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WorksheetsPregnancy IDM 8 Review
Total questions: 52
Worksheet time: 30mins
22 – 26 weeks
31 – 36 weeks
27 – 40 weeks
Early term
Full term
Late term
Post-term
When iron deficiency anemia is diagnosed during pregnancy, what would be the most appropriate management in a patient with mild illness? (Select all that apply)
Parenteral iron
Oral iron supplementation
Admission to hospital
Increase iron in diet
Leading cause of newborn meningitis
Causes sepsis in the mother
Leads to increased risk for immunization resistance
Risk for pharyngitis in newborn
If GBS is detected upon screening during the third trimester, what should be done?
Nothing, it is a self-limiting infection
Treat the baby with vancomycin
Administer intrapartum ampicillin IV (if not allergic to penicillin)
Give oral amoxicillin/clavulonate (Augmentin) to the mother immediately before birth
Should abruptly discontinue all caffeine products
Can have up to 2 cups (8oz) of caffeinated coffee/day
There is no limit on caffeine intake during pregnancy
The only safe form of caffeine is tea or chocolate
How much iron should be supplemented during pregnancy to account for increased blood volume (thus requirement for more Hgb to deliver oxygen to the baby)?
27 mg elemental iron daily
400 mcg elemental iron daily
1000 mg elemental iron daily
600 IU elemental iron daily
Select all true statements about alcohol use in pregnancy from below:
It is a teratogen at ALL fetal development stages
It can lead to fetal alcohol syndrome which may cause intellectual disability
It can cause low birthweight
One drink/day is an acceptable amount (just not more)
Can lead to macrosomia
A pregnant woman comes to the pharmacy to ask whether it would be safe to receive her influenza (it is flu season) and COVID-19 vaccines (not necessarily on the same day). What would be your response?
Yes, both are safe in pregnancy
Only influenza is safe during pregnancy
Only COVID-19 vaccine is safe during pregnancy
Pregnant women should not receive any vaccinations other than Tdap during pregnancy
Third trimester
Pre-conception
First trimester
Second trimester
Must wait until after (contraindicated)
Select all correct statement(s) regarding COVID-19 and pregnancy
There is an increased risk of catching COVID-19 when pregnant
Vaccination reduces the risk of severe illness, and hospitalization
COVID-19 vaccines can increase the risk of infertility so should be avoided
There is an increased risk for severe illness with COVID-19 when pregnant
Which would be reasonable recommendations to provide to a pregnant woman experiencing self-treatable nausea?
Try diphenhydramine first, before any non-pharmacological treatment
Eat slowly and avoid food triggers (i.e. spicy or fatty foods)
Avoid having an empty stomach
Ginger can be helpful
Use a bulk-forming agent
Which pharmacological treatments for constipation are relatively safe in pregnancy?
Bulk forming agents (i.e. Metamucil)
Castor oil
Mineral oil
Saline laxative
Osmotic laxatives
Women often suffer with heartburn while pregnant, espeically as the baby grows larger. Which of the following are reasonable recommendations?
Try to have smaller, more frequent meals
Avoid eating close to bedtime and elevate head of bed when sleeping
Take sucralfate as needed if non-pharmacological methods fail
Take magnesium trisilicate as needed if non-pharmacological methods fail
Take sodium bicarbonate as needed if non-pharmacological methods fail
Which are appropriate to recommend to a pregnant woman experiencing a headache?
Ensure proper hydration
Apply hot or cold packs as needed
Can try ibuprofen if non-drug methods fail
Avoid acetaminophen (proven unsafe for pregnancy)
What advice would you give a pregnant woman who approaches the pharmacy counter complaining of signs and symptoms of a vaginal yeast infection?
Recommend a 7-day vaginal azole treatment
Recommend to call the physician prior to self-care
Recommend probiotics
Call doctor and ask for oral fluconazole
A pregnant woman’s urine test at the doctor’s office is positive for bacteria. She does not have any symptoms and has anaphylactic allergies to all beta-lactams. Select all of the most appropriate actions from below.
To treat any positive case, regardless of symptoms
Only treat symptomatic cases (likely contaminant)
If treat, ciprofloxacin is drug of choice due to allergy
Phenazypyridine is useful to prevent symptoms
If treat, fosfomycin is an appropriate option
Topical creams including those with cocoa butter and vitamin E may help
UVA/B sunscreens help prevent stretch marks
Sunscreens with UVA/B are the best prevention of stretch marks
Most will continue post-partum, so it is important to see a dermatologist for management
Which is/are a safe option(s) for women who experience insomnia during pregnancy?
Melatonin
Benzodiazepines such as temazepam
Doxylamine (Unisom)
Address good sleep hygiene
Non-benzodiazepines such as Ambien or Sonata
All pregnant women
Only pregnant women with a history of T1DM
Only pregnant women with a history of either T1 or T2DM
Only pregnant women with either a history of T1/T2DM and increased risk factors for hyperglycemia such as obesity
Insulin
Glyburide
Canagliflozin
Exenatide
Metformin
What is/are the consequence(s) of pre-eclampsia?
Progression to eclampsia --> seizures and/or death
End-organ damage --> hypertensive emergency
Increased risk of severe bleeding due to thrombocytopenia
Increased risk of gestational diabetes
Increased risk of excessive weight gain
Patients who have pre-eclampsia should be managed with which medication(s) during active labor (intrapartum)?
IV labetalol for BP management
IV magnesium sulfate for seizure prophylaxis
IV amoxicillin for prevention of meningitis
Insulin for management of associated hyperglycemia
Which of the following are suitable ways to manage a pregnant patient with seasonal allergies (after consulting with OB/GYN)?
Nasal steroids
Nasal strips (i.e. Breathe Right)
Nasal decongestants
Nasal saline
OTC antihistamine such as chlorpheniramine
Which antitussive(s) is/are considered relatively safe to recommend to patients who develop cold and cough symptoms (unrelated to allergies) while pregnant?
Guaifenesin
Phenergan with codeine syrup
Hydrocodone-homatropine syrup
Dextromethorphan (DM)
Which of the following is considered relatively safe and effective treatment for aches and pains when experiencing cold / flu symptoms while pregnant?
No analgesic is considered safe in pregnancy, therefore only non-pharmacological treatment is appropriate
Acetaminophen
NSAIDs
Magnesium sulfate
Select all of the correct recommendations to a pregnant patient asks for your help for management of diarrhea?
Call your physician, as you should not self-treat diarrhea while pregnant
Try the “BRAT” diet (bananas, rice, applesauce, toast) until you hear from your doctor
You can treat yourself with bismuth subsalicylate and if it does not help, call the doctor
It is safe to self-treat with loperamide, as it has the most data of all antidiarrheals in pregnancy
What are safe antihypertensive options for patients with chronic hypertension while pregnant (select all that apply)?
ACE inhibitors
Spironolactone
Methyldopa
Labetalol
Nifedipine ER
Which are important pre-conception considerations in patients with chronic diabetes mellitus?
Establish glycemic control (ideally <6.5%)
Address potentially harmful medications such as ACEI and statins
Baseline ophthalmology exam (increased risk for retinopathy)
Start low dose aspirin
Initiate insulin pre-pregnancy in T2DM
Women often experience post-partum “after pains” as the uterus returns to its normal size. What would be the safest and most efficacious recommendation, whether nursing or not?
NSAIDs +/- APAP
Opioids
Witch hazel pads
APAP alone
Women who are breastfeeding will often complain of nipple and/or breast pain. What is/are some general recommendation(s) to help the nursing mother?
Administer concentrated vitamin E on the nipple
Air dry nipples
Avoid cleansers for the nipples
Lanolin may be helpful (ensure safe product for babies)
Empiric doxycycline is usually prescribed (call your doctor)
Which treatment(s) is/are absolutely NOT recommended for post-partum women who have inadequate milk supply?
Metoclopramide
Domperidone
Fenugreek herbal products
Supplementation with formula for babies who develop newborn jaundice due to dehydration
If a pregnant woman tests positive for GBS, why do we wait until birth to administer antibiotics (why not right away?)
Infection will return if treat too soon
Antibiotics used (such as penicillin) are teratogenic
Can lead to penicillin allergy in newborn
Can cause seizures in mother
Why should pregnant women be conscious of excess weight gain during pregnancy?
Risk of unusually large baby (macrosomia)
Risk to mom of HTN or preeclampsia
Risk for C-section
Risk of postpartum weight issues and morbidity
What is the recommended regimen for folic acid related to pregnancy?
400 mcg (0.4 mg) PO daily, continue for at least 12 weeks
1000 mg PO daily, continue for at least 12 weeks
27 mg PO daily, continue for at least 12 weeks
220 mg PO daily, continue for at least 12 weeks
Which correctly matches the dose and reason for iodine supplementation in pregnant women?
400 mcg daily to prevent neural tube defects
1300 mg daily to strengthen baby's teeth and bones
27 mg daily to ensure adequate oxygen delivered to baby
220 mg daily to ensure mom's thyroid health (and healthy baby brain)
Why is it recommended that pregnant women supplement EPA/DHA during pregnancy?
Promotes visual and cognitive development
Body cannot convert adequate amounts from alpha-linoleic acid (ALA)
Promotes adequate weight gain in the baby
Prevents fetal goiter
When conducting the 5As with a pregnant woman, what would be good to mention when in the "ADVISE" stage?
Can cause lung and heart issues for yourself
Can increase risk of stillborn baby by 50%
Can have a chance of SIDS in newborn
May increase risk of behavioral or psychological issues for the child
Can increase risk that your water will break too soon
Which is considered first-line as an intervention for a pregnant woman who is ready to quit smoking on her own (smokes 1/2 pack (10 cigarettes) per day)
Behavioral counseling with continued monitoring
Start low dose pharmcotherapy with bupropion in 2nd TM
Start NRT
Start low dose varenicline in 1st TM
A pregnant woman at the pharmacy counter asks if she should get her Tdap, if she already had it during her last pregnancy (which was 2 years ago). What is the answer and why?
Yes, immunity is short-lived and you should get redosed each pregnancy
No, only if it has been 5 years, as it can be toxic
No, only once in a lifetime, otherwise can cause tetanus in the baby
Yes, the vaccine is annual (whether pregnant or not)
Which are true related to pharmacological management of heartburn while pregnant?
Mag-Al (magnesium hydroxide / aluminum hydroxide) is a safe option
Alka-Seltzer Heartburn Relief (sodium bicarbonate) is a safe option
Pepcid (famotidine) has more data than Prevacid (lansoprazole)
NEVER give Carafate (sulcralfate)
Gaviscon Regular Strength Original (aluminum hydroxide / magnesium triliscate) is a safe option
A patient's husband was sent to your pharmacy to pick up something OTC to manage her postpartum perineal tear. What could you recommend?
NSAIDs
Acetaminophen
Cold pack
Warm pack
Wtich hazel pads
What would be appropriate to recommend to manage mastitis (empirically)?
Dicloxacillin
Cephalexin
Trimethoprim/sulfamethoxazole (suspect MRSA / beta-lactam allergy)
Gentamicin
Select all of the correct statements from the list below regarding postpartum depression (PPD):
Can be confused with "baby blues" therefore should be properly diagnosed
Can start before birth and continue up to 4 weeks after
SSRIs and SNRIs should not be given to patients who are nursing
Newer agents include brexanolone (IV) and zuranolone (PO) which are neurosteroids
Psychotherapy is first-line treatment in patients who have mild-moderate PPD
