Drug Therapy in Pregnancy & Lactation
Self Assessment
Instructions
This self-assessment study guide has 2 questions, each written using learning objectives from your Principles of Drug Therapy in Pregnancy & Lactation lecture. Not all learning objectives are covered. Participation/scores are not monitored. FYI this program makes noise sometimes.
Symbols
A clipboard will bring up relevant patient information.
A lightbulb in the top right corner of a page indicates that the page contains answers or explanations.
Question 1
For each pair of drugs, select which is more likely to cross the placenta.
Question 1
MOLECULAR WEIGHT
SOLUBILITY
PROTEIN BINDING
CHARGE
Small (<500 Da) → more likely to cross placenta
Lipophilic → more likely to cross placenta
Non-ionized → more likely to cross placenta
Low protein binding → more likely to cross placenta
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Large → less likely to cross placenta
Water-soluble → less likely to cross placenta
Highly protein-bound → less likely to cross placenta
Ionized → less likely to cross placenta
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
The next two pages contain subjective and objective information about a patient. Read the information then answer the two questions that follow. While answering questions, click the clipboard to review the patient information at any time.
Question 2
Subjective
Patient is a 30-year-old female presenting for her first prenatal appointment. Pharmacy consulted for medication review and recommendations. Patient believes last menstrual period was around 8 weeks ago. She and spouse are excited and nervous about pregnancy. Experiencing nausea which has significantly worsened over the last week or so, causing her to miss work twice. Lasts 2-4 hours every day. Vomited on two separate occasions. Also seeking advice about anxiety. Says she was prescribed fluoxetine as a teenager, which was effective, but has been managing well without medication for several years. Is feeling anxious about pregnancy and is worried about becoming overwhelmed.
Past medical history
- Hypertension
- Hypothyroidism
- Generalized anxiety disorder
Medications
- Lisinopril 40 mg once daily
- Levothyroxine 137 mcg once daily
Question 2
Objective
Vital sign
Result
BP
HR
RR
Weight
Height
136/86 mmHg
84 bpm
16 bpm
84 kg
165 cm
BMI
30.9 kg/m2
Test
Result
Potassium
Creatinine
eGFR
Glucose
TSH
4.4 mmol/L
0.8 mg/dL
>90 mL/min/1.73 m2
85 mg/dL
5.5 mlU/L
Free T4
1.3 ng/dL
Reference
3.5 - 5.0
0.6 - 1.2
>60
70 - 100
0.4 - 4.5*
0.8 - 1.8
*TSH reference limit upper range during pregnancy is 2.5 mlU/L.
Question 2
Current medications - Lisinopril 40 mg once daily - Levothyroxine 137 mcg once daily
Question 2
Current medications - Lisinopril 40 mg once daily - Levothyroxine 137 mcg once daily
Question 2
Hypothyroidism
It is recommended to increase levothyroxine dose by 25% once pregnancy is confirmed. TSH should be checked every 4 to 6 weeks throughout pregnancy and dose should be titrated accordingly.
Hypertension
ACE inhibitors (lisinopril) and ARBs (losartan) are contraindicated during pregnancy. Labetalol and nifedipine are first line, and methyldopa is second line.
Nausea/vomitting
Patient seems to have moderate to severe nausea, for which vitamin B6 and/or antihistamines are first line. It wouldn’t hurt to recommend nonpharmacologic options such as ginger or acupuncture as well. Ondansetron is a 3rd line option and should not be recommended. Polyethylene glycol is a helpful option for constipation, but will not help the patient’s nausea/vomiting.
Anxiety
Since patient is not currently on medications for anxiety, behavioral therapy would be first line. However, if the benefits outweigh risks for this patient, starting an SSRI (besides paroxetine) would be appropriate.
THANK YOU!
Subjective 32-year-old female presenting for first prenatal visit Last menstrual period: ~8 weeks ago Nausea
- Significantly worsened over last week or so
- 2-4 hours every day
- 2 vomiting episodes
Anxiety
- Fluoxetine effective as teenager; has been managing well without medication for several years
- Patient concerned about increasing anxiety with pregnancy news
PMH: hypertension, hypothyroidism, GAD
Objective (select information)Labs/vitals all from today
- BP: 136/86 mmHg
- Weight: 84 kg
- BMI: 30.9 kg/m2
- K: 4.4 mmol/L
- SCr: 0.8 mg/dL
- TSH: 5.5 mlU/L (H)
- Free T4: 1.3 mg/dL
Subjective 32-year-old female presenting for first prenatal visit Last menstrual period: ~8 weeks ago Nausea
- Significantly worsened over last week or so
- 2-4 hours every day
- 2 vomiting episodes
Anxiety
- Fluoxetine effective as teenager; has been managing well without medication for several years
- Patient concerned about increasing anxiety with pregnancy news
PMH: hypertension, hypothyroidism, GAD
Objective (select information)Labs/vitals all from today
- BP: 136/86 mmHg
- Weight: 84 kg
- BMI: 30.9 kg/m2
- K: 4.4 mmol/L
- SCr: 0.8 mg/dL
- TSH: 5.5 mlU/L (H)
- Free T4: 1.3 mg/dL
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Transcript
Drug Therapy in Pregnancy & Lactation
Self Assessment
Instructions
This self-assessment study guide has 2 questions, each written using learning objectives from your Principles of Drug Therapy in Pregnancy & Lactation lecture. Not all learning objectives are covered. Participation/scores are not monitored. FYI this program makes noise sometimes.
Symbols
A clipboard will bring up relevant patient information.
A lightbulb in the top right corner of a page indicates that the page contains answers or explanations.
Question 1
For each pair of drugs, select which is more likely to cross the placenta.
Question 1
MOLECULAR WEIGHT
SOLUBILITY
PROTEIN BINDING
CHARGE
Small (<500 Da) → more likely to cross placenta
Lipophilic → more likely to cross placenta
Non-ionized → more likely to cross placenta
Low protein binding → more likely to cross placenta
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Large → less likely to cross placenta
Water-soluble → less likely to cross placenta
Highly protein-bound → less likely to cross placenta
Ionized → less likely to cross placenta
Title
Title
Title
Title
Write a brief description here
Write a brief description here
Write a brief description here
Write a brief description here
The next two pages contain subjective and objective information about a patient. Read the information then answer the two questions that follow. While answering questions, click the clipboard to review the patient information at any time.
Question 2
Subjective
Patient is a 30-year-old female presenting for her first prenatal appointment. Pharmacy consulted for medication review and recommendations. Patient believes last menstrual period was around 8 weeks ago. She and spouse are excited and nervous about pregnancy. Experiencing nausea which has significantly worsened over the last week or so, causing her to miss work twice. Lasts 2-4 hours every day. Vomited on two separate occasions. Also seeking advice about anxiety. Says she was prescribed fluoxetine as a teenager, which was effective, but has been managing well without medication for several years. Is feeling anxious about pregnancy and is worried about becoming overwhelmed.
Past medical history
Medications
Question 2
Objective
Vital sign
Result
BP
HR
RR
Weight
Height
136/86 mmHg
84 bpm
16 bpm
84 kg
165 cm
BMI
30.9 kg/m2
Test
Result
Potassium
Creatinine
eGFR
Glucose
TSH
4.4 mmol/L
0.8 mg/dL
>90 mL/min/1.73 m2
85 mg/dL
5.5 mlU/L
Free T4
1.3 ng/dL
Reference
3.5 - 5.0
0.6 - 1.2
>60
70 - 100
0.4 - 4.5*
0.8 - 1.8
*TSH reference limit upper range during pregnancy is 2.5 mlU/L.
Question 2
Current medications - Lisinopril 40 mg once daily - Levothyroxine 137 mcg once daily
Question 2
Current medications - Lisinopril 40 mg once daily - Levothyroxine 137 mcg once daily
Question 2
Hypothyroidism
It is recommended to increase levothyroxine dose by 25% once pregnancy is confirmed. TSH should be checked every 4 to 6 weeks throughout pregnancy and dose should be titrated accordingly.
Hypertension
ACE inhibitors (lisinopril) and ARBs (losartan) are contraindicated during pregnancy. Labetalol and nifedipine are first line, and methyldopa is second line.
Nausea/vomitting
Patient seems to have moderate to severe nausea, for which vitamin B6 and/or antihistamines are first line. It wouldn’t hurt to recommend nonpharmacologic options such as ginger or acupuncture as well. Ondansetron is a 3rd line option and should not be recommended. Polyethylene glycol is a helpful option for constipation, but will not help the patient’s nausea/vomiting.
Anxiety
Since patient is not currently on medications for anxiety, behavioral therapy would be first line. However, if the benefits outweigh risks for this patient, starting an SSRI (besides paroxetine) would be appropriate.
THANK YOU!
Subjective 32-year-old female presenting for first prenatal visit Last menstrual period: ~8 weeks ago Nausea
- Significantly worsened over last week or so
- 2-4 hours every day
- 2 vomiting episodes
Anxiety- Patient concerned about increasing anxiety with pregnancy news
PMH: hypertension, hypothyroidism, GADObjective (select information)Labs/vitals all from today
Subjective 32-year-old female presenting for first prenatal visit Last menstrual period: ~8 weeks ago Nausea
- Significantly worsened over last week or so
- 2-4 hours every day
- 2 vomiting episodes
Anxiety- Patient concerned about increasing anxiety with pregnancy news
PMH: hypertension, hypothyroidism, GADObjective (select information)Labs/vitals all from today