Pregnant and Breastfeeding Ch. 25

26. In managing the pregnant patient, avoiding elective dental treatment is best until the third trimester.

ANS: False The second trimester is the preferred time for dental treatment. REF: p. 300

28. Aspirin is generally considered to be the best analgesic to administer during pregnancy.

ANS: False Aspirin can cause a variety of birth defects involving many organs. Acetaminophen is generally considered safe in pregnancy. REF: p. 302

27. Although opioids appear in breast milk when analgesic doses are administered, the small amounts appear have an insignificant effect on the nursing infant.

ANS: True Although large doses used by opioid addicts can cause adverse effects on the nursing infant, small analgesic doses appear to be safe. REF: p. 302

30. The wives of dental personnel who are exposed to trace amounts of nitrous oxide in the workplace have a higher incidence of spontaneous abortion.

ANS: True Continued exposure to small amounts of nitrous oxide by a man or woman can adversely affect the progress of a subsequent pregnancy. REF: p. 305

29. All NSAIDs carry a warning to avoid use during pregnancy.

ANS: True Studies in animals have not shown adverse effects on the fetus for ibuprofen and naproxen. Diflunisal (category C), but not naproxen (category B), has been shown to be teratogenic in rabbits in large doses. REF: p. 302

18. Which of the following tetracyclines is(are) contraindicated in pregnancy? (1) tetracycline, (2) minocycline, (3) doxycycline a. 1, 2, 3 b. 1, 2 c. 2, 3 d. 1, 3 e. 1 only

ANS: a All tetracyclines are contraindicated during pregnancy because of the potential for adversely affecting the fetus. They cross the placenta and are deposited in fetal teeth and bones. Deciduous teeth may become stained, and fetal bone growth inhibited. REF: p. 305

11. Which of the following is the NSAID of choice for the nursing mother? a. Ibuprofen b. Naproxen c. Diflunisal d. Ketoprofen

ANS: a Ibuprofen is the NSAID of choice for the nursing mother. All NSAIDs carry a warning to avoid use during pregnancy. REF: p. 302

21. Which of the following statements is true of the use of nystatin in either a pregnant woman or a nursing infant? a. Nystatin may be used by either the pregnant woman or nursing infant. b. Nystatin may be used by a pregnant woman, but not by a nursing infant. c. Nystatin may be used by a nursing infant, but not by a pregnant woman. d. Nystatin is not to be used by either a pregnant woman or a nursing infant.

ANS: a Nystatin is safe to use during pregnancy to treat oral Candida infections. It is not absorbed into the systemic circulation when taken orally or applied topically. It also may be used by either the pregnant woman or the nursing infant to treat thrush. REF: p. 305

15. The following agents have been demonstrated to produce skeletal abnormalities in the fetus except one. Which one is the exception? a. Doxycycline b. Erythromycin estolate c. Warfarin d. Aspirin

ANS: b Correct: Erythromycin estolate is not teratogenic. Incorrect choices: Doxycycline can inhibit fetal bone growth, warfarin can cause chondrodysplasia and hypoplastic nasal bridge, and aspirin can cause birth defects involving the skeleton. REF: pp. 303, 305

1. Which of the following statements is true regarding management of the pregnant dental patient? a. Avoid elective dental treatment except in the third trimester. b. Oral prophylaxis is best performed during the second trimester. c. The patient should be positioned in the Trendelenburg position during the last trimester. d. Both a and b are true. e. Both b and c are true.

ANS: b Correct: Perform oral prophylaxis before pregnancy or during the second trimester; monitor for periodontal conditions. Incorrect choices: Avoid elective dental treatment except in the second trimester. Position the patient in a recumbent position in the last trimester with the right hip elevated. REF: pp. 299-300

8. Which of the following adverse effects is associated with smoking? a. Neonatal dependence b. Intrauterine growth retardation, sudden infant death syndrome c. Abnormal development patterns, neonatal withdrawal syndrome d. Increased spontaneous abortion, premature labor, abnormal development, decreased school performance

ANS: b Correct: Smoking is associated with intrauterine growth retardation and sudden infant death syndrome. Incorrect choices: Heroin is associated with neonatal dependence. Amphetamines are associated with abnormal development patterns and neonatal withdrawal syndrome. Cocaine is associated with increased spontaneous abortion, premature labor, abnormal development, and decreased school performance. REF: p. 301

24. Use of which of the following agents during pregnancy is associated with "floppy infant syndrome?" a. Naproxen b. Diazepam c. Nystatin d. Warfarin

ANS: b Correct: Use of benzodiazepines during pregnancy has produced "floppy infant syndrome." Incorrect choices: Naproxen, nystatin, and warfarin do not cause "floppy infant syndrome." REF: pp. 305-306

6. A drug for which animal studies have failed to demonstrate a risk to the fetus and in which no adequate studies in pregnant women have been found would fall into which U.S. Food and Drug Administration (FDA) pregnancy risk category? a. Category A b. Category B c. Category C d. Category D e. Category X

ANS: b For category A, adequate studies have been performed in humans and animals without demonstrating fetal risk. REF: pp. 300, 302

9. Which of the following local anesthetics would be the best choice for dental application in the pregnant patient? a. Prilocaine b. Lidocaine c. Bupivacaine d. Mepivacaine

ANS: b Lidocaine is the local anesthetic of first choice for the pregnant woman because it is a category B drug and is not associated with methemoglobinemia, as is prilocaine. Incorrect choices: Unlike lidocaine and prilocaine, bupivacaine and mepivacaine are pregnancy category C. REF: p. 301

12. Which of the following opioids has been associated with teratogenicity? a. Morphine b. Codeine c. Lomotil d. Methadone

ANS: b Retrospective studies have associated the use of codeine during the first trimester with fetal abnormalities involving the respiratory, gastrointestinal, cardiac, and circulatory systems and with inguinal hernia and cleft lip and palate. REF: p. 302

4. The pregnant dental patient is most comfortable during which period? a. First trimester b. Second trimester c. Third trimester d. None of the above

ANS: b The second trimester is a good time to administer prophylaxis and any necessary dental treatment because the patient is beyond the morning sickness stages that might be experienced during the first trimester and is still comfortable reclining in the dentist's chair for a moderate duration. REF: p. 300

16. Erythromycin is concentrated in breast milk. A nursing mother should be given erythromycin only if the breast milk is expressed and discarded during treatment and 48 hours after the last dose. a. Both statements are true. b. Both statements are false. c. The first statement is true, the second is false. d. The first statement is false, the second is true.

ANS: c Although erythromycin is concentrated in the breast milk, it has not been documented to produce problems. REF: p. 305

23. Benzodiazepines are indicated for the treatment of __________ during pregnancy. a. Anxiety b. Restless leg syndrome c. Status epilepticus d. Both a and b e. Both b and c

ANS: c Benzodiazepines are only indicated for the treatment of status epilepticus during pregnancy. No dental use has been established. REF: p. 306

19. Which of the following antiinfective agents should be used for dental infections during pregnancy for susceptible anaerobic infections not sensitive to penicillin? a. Amoxicillin b. Cephalosporins c. Clindamycin d. Metronidazole

ANS: c Clindamycin should be used for dental infections during pregnancy for susceptible anaerobic infections not sensitive to penicillin. It also is indicated for prophylaxis of endocarditis in penicillin-allergic patients. No adverse fetal problems have been reported. REF: p. 305

2. The following measures should be taken when prescribing drugs to a pregnant woman, except one. Which one is the exception? a. No unnecessary drugs should be administered. b. An adequate health history should be taken at each appointment. c. Schedule morning appointments during the first trimester. d. Closely coordinate with the patient's obstetrician.

ANS: c Correct: Because of potential morning sickness during the first trimester, scheduling appointments in the afternoon is preferred during this period. Incorrect choices: The other options are all prudent measures to be followed with the pregnant dental patient. REF: p. 300

17. Which antiinfective agent is least teratogenic? a. Clarithromycin b. Doxycycline c. Cephalexin d. Metronidazole

ANS: c Correct: First- and second-generation cephalosporins have not been associated with teratogenicity (category B). Incorrect choices: Clarithromycin is category C. Doxycycline is category D. Although metronidazole is category B, it has been shown in animals to produce birth defects. REF: pp. 303, 305

20. Metronidazole: a. Should only be used during the second trimester of pregnancy b. Is expressly contraindicated for the nursing mother c. Has been shown to produce birth defects in animals d. Both a and b e. Both b and c

ANS: c Correct: Metronidazole has been shown to produce birth defects in animals. Incorrect choices: Metronidazole should be used carefully during the first trimester. The nursing mother should be given metronidazole only if breast milk is expressed and discarded during treatment and for 48 hours after the last dose. REF: p. 305

5. Proving that a drug is teratogenic is difficult because: a. Drugs are uniformly teratogenic. b. The timing of the drug exposure is consistent for each drug. c. One drug can produce a variety of abnormalities, and different drugs can produce the same abnormality. d. Different animal species and human are uniformly consistent in their responses to drugs.

ANS: c Correct: One drug can produce a variety of abnormalities, and different drugs can produce the same abnormality. Incorrect choices: Teratogenic drugs are not uniformly so. Timing of the drug exposure varies with each drug. Different animal species and humans vary among themselves in their responses to drugs. REF: p. 300

7. Epinephrine is an FDA category __________ drug. a. A b. B c. C d. D e. X

ANS: c Epinephrine is an FDA category C drug. For these drugs, animal studies have shown an adverse effect on the fetus, and studies in humans have been adequate or no studies are available in either animals or women. Potential benefits may warrant its use. REF: p. 302

25. Which of the following statements is true concerning fetal alcohol syndrome (FAS)? a. FAS involves growth retardation, central nervous system (CNS) abnormalities, and flat maxillary area or a thin lip. b. Infants born to mothers who drank throughout pregnancy show more tremors, hypertonia, restlessness, crying, and abnormal reflexes compared with control groups after birth. c. The safe alcohol threshold for the pregnant woman is 2 ounces of alcohol or 24 ounces of beer a day. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: FAS involves growth retardation, CNS abnormalities, and flat maxillary area or a thin lip. Infants born to mothers who drank throughout pregnancy show more tremors, hypertonia, restlessness, crying, and abnormal reflexes compared with control groups after birth. Incorrect choices: Pregnant dental patients should be encouraged to abstain from the ingestion of alcohol. No safe threshold level is known for the pregnant woman. REF: p. 307

22. Use of which of the following agents during pregnancy is associated with producing an abnormal number of digits in the newborn? a. Alcohol b. Codeine c. Erythromycin d. Ketoconazole

ANS: d Correct: Ketoconazole has been shown to be teratogenic in rats, causing syndactyly and oligodactyly, an abnormal number of digits. Incorrect choices: Alcohol, codeine, and erythromycin are not commonly known to produce an abnormal number of digits in the newborn. REF: pp. 304-305

13. Which of the following statements is true concerning the effect of opioids such as codeine on an infant after administration to the mother? a. Opioids appear in breast milk when analgesic doses are administered. b. If the mother is addicted, the infant will experience withdrawal symptoms after birth. c. The infant should be observed for signs of euphoria. d. Both a and b are true. e. Both b and c are true.

ANS: d Correct: Opioids appear in breast milk when analgesic doses are administered. The small doses appear to be insignificant. If the mother is addicted, the infant will experience withdrawal symptoms after birth. Incorrect choices: The infant should be observed for signs of sedation and constipation. REF: p. 302

10. Which of the following agents can cause premature closure of the patent ductus arteriosus? a. Acetaminophen b. Clindamycin c. Triazolam d. Ibuprofen

ANS: d Nonsteroidal antiinflammatory drugs (NSAIDs) can cause premature closure of the ductus arteriosus. The other choices do not produce this activity. REF: p. 302

14. Which of the following antiinfective agents is regarded as safe to use during pregnancy? a. Doxycycline b. Azithromycin c. Minocycline d. Amoxicillin

ANS: d The consensus is that amoxicillin is safe to use during pregnancy. Using amoxicillin for a dental infection that is not controlled by local measures would be acceptable. REF: pp. 303, 305

3. What are potential consequences of administering a drug to a pregnant woman? a. Teratogenicity to the fetus b. Spontaneous abortion c. Delayed and long-term physiologic and psychologic consequences d. Adverse reactions in the near-term fetus e. All of the above

ANS: e All of the other answers cover the generally accepted concerns regarding drug administration to a pregnant woman. Spontaneous abortion could occur on early exposure to a toxic agent, followed by teratogenicity, especially if the drug is present while the organs are forming, followed by adverse reactions to the fully formed fetus. Finally, exposure to a drug in utero may lead to adverse consequences that do not emerge until later in life. REF: p. 300