Medications in Pregnancy and Lactation
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Questions and Answers

Which antidiabetic drug is considered the drug of choice during pregnancy?

  • Glargine
  • Sulphonylurea
  • Metformin
  • Insulin (correct)

What is the recommended analgesic for use during pregnancy?

  • Paracetamol (correct)
  • Aspirin
  • Ibuprofen
  • Naproxen

Which of the following medications should be avoided during pregnancy due to the risk of neonatal hypoglycemia?

  • Insulin
  • Sulphonylurea (correct)
  • Metformin
  • Levothyroxine

Which vitamin should be avoided in excessive amounts during pregnancy due to its teratogenic effects?

<p>Vitamin A (C)</p> Signup and view all the answers

What is a safer choice of anti-infective agent during pregnancy?

<p>Amoxicillin (B)</p> Signup and view all the answers

Which vitamin has increased requirements during lactation?

<p>Vitamin B2 (B)</p> Signup and view all the answers

What dietary component is important for improving iron absorption in pregnant women?

<p>Vitamin C (B)</p> Signup and view all the answers

Which of the following immunizing agents is recommended for women planning a pregnancy?

<p>Rubella (D)</p> Signup and view all the answers

Which type of laxative is recommended as a first-line treatment for constipation during pregnancy?

<p>Bulk-forming laxatives (B)</p> Signup and view all the answers

What is the recommended management for nausea and vomiting in early pregnancy?

<p>Vitamin B6 combined with Doxylamine (C)</p> Signup and view all the answers

Which medication is considered the analgesic of choice for headache and back pain in pregnancy?

<p>Paracetamol (C)</p> Signup and view all the answers

Which of the following is NOT recommended during pregnancy for managing common cold symptoms?

<p>Combination drugs (B)</p> Signup and view all the answers

What is an important precaution for mothers on antiepileptic therapy during pregnancy?

<p>Single antiepileptic therapy is preferred (D)</p> Signup and view all the answers

Why is folic acid supplementation important during pregnancy?

<p>To prevent neural tube defects (D)</p> Signup and view all the answers

Which of the following laxatives may be considered if a stimulant effect is necessary during pregnancy?

<p>Magnesium salts (C)</p> Signup and view all the answers

What should be avoided to reduce the risk of worsening hemorrhoids during pregnancy?

<p>Straining at stool (A)</p> Signup and view all the answers

What is the concentration of caffeine in breast milk compared to the total dose taken by the mother?

<p>1% (C)</p> Signup and view all the answers

What potential risk is associated with the use of chloramphenicol while breast-feeding?

<p>Bone marrow suppression (B)</p> Signup and view all the answers

Which medication should be avoided in pregnant women receiving magnesium sulfate therapy?

<p>Nifedipine (B)</p> Signup and view all the answers

Which substance is likely to cause sedation in breast-fed infants?

<p>Diazepam (B)</p> Signup and view all the answers

Which substance is known to suppress thyroid function in infants when taken by a nursing mother?

<p>Propylthiouracil (C)</p> Signup and view all the answers

What is a significant risk associated with the use of angiotensin converting enzyme inhibitors during pregnancy?

<p>Fetal hypocephalic head (B)</p> Signup and view all the answers

Which drug is known to cause fetal bradycardia and slow development when used during pregnancy?

<p>Propranolol (A)</p> Signup and view all the answers

What effect do high doses of oral contraceptives have during breast-feeding?

<p>Suppresses lactation (D)</p> Signup and view all the answers

What are the potential effects of chronic use of barbiturates during pregnancy?

<p>Neonatal dependence (B)</p> Signup and view all the answers

What is the status of iodine (radioactive) in relation to breast milk?

<p>Sufficient quantities may cause thyroid suppression (C)</p> Signup and view all the answers

What impact did thalidomide have on infants born between 1959 and 1962?

<p>It led to severe malformations (C)</p> Signup and view all the answers

Which of the following drugs has been indicated to cause congenital goiter?

<p>Propylthiouracil (A)</p> Signup and view all the answers

Which of the following is contraindicated during breast-feeding?

<p>Heroin (B)</p> Signup and view all the answers

Which drug is safe for breast-feeding in most cases?

<p>Codeine (C)</p> Signup and view all the answers

What is a known effect of smoking during pregnancy on fetal development?

<p>Fetal hypoxia caused by carbon monoxide (C)</p> Signup and view all the answers

What is a known effect of smoking during pregnancy on the infant?

<p>Intrauterine growth retardation (D)</p> Signup and view all the answers

Which of the following is a common drug that may cause significant effects in breastfed infants?

<p>Metronidazole (A)</p> Signup and view all the answers

At what point in gestation does the risk of yellow-brown discoloration of teeth due to tetracycline use become apparent?

<p>After 17 weeks (D)</p> Signup and view all the answers

What potential health issue can be caused by the use of tetracycline during pregnancy?

<p>Discoloration of teeth (C)</p> Signup and view all the answers

Which medication is recommended as a first-line treatment for high blood pressure during pregnancy?

<p>Labetalol (D)</p> Signup and view all the answers

What long-term effect can smoking have on children exposed during pregnancy?

<p>Addiction to nicotine (A)</p> Signup and view all the answers

What is a characteristic of Labetalol as a medication?

<p>Causes vasodilation (D)</p> Signup and view all the answers

Which effect is associated with nicotine exposure to fetuses during pregnancy?

<p>Reduced motor movements (B)</p> Signup and view all the answers

Which type of medications are generally safe for controlling high blood pressure in pregnant women?

<p>Antihypertensives (D)</p> Signup and view all the answers

What does teratogenicity refer to?

<p>The ability to cause birth defects in the fetus. (D)</p> Signup and view all the answers

What category of drugs has been shown to be safe for use during pregnancy in the first trimester?

<p>Category A (D)</p> Signup and view all the answers

Which category of drugs shows positive evidence of human fetal risk?

<p>Category D (A)</p> Signup and view all the answers

Which drug is classified as Category X due to its teratogenic risk?

<p>Thalidomide (D)</p> Signup and view all the answers

What is the main concern regarding drugs in Category C?

<p>They should be used only when the benefits outweigh potential risks. (D)</p> Signup and view all the answers

What was the primary reason for thalidomide's controversial use during pregnancy?

<p>It was initially considered safe until proven otherwise. (A)</p> Signup and view all the answers

What distinguishes mutagenicity from teratogenicity?

<p>Mutagenicity involves changes in the genetic materials of reproductive cells. (C)</p> Signup and view all the answers

Which statement is true regarding Category B drugs?

<p>They have animal studies showing no harm to the fetus. (D)</p> Signup and view all the answers

Flashcards

Pregnancy Epilepsy Drugs

Lamotrigine and levetiracetam are generally considered safer options for epilepsy management during pregnancy.

High Dose Folic Acid in Epilepsy

High-dose folic acid supplementation isn't currently recommended in women with epilepsy during pregnancy; further research is needed.

Diabetes in Pregnancy

Maintaining good blood sugar control is vital for both mother and baby during pregnancy, and insulin is often a safer choice for control.

Diabetes Medication Considerations

Metformin has a very low risk associated with birth defects or complications, making it suitable before, during, and even while breastfeeding.

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Anti-infective Avoidances

Avoid using co-trimoxazole, tetracyclines, griseofulvin, itraconazole or ketoconazole during pregnancy.

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Pregnancy Analgesic Choices

Paracetamol is the preferred choice for pain relief and NSAIDs in topical forms are suitable during pregnancy; avoid long-term use of NSAIDs and COX-2 inhibitors.

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Lactation Vitamin Needs

Lactating women have an increased need for certain vitamins (folate, B vitamins, C) and should try to avoid excessive amounts.

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Pregnancy Diet Focus

A balanced diet with increased calories, including iron-rich foods (red meat), calcium/vitamin D (dairy), and folate-rich foods (green vegetables), is essential for a healthy pregnancy.

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Gastro-esophageal reflux in pregnancy

Heartburn during pregnancy. Antacids with low sodium and aluminum are often recommended.

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Constipation in pregnancy

Increased fiber, hydration, and exercise are key prevention strategies. Bulk-forming laxatives are initially recommended.

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Nausea/vomiting in pregnancy

Typically starts before 9 weeks and often subsides by the second trimester. Vitamin B6 is a first-line treatment.

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Hemorrhoids in pregnancy

May worsen during pregnancy. Avoid straining. Topical astringents are often recommended.

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Common cold treatment during pregnancy

Avoid drugs; they are not curative. Topical decongestants are preferred, like phenylephrine, oxymetazoline, or tramazoline. Saline drops are also recommended.

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Pain relief during pregnancy (headache/back pain)

Paracetamol is usually recommended for pain management.

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Epilepsy medications in pregnancy

Anti-epileptic drugs (AEDs) may increase risk of birth defects. Single-drug therapy preferred, folic acid supplementation crucial during planning and pregnancy.

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Folic Acid Supplementation during pregnancy

400 micrograms (mcg) of folic acid (vitamin B9) is advised before and throughout pregnancy. Prevents potential birth defects in the baby's brain, spinal cord, and autistic traits.

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Teratogenicity

The ability of chemicals or drugs to cause birth defects in a developing fetus after the zygote stage.

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Mutagenesis vs. Teratogenicity

Mutagenesis alters genetic material in sperm or eggs, causing future generations to be affected. Teratogenicity affects the developing fetus directly, causing birth defects.

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Pregnancy Drug Category A

Drugs in this category are considered safe for use during pregnancy, with minimal risk to the developing fetus.

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Pregnancy Drug Category B

Animal studies show no harm, but human studies are limited. Risk to the fetus is possible, but not confirmed.

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Pregnancy Drug Category C

Animal studies show potential harm, and human studies are lacking. Use only when benefits outweigh risks.

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Pregnancy Drug Category D

Evidence of harmful effects on the fetus exists. Use only when the benefit outweighs the risk and no safer options are available.

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Pregnancy Drug Category X

Definite risk of birth defects, contraindicated in pregnancy. Never used for pregnant women.

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Thalidomide

A drug used to treat morning sickness that caused severe birth defects. Highlighting the importance of thorough testing.

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Thalidomide Teratogenicity

Thalidomide, a drug used to treat morning sickness, caused severe birth defects in thousands of babies. The case highlighted the importance of thorough testing for teratogenic effects.

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Differential Sensitivity in Teratogenicity

Different species can have different sensitivities to teratogenic agents. This makes it a challenge to predict the effects of a drug on humans based solely on animal testing.

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Smoking's Impact During Pregnancy

Smoking during pregnancy can lead to fetal hypoxia, reduced birth weight, and long-term health problems for the child due to decreased oxygen delivery.

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Fetal Addiction to Drugs

Fetal exposure to addictive drugs like nicotine and cocaine can lead to the fetus developing a dependence on these drugs.

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Tetracycline Discoloration

Exposure to tetracycline during pregnancy can cause teeth to become discolored. This is particularly risky during later stages when deciduous teeth start calcifying.

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Methyldopa for High Blood Pressure

Methyldopa is often the first-line treatment for high blood pressure in pregnant women. It is safe and has been well-studied for this purpose.

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Labetalol for High Blood Pressure

Labetalol is another safe and effective medication for high blood pressure in pregnant women. It works by dilating blood vessels.

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Nifedipine in Pregnancy

Nifedipine, a calcium channel blocker, is NOT recommended for pregnant women receiving magnesium sulfate therapy for high blood pressure.

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Hydralazine for Pregnancy Hypertension

Hydralazine helps control high blood pressure during pregnancy. It can be taken orally or intravenously, even as an injection for severe cases.

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Avoid These Drugs During Pregnancy

ACE inhibitors (e.g., captopril, lisinopril) are associated with birth defects in babies. Diuretics like furosemide and hydrochlorothiazide are also unsafe.

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Propranolol's Effects on Pregnancy

Propranolol is a drug that should be avoided during pregnancy. It may cause birth defects like slow heartbeat, delayed development, and low blood sugar in the baby.

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Barbiturates During Pregnancy

Long-term barbiturate use during pregnancy can lead to drug dependence in newborns.

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Phenytoin's Pregnancy Risks

Phenytoin, an anti-epileptic drug, can lead to 'fetal hydantoin syndrome' with a range of birth defects.

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Streptomycin's Pregnancy Risks

Using streptomycin during pregnancy can damage the baby's inner ear, leading to hearing problems.

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Tetracycline During Pregnancy

Tetracycline can harm the baby's teeth and bones, causing discoloration and growth problems.

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Caffeine in Breast Milk

Caffeine passes into breast milk, but in very small amounts (about 1% of the mother's dose). This means it's generally safe for breastfeeding mothers to consume caffeine in moderation.

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Chloramphenicol and Breastfeeding

Chloramphenicol should be avoided while breastfeeding. While it doesn't cause 'gray baby syndrome', it can suppress bone marrow in infants.

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Diazepam and Breastfeeding

Diazepam (Valium) can cause sedation in breastfed infants. It can accumulate in newborns, so it's best avoided while breastfeeding.

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Iodine (Radioactive) and Breastfeeding

Radioactive iodine enters breast milk and can suppress the infant's thyroid function. It's essential to avoid breastfeeding if exposed to radioactive iodine.

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Drugs Contraindicated During Breastfeeding

Certain drugs are strongly discouraged during breastfeeding because they can have harmful effects on the infant. These include androgens, MAO inhibitors, heroin, lithium, phencyclidine, cocaine, cyclosporine, ergotamine, bromocriptine, and high-dose pyridoxine.

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Drugs That May Suppress Lactation

Some medications can reduce milk production. These include androgens, MAO inhibitors, ergot derivatives, bromocriptine, thiazide diuretics, levodopa, and high-dose pyridoxine.

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Propylthiouracil and Breastfeeding

Propylthiouracil can suppress the infant's thyroid function. It's generally advised to avoid breastfeeding while taking this medication.

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Oral Contraceptives and Breastfeeding

Oral contraceptives, especially in high doses, can suppress lactation. Lower-dose options may be considered, but it's best to discuss with a doctor.

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Study Notes

Drugs Used in Pregnancy and Lactation

  • Drugs are categorized based on potential side effects on the fetus
  • Different categories (A, B, C, D, X) exist

Gastroesophageal Reflux

  • Antacids with low sodium and no aluminum may be recommended
  • Omeprazole (take once daily), use with caution

Constipation

  • Increase fiber intake, stay hydrated, and exercise
  • Bulk-forming laxatives (e.g., ispaghula) are first-line treatment
  • Osmotic laxatives (e.g., lactulose, sorbitol) may be considered
  • Stimulant laxatives (e.g., magnesium salts) if needed

Nausea and Vomiting

  • Usually begins before 9 weeks of pregnancy
  • Often resolves by the second trimester (14 weeks)
  • Vitamin B6 is recommended as first-line treatment
  • Adding doxylamine (first-generation antihistamine) with B6 may reduce symptoms by 70%

Hemorrhoids

  • May worsen during pregnancy
  • Avoid straining at stool
  • Use topical anesthetics and corticosteroids cautiously
  • Astringents are preferred

Common Cold

  • Avoid use of drugs, generally not curative
  • Prefer topical decongestants (phenylephrine, oxymetazoline, or tramazoline)
  • Systemic administration is less preferred in pregnancy and breastfeeding
  • Use saline drops

Headache and Back Pain

  • Common complaints during pregnancy
  • Paracetamol is the analgesic of choice

Epilepsy in Pregnancy

  • Anti-epileptics may increase risk of congenital malformations (neural tube defects)
  • Dose adjustments are needed throughout pregnancy
  • Single anti-epileptic drug is preferred over multiple
  • Folic acid supplementation is recommended during planning and throughout the pregnancy
  • Neonatal hemorrhage is a risk after birth, counteracted by vitamin K injection
  • Mother compliance is crucial

Folic Acid

  • 400 micrograms (mcg) of folic acid (vitamin B9) before and during pregnancy can reduce birth defects
  • Lamotrigine and levetiracetam are relatively safer choices for women with epilepsy

Diabetes

  • Blood glucose control is crucial during pregnancy
  • Insulin is the preferred drug during pregnancy
  • Sulfonylureas are relatively contraindicated due to neonatal hypoglycemia risk
  • Metformin poses low risk of birth defects; safe for both before and during pregnancy, and while breastfeeding

Anti-Infective Agents

  • Avoid co-trimoxazole, tetracyclines, griseofulvin, and ketoconazole
  • Amoxicillin and erythromycin are recommended

Analgesics

  • NSAIDs may delay labor onset and increase duration if taken in the third trimester, topical formulations preferred
  • Paracetamol favored

Vitamins

  • Increased vitamin and mineral requirements (folate, B2, B6, B12, C) during lactation
  • Avoid megadose regimens

Immunization and Pregnancy

  • Limit immunizing agents during pregnancy
  • Consider tetanus toxoids (for accidents) and influenza vaccines based on case
  • Rubella vaccination of women planning pregnancy should be promoted

Diet and Pregnancy

  • Pregnant women need a healthy, balanced diet with increased calorie intake
  • Include foods high in calcium, vitamin D, iron, and folate
  • Avoid excessive vitamin A intake
  • Iron rich foods, vitamin C supplementation (citrus fruit) for better absorption

Mutagenesis vs. Teratogenicity

  • Mutagenesis is the ability of chemicals to alter the genetic material of egg or sperm by changing the nucleus
  • Teratogenicity is the ability of chemicals to cause birth defects in the fetus after zygote formation

Drug Categorization

  • Based on potential side effects on the fetus
  • Category A: considered safe (e.g., some thyroid hormones)
  • Category B: animal studies don't show harm; controlled studies in pregnant women lacking or inadequate
  • Category C.: Animal studies showing potential teratogenic effects or human studies lacking
  • Category D: Positive evidence of human fetal risk, but may be acceptable in life-threatening situations or severe diseases
  • Category X: Studies show definite human fetal teratogenic risk; contraindicated for pregnant women

Thalidomide

  • Famous example of teratogenic effects in humans: birth defects related to the administration of thalidomide to pregnant women
  • Considered safe in testing, used to treat nausea, tension, and sleep issues
  • German pediatrician (W. Lenz) and Australian physician identified thalidomide's teratogenic effects
  • Approximately 8000 infants affected between 1959 and 1962

Smoking During Pregnancy

  • Children whose mothers smoked exhibited developmental delays and lower birth weights
  • Smoking impacts the fetus due to fetal hypoxia, intrauterine growth retardation, decreased fetal heart rate, and increased blood viscosity

Long-Term Effects of Smoking in Children

  • Nicotine and cocaine are addictive, impacting developing fetuses
  • Constriction of blood vessels and reduced oxygen delivery affecting the fetus, increasing the risk of pneumonia and bronchitis

Tetracyclines

  • May cause yellow-brown discoloration of teeth if used in late pregnancy, when deciduous teeth are calcifying
  • Oxytetracycline and doxycycline have a lower incidence of tooth staining

Medications for High Blood Pressure During Pregnancy

  • Methyldopa: a first-line oral medication for hypertension; can be given intravenously in sever cases
  • Labetalol: another first-line oral medication that causes vasodilation; can also be administered intravenously
  • Nifedipine: a calcium channel blocker, use with caution in relation to magnesium sulfate treatment
  • Hydralazine: oral or intravenous use for controlling hypertension in pregnancy (may be injected in severe cases)

Antihypertensives to Avoid During Pregnancy

  • ACE inhibitors: associated with birth defects (fetal hypocephalic head, renal defects, anuria)
  • Diuretics (furosemide, hydrochlorothiazide): should be avoided during pregnancy
  • Propranolol: associated with birth defects like fetal bradycardia, slowed development, and neonatal hypoglycemia.

Drugs with Adverse Effects on the Fetus

  • Specific drugs and their impact on fetus during pregnancy trimester

Common Drugs Excreted in Breast Milk

  • Effects and comments on some common drugs impacting infant through breast milk intake

Drugs Contraindicated During Breastfeeding

  • List of drugs to avoid during breastfeeding; drugs that may suppress lactation

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Description

This quiz covers essential information about medications and treatments for various conditions during pregnancy and lactation. It includes drug classifications, effective treatments for nausea, constipation, and more, while emphasizing safety for both mother and baby. Test your knowledge on managing common pregnancy-related health issues.

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