Term
| When does fetal organogenesis take place? |
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Definition
First 8 weeks after conception:
- Heart - 3rd-6th week
- Limb - 4th-7th week
- Palate - 6th-8th week |
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Term
| How does drug exposure affect the 2nd and 3rd trimesters? |
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Definition
2nd - affects growth and cognition
3rd - Nutrition and size |
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Term
| How is the fetus different from adults? |
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Definition
- Increased blood flow
- lower pH
- protein binding lower affinity - bigger rxn to protein bound drugs
- Underdeveloped hepatic fxn |
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Term
| How do drugs transfer across the placenta? |
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Definition
- Lipophilic - more likely to cross
- Unionized - more likely to cross. Acids unionized at pKa > 7.4, bases at pKa < 7.4
- MW < 600 likely to cross
- Low protein binding will cross
**Does not cross: Placental binding drugs. |
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Term
| What are the FDA categories for teratogenic risk? |
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Definition
- A - No risk to the fetus in first 3 months or later. Colace, prenatal vitamins, tylenol
- B - Safe in animals, no evidence of harm in humans.
- C - May have been risk in animals, risk cannot be ruled out. Assess benefits
- D - Clear evidence of risk, may have benefits in a serious condition (PTU)
- X - Contraindicated, risk outweighs benefit. |
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Term
| What are problems with the FDA categories? |
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Definition
- Severity of AE not included
- Data not specified to be human or animal
- Does not specify trimester
- ** Increasing category does not equal increasing risk
- Doesn't help w/ clinical decisions
- Same category doesn't equal same risk |
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Term
| What are the proposed changes to FDA pregnancy labeling? |
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Definition
- Pregnancy exposure registry info: summary of reports
- Frequency of risk in general population
- Fetal risk summary
- Risk to mother or fetus
- Specific details |
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Term
| What analgesic is the drug of choice in pregnancy? What should be avoided? |
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Definition
- Yes - Tylenol and codeine
- No - ASA and NSAIDs chronically or after 26 weeks |
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Term
| What antibiotics are the drugs of choice in pregnancy? Which should be avoided? |
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Definition
- Yes - PCN, nitrofurantoin, erythromycin
- No - cephalosporins, tetracyclines, aminoglycosides, fluoroquinolones |
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Term
| What is the drug of choice in anticoagulation for pregnancy? |
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Definition
- Heparin only
- Warfarin - Category X |
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Term
| What is the caution w/ anticonvulsants in pregnancy? |
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Definition
| Cause neuronal tube defects, especially valproic acid. Prophylaxis with Vit K and folic acid. |
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Term
| What are the drugs of choice for HTN in pregnancy? |
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Definition
- yes - methyldopa, beta blockers (not atenolol), nifedipine
- No - AceI and ARBs |
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Term
| How much caffeine can be consumed while pregnant? |
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Definition
| LEss than 2 cups/day is regarded as safe |
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Term
| Can Accutane be used for acne in pregnancy? |
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Definition
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Term
| What can be used to treat high cholesterol in pregnancy? |
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Definition
Only bile acid sequestrants
Statins are Category X |
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Term
| What drugs are category X? |
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Definition
Hormonal drugs - Anastrazole, Clomid, 5alpha reductase inhibitors, estrogen, OCs, progesterone, Evista
- MTX
- Statins
- Phentermine
- Warfarin
- Topamax
- Temazepam |
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Term
| What drugs for CHD are Category D? |
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Definition
AceI, ARBs, atenolol
Amiodarone
Dipyridamole/ASA
NSAIDs |
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Term
| What drugs for seizures are category D? |
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Definition
Most antiepileptics:
BZDs (except temazepam is X)
Carbamazepine
Divalproex
Phenobarb.
Phenytoin |
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Term
| What drugs for mood are Category D? |
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Definition
Lithium
Paroxetine
SSRIs in general - judge patient |
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Term
| What other drugs are Category D? |
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Definition
Azathioprine
Efavirenz, emtricitabine, and tenofovir
Tamoxifen
Tetracyclines
PTU - but drug of choice in hyperthyroidism. |
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Term
| What factors are considered when looking at lactation? |
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Definition
- Used in pediatric population?
- Drug < 100 MW will cross
- acids w/ pKa > 7 will cross, bases w/ pKa < 7 will cross.
- High protein bound --> decreased concentration in milk
- Lipophilic - will cross
- Long t1/2 - constant exposure. |
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Term
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Definition
In the last week of luteal phase, MILD mood disturbances and physical symptoms that resolve w/ onset of menses
- Physical - bloating, pain, HA, breast tenderness
- AT LEAST ONE somatic mood symptom |
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Term
| What is Premenstrual Dysphoric Disorder (PMDD)? |
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Definition
- worse than PMS, may continue into menses. Must have a symptom free period.
- At least 5 somatic symptoms w/ one core symptom of markedly depressed mood, marked anxiety, marked affective lability, marked anger.
- Confirmed after monitoring 2 cycles |
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Term
| What are symptoms of PMS/PMDD related to? |
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Definition
- Reduced allopregnanolone levels - modulates GABA
- RAAS system. Estrogen induces angiotensin --> bloating and tenderness. |
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Term
| What nonpharmacologic Tx is recommended for PMS |
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Definition
- Reduce caffeine, sodium, and sugar intake
- Increase complex CHO |
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Term
| What supplements can be used for PMS/PMDD? |
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Definition
- Calcium (1200 mg/day) - improves mood, bloating, pain
- B6 (50-100 mg/day) - mood and pain
- Mg (360 mg/day) - Mood and edema. GI upset
- Vit E (400 IU/day) - mood and pain
** other natural supplements not recommended. Gingko, St. John's wort, and chasteberry may be beneficial. |
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Term
| How are SSRIs used for PMDD? |
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Definition
First line therapy - response in first cycle. Can use continuous or intermittent dosing.
**Do not help fatigue
- Fluoxetine/Sarafem - 10-20 mg/day
- Paroxetine/Paxil CR -12.5-25 mg/day
- Sertraline/Zoloft - 25-150 mg/day |
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Term
| What OC is indicated for PMDD? |
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Definition
| - Yaz (NOT YASMIN) - 20 mcg EE/3 mg drospirenone. Must monitor drosp. |
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Term
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Definition
Cramps/pelvic pain with or prior to menses.
- Primary - normal pelvic anatomy. Prostaglandins = inflammatory response, contractions, pain
- Secondary - Underlying pathology. Endometriosis, infection, polyps |
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Term
| What is first line Tx for dysmenorrhea? |
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Definition
Topical heat q12h/exercise/low fat diet
THEN
Scheduled NSAIDs starting day prior to menses: Ibuprofen 800 mg po TID or Naproxen 250 mg q6-8 h. |
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Term
| What is 2nd and 3rd line for dysmenorrhea if NSAIDs do not work? |
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Definition
- OCs - reduce endometrial growth: Monophasic EE < 35 mcg w/ norgestrel or levonorgestrel
THEN
Depo-MPA or levonorgestrel IUD --> Inhibits growth of endometrium and reduces menstrual flow. |
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Term
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Definition
A Symptom, not a diagnosis.
- Primary - has never started period
- Secondary - Absence for 3 cycles. Why? Pregnancy, low BMI, uterine disorders |
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Term
| What is the pathophys of amenorrhea? |
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Definition
- Hypothalamus - eating disorder, excessive exercise
- Pituitary - thyroid disease, DA drugs. Hyperprolactinemia - Tx w/ DA agonist
- Ovaries - do not respond to FSH/LH
- Uterus/Vagina
**Progestin induces bleeding --> estrogen/progestin therapy |
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Term
| What causes anovulatory bleeding? |
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Definition
Most common cause: PCOS
OTher: Hyperprolactinemia, hypothalamic amenorrhea, thyroid disease |
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Term
|
Definition
- Failure of predictable ovulation
- Infertility
- Hyperandrogenism - acne, hair growth
- Ovarian abnormalities
- Mood disorder
- Metabolism issues - DM2, lipids |
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Term
|
Definition
- If amenorrhea: oral MPA 10mg x10 days, THEN --> OC ~30 mg EE w/ low androgenic progestin
- Glucose intolerance: Metformin up to 2,000 mg/day
- Androgenic Sx: Usually cured by OCs. May use spironolactone 50-100 mg BID after 6 months. Do not use w/ drospirenone.
- Pregnancy desired: Control weight, clomid |
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Term
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Definition
| Heavy menstrual blood loss >80 mL/cycle. Due to miscarriage, uterine fibroids, bleeding disorders |
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Term
| How is Menorrhagia treated? |
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Definition
- Contraception desired: Levonorgestrel IUD or COCs
- NSAIDs during cycle: Mefenamic acid, Naproxen, or Ibuprofen
- If NSAIDs don't work: Lysteda 1300 mg q8h for 4-7 days per cycle |
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