PMH-C Exam Medications Exam Questions And
Answers Graded A+ 2025/2026
positive stress response - -normal and essential part of healthy development
-brief increases in heart rate and mild elevations in hormone levels
-e.g. vaccines, new caregiver
tolerable stress response - -activates the body's alert systems
-if time-limited and buffered by relationships with adults, the brain and other organs
recover
-from more severe, longer-lasting difficulties
-e.g. loss of a loved one, natural disaster, frightening injury
toxic stress response - -prolonged activation of stress response systems can disrupt the
development of brain architecture and other organ systems and can increase risk for
enduring stress-related disease
-from strong, frequent, and/or prolonged adversity
-e.g. physical or emotional abuse or neglect
fetal programming - -Through the mother's biochemistry, the fetus "learns" what to
expect regarding resources, pathogens, etc., and develops accordingly.
-Experiences in the womb (e.g. maternal nutrition, stress) influence which genes are
turned on or off, and therefore how brains and bodies develop.
The fetus is well protected from toxic effects of everyday maternal stress because: - -
Maternal hypothalamic pituitary adrenal (HPA) axis has reduced baseline activity and
reduced responsiveness.
-a placental enzyme (11BHSD2*) inactivates some circulating maternal glucorticoids.
With severe, prolonged maternal distress... - -Maternal cortisol level can overwhelm
placental defenses.
-This increases methylation at promoter regions of fetal genes that affect glucorticoid
receptors.
-The child's stress response system can become hypersensitive.
-There is an increased risk of preterm birth.
indirect effects of untreated perinatal depressive symptoms (parent) - -greater use of
alcohol, cigarettes, and illicit addictive substances
-less healthy nutrition
-higher BMI
-less participation in prenatal care
-reduced length of breastfeeding
indirect effects of untreated perinatal depressive symptoms (child) - -increased
activation of the flight or fight response in babies
, -infants and children may struggle to learn new tasks and demonstrate more anxiety
and fear in aversive situations
-long term effects in children (inc. more emotional/behavioral problems, reduced
cognitive functioning, exaggerated neurophysiologic and emotional responses to stress)
potential concerns re: medication use in pregnancy - -congenital malformations (birth
defects)
-pregnancy loss (miscarriage, stillbirth)
-excessive bleeding
-gestational hypertension and/or pre-eclampsia
-gestational diabetes
-preterm delivery
-low birth weight
-neonatal side effects (Neonatal Adaptation Syndrome)
-neonatal persistent pulmonary hypertension
-long term neurobehavioral effects
-autism
risks of medication in first trimester - physical teratogenicity (congenital abnormalities)
risks of medication in second trimester - behavioral teratogenicity (enduring changes in
learning, attention, behavior, cognition)
risks of medication in third trimester - -physiologic development (e.g. pulmonary)
-effects on growth
-effects on labor timing
-neonatal side effects
FDA pregnancy risk categories - -5 categories: A, B, C, D, X
-mislead healthcare providers to believe that risk increases by category (it DOESN'T)
-based mainly on animal data
-drugs were "demoted" the more they were studied in humans
-categories abolished on 6/30/15
-instead: FDA phasing in risk summaries and clinical considerations
previous labeling: 8.1 Pregnancy. new labeling: - 8.1 Pregnancy (includes Labor and
Delivery)
previous labeling: 8.2 Labor and Delivery. new labeling: - 8.1 Pregnancy (includes Labor
and Delivery)
previous labeling: 8.3 Nursing Mothers. new labeling: - 8.2 Lactation (includes Nursing
Mothers)
[no previous labeling]. new labeling: - 8.3 Females and Males of Reproductive Potential
Answers Graded A+ 2025/2026
positive stress response - -normal and essential part of healthy development
-brief increases in heart rate and mild elevations in hormone levels
-e.g. vaccines, new caregiver
tolerable stress response - -activates the body's alert systems
-if time-limited and buffered by relationships with adults, the brain and other organs
recover
-from more severe, longer-lasting difficulties
-e.g. loss of a loved one, natural disaster, frightening injury
toxic stress response - -prolonged activation of stress response systems can disrupt the
development of brain architecture and other organ systems and can increase risk for
enduring stress-related disease
-from strong, frequent, and/or prolonged adversity
-e.g. physical or emotional abuse or neglect
fetal programming - -Through the mother's biochemistry, the fetus "learns" what to
expect regarding resources, pathogens, etc., and develops accordingly.
-Experiences in the womb (e.g. maternal nutrition, stress) influence which genes are
turned on or off, and therefore how brains and bodies develop.
The fetus is well protected from toxic effects of everyday maternal stress because: - -
Maternal hypothalamic pituitary adrenal (HPA) axis has reduced baseline activity and
reduced responsiveness.
-a placental enzyme (11BHSD2*) inactivates some circulating maternal glucorticoids.
With severe, prolonged maternal distress... - -Maternal cortisol level can overwhelm
placental defenses.
-This increases methylation at promoter regions of fetal genes that affect glucorticoid
receptors.
-The child's stress response system can become hypersensitive.
-There is an increased risk of preterm birth.
indirect effects of untreated perinatal depressive symptoms (parent) - -greater use of
alcohol, cigarettes, and illicit addictive substances
-less healthy nutrition
-higher BMI
-less participation in prenatal care
-reduced length of breastfeeding
indirect effects of untreated perinatal depressive symptoms (child) - -increased
activation of the flight or fight response in babies
, -infants and children may struggle to learn new tasks and demonstrate more anxiety
and fear in aversive situations
-long term effects in children (inc. more emotional/behavioral problems, reduced
cognitive functioning, exaggerated neurophysiologic and emotional responses to stress)
potential concerns re: medication use in pregnancy - -congenital malformations (birth
defects)
-pregnancy loss (miscarriage, stillbirth)
-excessive bleeding
-gestational hypertension and/or pre-eclampsia
-gestational diabetes
-preterm delivery
-low birth weight
-neonatal side effects (Neonatal Adaptation Syndrome)
-neonatal persistent pulmonary hypertension
-long term neurobehavioral effects
-autism
risks of medication in first trimester - physical teratogenicity (congenital abnormalities)
risks of medication in second trimester - behavioral teratogenicity (enduring changes in
learning, attention, behavior, cognition)
risks of medication in third trimester - -physiologic development (e.g. pulmonary)
-effects on growth
-effects on labor timing
-neonatal side effects
FDA pregnancy risk categories - -5 categories: A, B, C, D, X
-mislead healthcare providers to believe that risk increases by category (it DOESN'T)
-based mainly on animal data
-drugs were "demoted" the more they were studied in humans
-categories abolished on 6/30/15
-instead: FDA phasing in risk summaries and clinical considerations
previous labeling: 8.1 Pregnancy. new labeling: - 8.1 Pregnancy (includes Labor and
Delivery)
previous labeling: 8.2 Labor and Delivery. new labeling: - 8.1 Pregnancy (includes Labor
and Delivery)
previous labeling: 8.3 Nursing Mothers. new labeling: - 8.2 Lactation (includes Nursing
Mothers)
[no previous labeling]. new labeling: - 8.3 Females and Males of Reproductive Potential
