

What is a major risk factor for developing preeclampsia?

lifestyle modifications

What is first line for treatment of morning sickness, nausea, and vomiting in pregnancy?

pyridoxine ± doxylamine

What is second line for treatment of morning sickness, nausea, and vomiting in pregnancy?

vitamin B6

What is another term for pyridoxine?

ginger

What natural product is rated "possibly effective" for treating morning sickness?

lifestyle modifications

What is first line for GERD/heartburn in pregnancy?

3 hours

If GERD symptoms in pregnancy occur while sleeping, it's recommended to elevate the head of the bed and not eat for ________ prior to sleep.

calcium carbonate

What is second line for GERD/heartburn in pregnancy?

Tums

What is the brand name for calcium carbonate?

simethicone

What is first line for flatulence in pregnancy?

lifestyle modifications

What is first line for constipation in pregnancy?

increase fiber intake, increase fluid intake, increase physical activity

What are 3 lifestyle modifications for constipation in pregnancy?

calcium polycarbophil, psyllium

What are 2 second line treatment options for constipation in pregnancy?

cromolyn

What is first line for cough/cold/allergies in pregnancy?

first generation antihistamine

What drug class is second line for cough/cold/allergies in pregnancy?

clorpheniramine

What first generation antihistamine is preferred for cough/cold/allergies in pregnancy?

beclomethasone, budesonide

What 2 nasal steroids are preferred for chronic allergy symptoms in pregnancy?

alcohol

Liquid allergy medications containing ________ should be avoided during pregnancy.

acetaminophen

What drug is first line for mild pain in pregnancy?

NSAIDs; aspirin

When treating pain in pregnancy, ________, including ________, should be avoided, especially at 20 weeks gestation or later.

budesonide

What drug is first line for asthma maintenance therapy in pregnancy?

albuterol

What drug is first line for asthma rescue therapy in pregnancy?

budesonide

What is the preferred inhaled steroid for infants?

labetalol, methyldopa, nifedipine

What 3 drugs are preferred for hypertension in pregnancy?

ACE inhibitors, aliskiren, ARBs, Entresto

What 4 hypertension drugs/classes are contraindicated in pregnancy?

insulin

What drug is preferred for diabetes in pregnancy?

azithromycin, cephalosporins, erythromycin, penicillins

What 4 antibiotic drugs/classes are generally considered safe to use in pregnancy?

topical antifungal

What class is preferred for vaginal fungal infections in pregnancy?

ampicillin, cephalexin

What 2 drugs are preferred for UTI in pregnancy?

Bactrim, nitrofurantoin; 2 weeks

________ and ________ should be considered last line for UTI during the first trimester of pregnancy and should not be used in the last ________ of pregnancy.

true

True or False: Bacteriuria in pregnancy must be treated even if asymptomatic.

IgG

Women can be tested for toxoplasmosis prior to pregnancy with a(n) ________ test.

cat feces, unpasteurized dairy products

If unsure of toxoplasmosis status, it is best to avoid ________ and ________ during pregnancy.

low molecular weight heparin

What drug is preferred for venous thromboembolism in pregnancy?

pneumatic compression devices ± low molecular weight heparin

What is preferred for venous thromboembolism prophylaxis in pregnancy?

false (haven't been adequately studied for use in pregnancy)

True or False: Oral factor Xa inhibitors and direct thrombin inhibitors are recommended for venous thromboembolism in pregnancy.

levothyroxine

What drug is preferred for hypothyroidism in pregnancy?

30-50

Levothyroxine will require a(n) ________% dose increase during pregnancy.

propylthiouracil

What drug is preferred for hyperthyroidism if trying to conceive or in the first trimester of pregnancy?

methimazole

What drug is typically used for hyperthyroidism in the second and third trimesters of pregnancy?

liver damage

Both propylthiouracil and methimazole have a high risk for ________.

true

True or False: The American Academy of Pediatrics recommends babies be exclusively breastfed for the first six months of life as long as it's mutually desired by the mother and baby.

400

Babies receiving breast milk partially or exclusively should receive ________ IU of vitamin D daily until they're consuming at least one liter of vitamin D-fortified formula/day.

1; 4-6

Breastfed babies require ________ mg/kg of iron daily during months ________.

LactMed

What resource can be used to check for drug safety during breastfeeding?

codeine, tramadol

What 2 drugs should not be used to treat pain in breastfeeding mothers due to the risk of excessive sleepiness, breathing difficulty, and/or death in the infant?

2D6

Breastfed infants have died, especially in mothers taking codeine who were CYP________ ultra-rapid metabolizers.

false (not recommended at all in U.S.)

True or False: Breastfeeding is recommended for women with HIV infection as long as they are adherent to their antiretroviral therapy.

amiodarone, amphetamines, ergotamines, lithium, metronidazole, phenobarbital, statins

What 7 drugs/classes require a breastfeeding mother to pump and dispose of the breastmilk when drug concentrations are at their highest?