Pregnancy and lactation represent unique physiological states that profoundly alter medication pharmacokinetics, making drug therapy in this “special population” a significant challenge. Ensuring the safety of both the mother and child is paramount, a topic covered in depth in the Patient Care 5 and Principles of Drug Therapy Individualization curricula. This quiz will test your knowledge on the principles of placental and breast milk drug transfer, teratogenicity, and the clinical decision-making required for safe medication management during pregnancy and lactation.
1. Which of the following physiological changes occurs during pregnancy and can significantly increase the volume of distribution (Vd) for hydrophilic drugs?
- a. Decreased body fat
- b. Increased plasma volume
- c. Decreased cardiac output
- d. Increased protein binding
Answer: b. Increased plasma volume
2. The glomerular filtration rate (GFR) during the second and third trimesters of pregnancy typically:
- a. Decreases by 50%.
- b. Increases by up to 50%.
- c. Remains unchanged.
- d. Cannot be measured.
Answer: b. Increases by up to 50%.
3. An increased GFR during pregnancy may require what dosage adjustment for a renally cleared drug like cefazolin?
- a. A lower dose or extended interval.
- b. No change in dose.
- c. A higher dose or more frequent interval.
- d. Switching to an oral formulation.
Answer: c. A higher dose or more frequent interval.
4. A drug with which of the following properties is most likely to cross the placental barrier?
- a. High molecular weight, highly protein-bound, ionized.
- b. Low molecular weight, lipophilic, low protein binding.
- c. A large, hydrophilic molecule.
- d. A highly charged molecule.
Answer: b. Low molecular weight, lipophilic, low protein binding.
5. The most critical period for teratogenic exposure leading to major structural malformations is:
- a. The third trimester.
- b. The first trimester (weeks 3-8 of gestation).
- c. The second trimester.
- d. During labor and delivery.
Answer: b. The first trimester (weeks 3-8 of gestation).
6. The “Female Reproduction and Pregnancy” topic is a specific lecture in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. Which of the following medications is a known teratogen, absolutely contraindicated in pregnancy?
- a. Acetaminophen
- b. Penicillin
- c. Warfarin
- d. Ondansetron
Answer: c. Warfarin
8. The new Pregnancy and Lactation Labeling Rule (PLLR) replaced the old A, B, C, D, X categories with:
- a. A simple “safe” or “unsafe” rating.
- b. A narrative summary of risks, clinical considerations, and data.
- c. A numerical score from 1 to 5.
- d. A color-coded system.
Answer: b. A narrative summary of risks, clinical considerations, and data.
9. Which property would make a drug less likely to pass into breast milk?
- a. Low molecular weight
- b. High lipophilicity
- c. High maternal protein binding
- d. Weak base
Answer: c. High maternal protein binding
10. The Relative Infant Dose (RID) is a calculation used to estimate infant exposure to a drug via breast milk. A RID of less than what percentage is generally considered acceptable?
- a. 1%
- b. 5%
- c. 10%
- d. 25%
Answer: c. 10%
11. “Special Patient Populations” is a lecture topic within the Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
12. To minimize infant exposure to a medication while breastfeeding, a mother should be counseled to:
- a. Take the medication right before a feeding session.
- b. Take the medication immediately after a feeding session.
- c. Double the dose to clear it faster.
- d. Stop breastfeeding entirely for all medications.
Answer: b. Take the medication immediately after a feeding session.
13. Which of the following is a safe and appropriate choice for managing constipation during pregnancy?
- a. Castor oil
- b. Mineral oil
- c. Bulk-forming laxatives like psyllium.
- d. Stimulant laxatives like senna.
Answer: c. Bulk-forming laxatives like psyllium.
14. A key role of a pharmacist is to counsel women of childbearing potential on the importance of taking what supplement to prevent neural tube defects?
- a. Iron
- b. Calcium
- c. Folic acid
- d. Vitamin B12
Answer: c. Folic acid
15. Counseling patients on the appropriate use of medications is a key objective for student pharmacists.
- a. True
- b. False
Answer: a. True
16. Which of the following antihypertensive drug classes is contraindicated in the second and third trimesters of pregnancy?
- a. Beta-blockers
- b. ACE inhibitors and ARBs
- c. Calcium channel blockers
- d. Methyldopa
Answer: b. ACE inhibitors and ARBs
17. The management of women’s health is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. A decrease in serum albumin during pregnancy can lead to what change for a highly protein-bound drug?
- a. An increase in the free, active fraction of the drug.
- b. A decrease in the free, active fraction of the drug.
- c. No change in the free fraction.
- d. An increase in the total drug concentration.
Answer: a. An increase in the free, active fraction of the drug.
19. Which of the following is considered the first-line pharmacologic treatment for nausea and vomiting of pregnancy?
- a. Metoclopramide
- b. Ondansetron
- c. Doxylamine/Pyridoxine
- d. Promethazine
Answer: c. Doxylamine/Pyridoxine
20. An active learning session on women’s health is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A lactating mother needs pain relief. Which of the following is generally considered a safer option?
- a. Codeine
- b. Tramadol
- c. Ibuprofen
- d. Hydrocodone
Answer: c. Ibuprofen
22. Which of the following is a reliable, evidence-based resource for information on drugs in pregnancy and lactation?
- a. A social media parenting group.
- b. A general internet search.
- c. Briggs’ Drugs in Pregnancy and Lactation or LactMed database.
- d. The pharmacist’s own pregnancy experience.
Answer: c. Briggs’ Drugs in Pregnancy and Lactation or LactMed database.
23. The “Reproductive Self-Care” module is part of the Patient Care I course.
- a. True
- b. False
Answer: a. True
24. An active learning session on women’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A drug with a high milk-to-plasma (M/P) ratio means that:
- a. Very little of the drug passes into breast milk.
- b. The drug concentrates in breast milk.
- c. The drug is safe for breastfeeding.
- d. The drug has a short half-life.
Answer: b. The drug concentrates in breast milk.
26. Why is codeine generally avoided in breastfeeding mothers?
- a. It is not an effective analgesic.
- b. Some mothers who are ultra-rapid metabolizers of CYP2D6 can produce high, potentially toxic levels of morphine in their breast milk.
- c. It causes constipation in the mother.
- d. It has no potential for abuse.
Answer: b. Some mothers who are ultra-rapid metabolizers of CYP2D6 can produce high, potentially toxic levels of morphine in their breast milk.
27. The placenta contains drug-metabolizing enzymes and transporters, acting as a partial metabolic barrier.
- a. True
- b. False
Answer: a. True
28. An active learning session on women’s health is part of which course module?
- a. Module 3: Women’s Health
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 3: Women’s Health
29. A patient is taking valproic acid for seizures and is planning a pregnancy. The pharmacist should:
- a. Tell her to continue the medication as it is safe.
- b. Recognize that valproic acid is a known teratogen and ensure the patient discusses preconception planning with her neurologist.
- c. Recommend doubling the dose.
- d. Recommend she stop the medication immediately on her own.
Answer: b. Recognize that valproic acid is a known teratogen and ensure the patient discusses preconception planning with her neurologist.
30. The “Management of Women’s Health” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. Which property of a drug would be most likely to limit its transfer into breast milk?
- a. High lipophilicity
- b. Low molecular weight
- c. Weakly basic pKa
- d. High degree of ionization at plasma pH
Answer: d. High degree of ionization at plasma pH
32. The risk versus benefit assessment is a key part of pharmacotherapy decisions in pregnancy.
- a. True
- b. False
Answer: a. True
33. An infant whose mother is taking a CNS depressant while breastfeeding should be monitored for:
- a. Hyperactivity
- b. Sedation, poor feeding, and limpness.
- c. Jaundice
- d. A skin rash
Answer: b. Sedation, poor feeding, and limpness.
34. The safest option for managing a condition during pregnancy is to:
- a. Always use medication.
- b. Use the most effective non-pharmacologic option first, if appropriate.
- c. Use the newest drug available.
- d. Use multiple drugs at once.
Answer: b. Use the most effective non-pharmacologic option first, if appropriate.
35. A pregnant patient has a UTI. Which antibiotic would be an appropriate choice?
- a. Doxycycline
- b. Ciprofloxacin
- c. Cephalexin
- d. Trimethoprim (in the first trimester)
Answer: c. Cephalexin
36. The pharmacist’s role in managing therapy during pregnancy and lactation is to:
- a. Provide evidence-based information to both patients and providers.
- b. Assess the risks and benefits of therapy.
- c. Counsel on strategies to minimize infant exposure during lactation.
- d. All of the above.
Answer: d. All of the above.
37. Which of the following is generally considered safe to use during lactation?
- a. Lithium
- b. Amiodarone
- c. Metformin
- d. Chemotherapy agents
Answer: c. Metformin
38. The “Introduction to Women’s Health” lecture is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
39. A drug that is highly bound to plasma proteins will have a ____ concentration of free drug available to cross the placenta.
- a. higher
- b. lower
- c. unchanged
- d. The protein binding does not matter.
Answer: b. lower
40. An active learning session covering women’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The principle of using the lowest effective dose for the shortest possible duration is particularly important during pregnancy.
- a. True
- b. False
Answer: a. True
42. Which of the following is NOT a physiological change in pregnancy that affects pharmacokinetics?
- a. Increased GFR
- b. Increased plasma volume
- c. Decreased hepatic blood flow
- d. Delayed gastric emptying
Answer: c. Decreased hepatic blood flow
43. A pregnant patient with hypothyroidism will likely need:
- a. To stop her levothyroxine.
- b. A decrease in her levothyroxine dose.
- c. An increase in her levothyroxine dose.
- d. No change in her dose.
Answer: c. An increase in her levothyroxine dose.
44. What is the best advice for a patient planning a pregnancy?
- a. Stop all medications immediately.
- b. Review all current prescription, OTC, and herbal medications with a pharmacist and physician.
- c. Continue all medications as is.
- d. Wait until after the first trimester to review medications.
Answer: b. Review all current prescription, OTC, and herbal medications with a pharmacist and physician.
45. Which of the following best describes the new PLLR format?
- a. It provides a definitive “yes” or “no” answer about drug safety.
- b. It provides a narrative summary to help clinicians and patients make individualized risk-benefit decisions.
- c. It applies only to over-the-counter medications.
- d. It is identical to the old letter category system.
Answer: b. It provides a narrative summary to help clinicians and patients make individualized risk-benefit decisions.
46. A drug with a short half-life may be preferred during lactation because:
- a. It allows for more flexibility in timing the dose around breastfeeding sessions.
- b. It stays in the mother’s system longer.
- c. It is more potent.
- d. It has fewer side effects.
Answer: a. It allows for more flexibility in timing the dose around breastfeeding sessions.
47. “Special Patient Populations” is a lecture in the Principles of Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
48. An active learning session on women’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
49. The overall management of pharmacotherapy in pregnancy and lactation requires:
- a. A “one-size-fits-all” approach.
- b. Avoiding all medications.
- c. An individualized risk versus benefit assessment for every medication.
- d. Relying only on information from the drug manufacturer.
Answer: c. An individualized risk versus benefit assessment for every medication.
50. The ultimate goal of learning about medication use in pregnancy and lactation is to:
- a. Help patients achieve necessary therapeutic outcomes while minimizing risk to both the mother and the infant.
- b. Memorize a list of all teratogenic drugs.
- c. Pass the final exam.
- d. Be able to advise all women to stop breastfeeding if they need any medication.
Answer: a. Help patients achieve necessary therapeutic outcomes while minimizing risk to both the mother and the infant.