Drug use in Pregnancy
A pregnant woman has a bacterial vaginosis infection. Which of the following antibiotics are acceptable treatment options? (Select ALL that apply.)
A) Clindamycin oral C) Metronidazole oral
It is best to avoid all drugs, if possible, during this stage of pregnancy; in this stage of pregnancy the risk of severe birth defects is highest:
A) First trimester It is best to avoid all drugs if possible during 1st trimester (when organogenesis, or organ development occurs) and to use lifestyle recommendations first, to see if you can avoid the use of over-the-counter or prescription agents. If using OTC agents it is best to recommend only ACOG-first line recommendations; otherwise, have the patient consult with her OB-GYN.
Select the lifestyle changes that might help reduce constipation during pregnancy (and at other times as well): (Select ALL that apply.)
A) Increasing fiber in the diet. B) Adequate fluid intake. D) Physical activity can be helpful, using forms that are safe during pregnancy. E) Changing from white rice to brown rice, or from white bread to whole grain bread. Caffeine-containing drinks are not counted as positive fluid intake, but are neutral; although they do increase fluid intake, they cause mild diuresis.
A pharmacist will provide information on medical rounds for a patient who is pregnant and requires treatment for venous thromboembolism. Which of the following points is/are correct? (Select ALL that apply.)
A) Low molecular right heparin is the preferred treatment in pregnancy. Unfractionated heparin use is acceptable during the last month or if delivery appears imminent. Pneumatic compression is NOT a risk to the fetus, as the fetus is not located where the compression will occur. These devices can be used prior to delivery in women with thrombosis if they require a C-section. In this case, agents that increase bleeding risk are avoided. *Warfarin is pregnancy category X; contraindicated for use in any stage of pregnancy.*
Which of the following are acceptable treatment options for vaginal trichomoniasis during pregnancy? (Select ALL that apply.)
A) Metronidazole, oral 2 grams x 1 B) Metronidazole, oral 500 mg BID x 7 days Another option is metronidazole, oral 250 mg TID rather than 500 mg BID, either for 7 days duration. *If one day course can be used it is preferable*, but side effects from the larger dose need to be considered.
A pharmacist will provide information on treatment options for hyperthyroidism during pregnancy. (Select ALL that apply.)
A) Propylthiouracil is Pregnancy Category D and is used during the first trimester. C) Methimazole is Pregnancy Category D and is used after the first trimester. E) Both agents can cause serious liver damage. Propylthiouracil is used in the first trimester and if trying to conceive, although it is highly preferable to get rid of the hyperthyroidism first, since both drugs used are teratogenic, *in addition to causing much nausea, and are liver-toxic.*
A woman has been instructed by her physician to get a folic acid 1 mg tablet and to take one daily. She has looked on the pharmacy shelf and cannot locate this dose. She goes to ask the pharmacist who provides this information: (Select ALL that apply.)
A) She can purchase a 400 microgram dose over-the-counter. B) She can purchase an 800 microgram dose over-the-counter. C) Another name for folic acid is vitamin B9. D) One milligram is the same thing as 1000 micrograms. Prescription prenatal vitamins (PrimaCare ONE, Zenate, others) usually contain 1,000 mcg, or 1 mg, of folic acid. Some prescription products vary; others contain 800 mcg. There are now some 1 mg products available over-the-counter.
It is October and in the prime of influenza vaccine season. Kathleen McGee is pregnant (at week 30) and has gone to see her physician for a check-up. Choose the correct statements: (Select ALL that apply.)
A) She should receive the influenza shot now. C) She should receive the Tdap vaccine now. REMEMBER: Pregnant women cannot use live vaccines.
Beth Burack is in the third month of pregnancy. She has a condition that is usually treated with a Pregnancy Category X drug. Select the correct statement concerning Pregnancy Category X:
A) The drug is contraindicated in pregnancy, under all circumstances. Pregnancy Category X means that studies in animals or humans show fetal abnormalities; the use in pregnancy is contraindicated in all stages.
Jada Green is pregnant with her second child. She is in the pharmacy to pick up her prenatal vitamin prescription. The pharmacist asks Ms. Green if she is consuming adequate dairy products. She replies that she does not like to drink milk because it gives her an upset stomach. Select the correct statements: (Select ALL that apply.)
A) The prenatal vitamin contains about 200 milligrams of calcium; Ms. Green requires about five times this amount. B) If the mother does not consume adequate calcium, the child will build his or her skeleton by depleting the mothers. C) Ms. Green can purchase milk that contains the lactase enzyme, such as Lactaid, that should not cause stomach upset. D) Perhaps Ms. Green can get the additional calcium from calcium supplements; choose one that contains vitamin D.
What are preferred treatments for nausea, including morning sickness, during pregnancy? (Select ALL that apply.)
A) Vitamin B6 B) Pyridoxine Pyridoxine, which is vitamin B6, is considered first-line by ACOG, which can be given with a first-generation antihistamine.
Which organization sets most of the recommendations for drug use during pregnancy?
B) *ACOG* The American College of Obstetricians and Gynecologists (ACOG) sets the recommendations for the safe and effective use of medications for most female conditions, including pregnancy.
A pharmacist is consulted regarding acceptable treatment options for a pregnant woman with a chlamydia infection. (Select ALL that apply.)
B) Amoxil can be used as an alternative. C) Zithromax is also part of the preferred gonorrhea treatment regimen. E) Zithromax is a preferred agent. NOTE: Clarithromycin is not a safe macrolide for use in pregnancy. The preferred regimen for gonorrhea includes Azithromycin 1g x1 + Ceftriaxone 250 mg IM x1.
A pharmacist is asked questions regarding asthma medication use during pregnancy and in infants. Select the correct statements. (Select ALL that apply.)
B) Budesonide is the preferred medication for infants with asthma, in the Respules inhalation formulation. C) All pregnant women with asthma should have an albuterol inhaler. *Budesonide is the preferred steroid for use by the pregnant mother as well*; it comes as the *Pulmicort Flexhaler and as the Pulmicort Respules* (solution for use in a nebulizer).
What is the preferred treatment for heartburn during pregnancy?
B) Calcium Antacids, and in particular calcium, is first-line for heartburn (GERD, or reflux) in pregnancy. Chewable calcium, such as in Tums or store-brands, is the usual recommendation. Simethicone (Mylicon, Mylicon infant drops) can be recommended in pregnancy (and in infants) for gas; it is not for heartburn.
What is the preferred treatment for constipation during pregnancy?
B) Fiber, such as psyllium Fiber is first-line for constipation in pregnancy. If dietary fiber is adequate, that would be preferable, but often supplemental fiber is required.
Select the correct statements regarding treatment of hypothyroidism during pregnancy: (Select ALL that apply.)
B) Levothyroxine is the treatment of choice for hypothyroidism in pregnancy. C) Hypothyroidism is always treated in pregnancy, and the dose will need to be increased as the Vd increases. D) Levothyroxine is pregnancy category A. NOTE: Hypothyroidism in pregnancy is always tested for and treated if present.
A drug is categorized by the FDA as Pregnancy Category D. Select the correct definition for the meaning of Pregnancy Category D:
B) Positive evidence of fetal risk is available, but the benefits may outweigh the risk if life-threatening or serious disease. Use caution: some "D"s are more dangerous than other "D"s and it is not acceptable to take chances with the health of the baby unless there is no other option.
Select the lifestyle changes that might help reduce heartburn during pregnancy: (Select ALL that apply.)
B) Splitting large meals into smaller, more frequent meals. C) Avoiding foods that worsen the heartburn (often this is spicy/odorous foods, caffeine, mints, fatty foods). D) Not eating three hours prior to bedtime.
What is the preferred treatment for allergy symptoms (runny nose, itchy eyes) during pregnancy?
C) Chlor-Trimeton *Chlorpheniramine* (Chlor-Trimeton) is a first generation antihistamine, and is *preferred in pregnancy*. Other first-generation agents are used, such as diphenhydramine (Benadryl). Pharmacists generally recommend their own store's "brand" to save the patient money over brand-name products.
A pregnant woman at 38 weeks gestation has an E. coli UTI that is sensitive to amoxicillin, fosfomycin, sulfamethoxazole-trimethoprim and nitrofurantoin. She has no known drug allergies. Of the following antibiotics, which option is not preferred due to possible safety risks if other, safer options are available?
C) Sulfamethoxazole-trimethoprim - *Bactrim* Sulfamethoxazole-trimethoprim can cause hyperbilirubinemia and kernicterus when given near term. *Kernicterus is a bilirubin-induced brain dysfunction.*
Julia Bernadino is a 17 year-old female who enters the pharmacy to pick up her birth control pills. The pharmacist would provide a benefit by ensuring that Ms. Bernadino is receiving adequate intake of this B vitamin:
C) Vitamin B9 This is folic acid Folic acid, vitamin B9, is in many healthy foods, including fortified cereals (some of which are not healthy), dried beans, leafy green vegetables and orange juice. An OTC multivitamin that contains 400-800 mcg of folic acid can be recommended.
A pregnant female approaches the pharmacy counter with a bottle of ibuprofen. She informs the pharmacy intern that she has a headache from spending too many hours on a computer and that she has been told that ibuprofen is the safe to take during pregnancy, but not in the third trimester. What is a correct statement to tell this patient?
D) Acetaminophen, such as in Tylenol and store-brands, is safest in pregnancy and NSAIDs are not recommended in most cases. Acetaminophen is the analgesic/antipyretic drug of choice in pregnancy, and is pregnancy Category C. *NSAIDs (e.g. ibuprofen, naproxen) are pregnancy category C during the first and second trimester and are pregnancy category D* during the third trimester.
A pregnant woman has an infection that is sensitive to amoxicillin, cephalexin, azithromycin, erythromycin and clarithromycin. Of the above antibiotics, which is considered the *least safe in pregnancy*?
D) Clarithromycin Generally considered safe to use in pregnancy are penicillins (including amoxicillin and ampicillin (both Pregnancy Category B), cephalosporins, erythromycin and azithromycin, also both Pregnancy Category B. Clarithromycin, which is Pregnancy Category C, is not preferred.
A drug is categorized by the FDA as Pregnancy Category A. Select the correct definition for the meaning of Pregnancy Category A:
E) Controlled studies in animals and women have shown no risk in the first trimester, and possible fetal harm is remote.
It is common for women to get anemic during pregnancy and the iron in the prenatal vitamin or as a separate supplement can be important. What is the best way to get the highest amount of iron absorbed from a supplement?
E) Take the iron on an empty stomach.' While it is true that iron is absorbed better on an empty stomach, it is also accurate that many women are nauseated (most often in the morning) during pregnancy and taking an iron-containing vitamin usually worsens the nausea. *It may be useful to move the iron-containing prenatal vitamin to a time later in the day.*
