Drug Use In Pregnancy And Lactation

Front 1

Medication related factors that elevate the level of drug transfer

Back 1

High lipophilicity,
Low ionization,
Low maternal protein binding,
Low molecular weight....
The opposite of these would have trouble passing placenta

Front 2

Agents that exhibit teratogencity effects in 2nd and 3rd trimesters

Back 2

Tetracycline and NSAIDs

Front 3

Some known tertogens during organogenesis include:

Back 3

Chemotherapy agents, certain sex hormones, lithium (may be better than CBZ or others), warfarin, antiepileptic agents, thalidomide, retinoids

Front 4

How much folic acid is recommended for women during pregnancy? How about for a woman with a previous pregnancy complicated y neural tube defect?

Back 4

400 mcg/day; 4 mg/day for previous complication

Front 5

Whats the window of opportunity to start folic acid?

Back 5

Neural tube closes within the first four weeks of pregnancy

Front 6

What are nicotine patchesranked in pregnancy

Back 6

Nicotine by itself is less of a threat than smoking

Front 7

How should constipation be treated in pregnancy?

Back 7

First approach is diet hydration and exercise. Fiber, stool softeners, MoM, Mag cit, lactulose, PEG, and sorbitol can be considered..
Castor Oil and Mineral Oil should be avoided

Front 8

GERD treatments in pregnancy

Back 8

–non-pharmacological interventions
include small, frequent meals, caffeine reduction, no bedtime meals, elevation of the head of the bed. Most of the common calcium, aluminum, or magnesium oral antacids, sucralfate, ranitidine and cimetidine are considered safe. Sodium bicarbonate should be avoided. Metoclopramide has been used in pregnancy. Less is known about lansoprazole and omeprazole.

Front 9

Hemorrhoid treatment in pregnancy

Back 9

Topical anesthetics, asatringents, fiber, fluids, sitz baths

Front 10

N/V treatment in pregnancy

Back 10

smaller, frequent meals and
accupressure may be helpful. Antihistamines
(e.g. doxylamine), vitamins (pyridoxine),
phenothiazines, metoclopramide, ondansetron,
and ginger have been used.

Front 11

Gestational Diabetes treatment

Back 11

Nutrition, exercise, insulin is drug of choice; glyburide may be consideredl metfomin may also be reasonabe alternative

Front 12

Hypertension Treatment in pregnancy drugs

Back 12

Methyldopa, labetolol, CCB; ACE-I should be avoided due to renal toxicities

Front 13

Migraine/HA treatment in pregnancy

Back 13

APAP, NSAIDs (avoid at term), caffeine; Narcotics (narcotic analgesics are considered safe) and benzos are not indicated (can only be used if absolutely necessary)

Front 14

What BB can be used as preventative therapy for migraine in pregnancy?

Back 14

Propranolol

Front 15

Can ASA and indomethacin be used for migraine treatment in pregnancy?

Back 15

No; they're potent prostaglandin inhibitors (associatied with premature closure of ductus arteriosis)

Front 16

Can sumatriptan, ergotamine, dihydroergotamine be used for migraine treatment in pregnancy

Back 16

Sumatriptan is controversial for migraine abortive therapy; ergotamine and dihydroergotamine should be avoided

Front 17

What Abx are C/I in Pregnancy

Back 17

Fluoroquinolones and tetracyclines

Front 18

When is nitrofurantoin used in pregnancy

Back 18

Not in late pregnanc; should not be used after 37 weeks in patients with glucose 6 phosphate dehydrogenase deficiency due to concern about hemolytic anemia in the newborn

Front 19

What can sulfa containing drugs cause if given at term?

Back 19

Kernicterus

Front 20

When should trimethoprim be avoided in pregnancy?

Back 20

It's a folate antagonist and should be avoided in first trimester

Front 21

Treatment of Chlamydia?

Back 21

Azithromycin 1 g or Amoxicillin 500 mg TID x7 days

Erythromycin base or ethylsuccinate is an alternative treatment.

Front 22

Why should erythromycin estolate be avoided in pregnancy?

Back 22

Due to potential for hepatotoxicity

Front 23

Women with primary outbreak during pregnancy should be treated with?

Back 23

Acyclovir

Front 24

Women with first episode infection of genital herpes or outbreak at the time of delivery should..

Back 24

Have a cesarean section

Front 25

What are the most effective treatments for allergic rhinitis in pregnancy?

Back 25

Beclomethasone, budesonide

Front 26

First line antihistamines for pregnancy?

Back 26

Chlorpheniramine and hydroxyzine

Nasal cromolyn appears safe

Front 27

Preferred inhaled corticosteroid during pregnancy for asthma?

Back 27

Budesonide

Other inhaled corticosteroids may also be considered if effective before pregnancy.

Front 28

Are long acting beta agonists considered safe in pregnancy?

Back 28

yes

Front 29

In epilepsy during pregnancy, what strength of folic acid should be given?

Back 29

4-5 mg daily before pregnancy and through first trimester, and vitamin K during last month of gestation

Front 30

What should you do for drugs in women with epilespy and pregnant?

Back 30

Use monotherapy with drug that has controlled SZ most effectively

Front 31

What are the most common depression medication used in pregnancy?

Back 31

SSRI

Front 32

Adverse outcomes from SSRI in pregnancy?

Back 32

Neonatal persisitent pulmonary HTN. withdrawal effect in newborn (irritability and difficulties with feeding and breathing), and increased risk for cardiac defects (paroxetine)

Front 33

Does the pregnancy category (A,B,C,D,X) apply to lactation as well?

Back 33

Nope.

Front 34

If a drug is highly protein bound in maternal circulatory system, is it going to pass through lactation to the baby?

Back 34

Not as likely

Front 35

If mom is taking a short acting drug TID when should she take it?

Back 35

Right after breast feeding..

That way the breast milk will have lower levels of drug when breast feeding

Front 36

Should you use short or long acting forms in breast feeding moms?

Back 36

Short acting