Nausea and Vomiting in Pregnancy - Medicine Question Bank

Contents

1 Risk factors for nausea and vomiting of pregnancy are all except
2 Pathogenesis of NVP involves all except
3 Hyperemesis gravidarum (HG) can cause all of the pathological changes except
4 Biomarkers for HG are all except
5 The newly introduced resurgent therapy Diclegis for for nausea and vomiting in pregnancy is a combination of
6 Which of the following antiemetic is a pregnancy C category drug
7 In shorts

Risk factors for nausea and vomiting of pregnancy are all except

A. History of migraine headaches
B. Helicobacter pylori (H. pylori) infection
C. Corpus luteum present in the right ovary
D. Smoking before pregnancy

ANSWER

Ans. D. Smoking before pregnancy
Smoking before pregnancy and vitamin use before and/or in early pregnancy are associated with a decreased risk for NVP. Maternal alcohol consumption prior to conception has also been found to be protective for nausea and vomiting of pregnancy.

Pathogenesis of NVP involves all except

A. Excess of chorionic gonadotropin or higher biological activity of hCG
B. Ovarian hormones, estrogen and progesterone
C. Thyroid-stimulating hormone
D. Placental prostaglandin E2

ANSWER

Ans. C. Thyroid-stimulating hormone
Hormones including thyroid-stimulating hormone, growth hormone, prolactin, adrenocortical-stimulating hormone, cortisol, luteinizing hormone, and follicle-stimulating hormone have also been evaluated and are not considered to contribute to the pathogenesis of NVP. Thyroid stimulating hormone levels may be low in HG due to cross-reaction between the alpha-subunit of HCG with the TSH receptor.

Hyperemesis gravidarum (HG) can cause all of the pathological changes except

A. Subendocardial hemorrhage
B. Fatty infiltration of liver with necrosis
C. Pneumomediastinum
D. Fatty change in the cells of first convoluted tubule

ANSWER

Ans. B. Fatty infiltration of liver with necrosis.
Lipid deposition occurs with small droplets (microvesicular) and without any necrosis.

Biomarkers for HG are all except

A. Ketonuria
B. High TWBC
C. Low urinary chloride
D. Hemodilution

ANSWER

And. D. Hemodilution
There is hemoconcentration leading to rise in hemoglobin percentage, RBC count and hematocrit values. There is slight increase in the white cell count with increase in eosinophils.

The newly introduced resurgent therapy Diclegis for for nausea and vomiting in pregnancy is a combination of

A. 10 mg doxylamine succinate and 10 mg pyridoxine HCl
B. 10 mg metoclopramide in combination with pyroxamine
C. 8mg Zofran with 10 mg pyridoxine HCl
D. 15 mg Mirtazapine with 10 mg metoclopramide

ANSWER

Ans. A. 10 mg doxylamine succinate and 10 mg pyridoxine HCl
Diclegis is the only FDA-approved medication of nausea and vomiting of pregnancy and is rated as category A for pregnancy. Doxylamine succinate is an antihistamine (H1 blocker), which is responsible for the drug’s sedative and anti-emetic effects.

Which of the following antiemetic is a pregnancy C category drug

A. Metoclopramide
B. Promethazine
C. Ondansetron
D. Doxylamine

ANSWER

Ans. B. Promethazine
Promethazine has multiple mechanisms of actions including weak central nervous system blockade of dopamine and serotonin receptors, muscarinic-blocking effects as well as strong, long-lasting antihistamine action. Promethazine has been shown to cross the placental barrier and be expressed in breast milk. It is considered to be a category C drug due to potential neurologic effects on the fetus

In shorts

Clonidine, a centrally acting alpha-agonist, is commonly utilized as an antihypertensive agent; however, it has also been referenced in treatment of patients with refractory hyperemesis gravidarum.

Metoclopramide is supplied with a “black box” warning of possible irreversible tardive dyskinesia and is absolutely contraindicated in patients who are taking other medications with possible extrapyramidal effects. It is currently rated as pregnancy category B agent.

Zofran does not promote gastrointestinal motility and is therefore an agent of choice in cases of emesis and diarrheal symptoms. It is not recommended in cases of nausea where gastroparesis or ileus may be a concern.

Mirtazapine has been found to be specifically beneficial in cases of hyperemesis gravidarum compounded by a psychiatric diagnosis such as depression

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Risk factors for nausea and vomiting of pregnancy are all except

Pathogenesis of NVP involves all except

Hyperemesis gravidarum (HG) can cause all of the pathological changes except

Biomarkers for HG are all except

The newly introduced resurgent therapy Diclegis for for nausea and vomiting in pregnancy is a combination of

Which of the following antiemetic is a pregnancy C category drug

In shorts

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