52-53: medications in preg and lactation NOT DONE Flashcards
inc what in prenatal diet
-300-400 calories
-folate and folic acid
-calcium intake
-vitamin D
-protein
dec what in prenatal diet
-artificial sweeteners
-unpasteurized foods
-alcohol
-unwashed fruits and veggies
-herabl teas
-undercooked meat
-caffeine
Caffeine intake during pregnancy
-takes longer to be metabolized
-less than 200 mg/day
Benefits of prenatal supplements
-help w fetal development
-prevent fetal and maternal complications
Timing of prenatal supplements
-ideally start 3 months before conception
-folic acid at least one month before getting preg
Prenatal vitamins and minerals
-calcium
-iron
-iodine
-choline
-Vit A, B6, B12, C, D
-folic acid
Vaccine recommendations for pregnant women
-inactivated influenza
-Tdap during each pregnancy
-RSV weeks 32-36
-covid-19
Vaccines to AVOID in pregnant women
-HPV
-MMR
-LIVE influenza
-Varicella
-yellow fever
-typhoid fever
Fetal alcohol syndrome
-CNS abnormalities
-growth defects
-facial dysmorphia
Fetal alcohol syndrome birth defects
-growth deformities
-facial abnoramlities
-CNS impairment
-behavior disorders
-impaired intellectual development
Tobacco use during pregnancy
-preterm birth
-low birth weight
-birth defects
-sudden infant death syndrome
Marijuana use during pregnancy
-low birth weight
-brain development disruption
-decreased attention span
-behavioral problems
-marijuana use in child by 14
Opioid use during pregnancy
-maternal death
-poor fetal growth
-preterm birth
-still birth
-neonatal withdrawal
medication for substance abuse
-methadone
-buprenorphine
Neonatal Opioid Withdrawal Syndrome
-72 hours after birth
-tremors
-sleep problems
-reflexes
-seizures
-poor feeding
-shit and vomit
Neonatal opioid withdrawal syndrome treatment
-buprenorphine, morphine, methadone
-IV fluids
-higher calorie formula
Absorption in pregnancy
-slower GI
-inc extent of absorption
-dec rate of absorption
Distribution in pregnancy
-inc Vd of hydrophillic drugs
-dec protein binding
Metabolism in pregnancy
-inc CYP3A4 activity
-dec CYP2C19 activity
Excretion in pregnancy
-inc renal hepatic blood flow
-inc CrCl
Teratogen
-drug or environmental agent with potential to cause abnormal fetal growth and development
-hazardous medication and require special handling
Common teratogens
Short-term complications in pregnancy
-nausea
-heartburn
-constipation
-pain, fever, headache
-cough and cold
-UTI
Nausea and vomiting risk factors in pregnancy
-h/o motion sickness
-GERD
-high fat diet
-younger patients
Hyperemesis gravidarum
-severe formm of nausea and vomiting
-weight loss, electrolyte imbalances, dehydration
Nausea and vomiting treatment
1st nonpharmacologic
2nd pharmacologic
Non-pharmacologic treatment of vomiting
-avoid triggers
-drink throughout the day
-eat smaller, freq, dry meals
-eat dry toast or crackers before getting out of bed
-avoid spicy foods
-keep stomach from being empty
Pharmacological treatment
- Pyridoxine (Vit B6)
- Doxylamine and Pyridoxine
- Meclizine, Dimenhydrinate, diphenhydramine
- ondansetron, metoclopramide
GERD/Heartburn in pregnancy
-usually 3rd trimester
-hormone changes
-esophageal sphincter relaxing
-uterus enlarging
Non-pharmacological treatment of GERD
-smaller freq meals
-eat slowly
-avoid food and drinks 3 hours before bed
-elevate head of bed
-avoid smoking and alcohol
GERD pharmacological treatment
- antacids
- sucralfate (not absorbed in GI tract)
- Histamine- 2 receptor antagonists, proton pump inhibitors
Constipation non-pharmacological treatment
-eat 25-30g fiber
-inc fluid intake
-exercise
constipation pharmacological treatment
-fiber
-osmotic lax
-stool softeners
-avoid castor oil or mineral oil
Pain fever headache non-pharma treatment
-cool compress
-manage stress
-inc relaxation techniques
-get at least 8 hours of sleep each night
pain, fever, headache pharmacological treatment
-acetaminophen
-AVOID NSAIDs and aspirin
Cough, cold, allergy treatment
-ensure appropriate vax
1. cromolyn
2. chlorpheniramine, diphenhydramine
-loratadine and cetirizine during 2nd and 3rd trimester
-oral decongestants should be avoided during 1st trimester
UTI and adverse pregnancy outcomes
-preterm delivery
-low birth weight
-sepsis
UTI prevention
-hydration
-proper wiping and voiding before and after sex
-wear cotton undies
-avoid tight clothes
UTI recommended treatment
-cephalexin
-nitrofurantoin and sulfa with trimethoprim
-amoxicillin
-fosfomycin and nitrofurantoin
What to avoid in UTI treatment
-fluoroquinolones
-tetracyclines
-sulfamethoxazole with trimethoprim
chronic disease states during pregnancy
-depression and anxiety
-gestation diabetes
-HYPO/HYPERthyroidism
-thromboembolism
-preeclampsia and eclampsia
-epilepsy
-group B strep
Depression and anxiety treatment in pregnancy
-treat w psychotherapy, antidepressants or both
-SSRIs do not inc risks of birth defects
Gestational Diabetes
-24-28 weeks for first time in pregnancy
Gestational diabetes treatment
-diet and exercise
-regular self-monitoring of blood glucose
-monitoring baby
-insulin
-metformin and sulfonylureas
Hypothyroidism
-tiredness
-weight gain
-intolerance to cold temps
-dry, course hair
Hypothyroidism treatment
-levothyroxine
-inc dose when pregnant
Hyperthyroidism treatment
-propylthiouracil preferred during the first trimester
-consideration should be given to switching to methimazole after 1st trimester
Thromboembolism
-4-5x risk of blood clots
-can happen due to status of blood flow, endothelial injury, or hypercoagulability
Thromboembolism nonpharmacological treatment
-inferior vena cava IVC filter
-compression stockings
Pharmacologic treatment of thromboembolism
-LMWH during pregnancy does not cross placenta or have teratogenic effects
-at least 2 months and until 3 weeks postpartum
AVOID warfarin
Preeclampsia
-a sudden spike in BP plus proteinuria
-usually 3rd trimester
-may develop after delivery of baby
preeclampsia symptoms
-thrombocytopenia
-LFT elevation
-headaches
-vision changes
-SOB
-N/V
preeclampsia complications
-maternal complications
-placental abruption
-fetal or newborn death
-eclampsia
Preeclampsia prevention
-aspirin 60-80mg in late 1st trimester
-calcium supplementation
-exercise
-early delivery is often recommended
Preeclampsia treatment
-hydralazine (IV or IM)
-labetalol
-Nitroprusside
-Nifedipine
-avoid ACE/ARBs
Eclamsia
-seizures that occur in pts with preeclampsia
-can lead to stroke or death
Eclasmia treatment
-magnesium sulfate 4-6g bolus
-relaxes blood vessels in cerebrum
-alternatives: phenytoin, benzodia
Group B strep
-baby infection from vagina
Group B strep treatment
- penicillin G or ampicillin IV once labor has started
-Cefazolin if mild PCN allergy
-Clindamycin and vancomycin if severe PCN allergy
Preterm labor
-before 37 weeks
Medications for preterm labor
-Progesterone 200mg vag suppository if NO history
-250 mg IM if history
Premature membrane rupture treatment in under 34 weeks
-corticosteroids to develop lungs
-antibiotics to prevent infection
-Tocolytics to stop labor
-magnesium sulfate to help fetus brain
Deliver baby after
37 weeks premature membrane rupture
Stages of Labor
- early and active labor
- birth of baby
- delivery of the placenta
Labor Dystocia
-below minimal normal rate of change or descent
Labor Dystocia complications
-fetal distress
-infection risk
-postpartum hemorrhage
-uterine rupture
-inc risk of trauma
Prevention of labor dystocia
-avoid admission during latent stages of labor
-inc access to labor to labor support
-consider induction of labor at or beyond term
-an upright or walking position
-use cervical ripening agents
Treatment of labor dystocia
-oxytocin
-cesarean section
When to induce labor
-over 41-42 weeks
-preeclampsia
-infection
-fetal compromise
-diabetes, renal disease, pulmonary disease, HTN
Risk of induction
-low fetal HR
-failed induction
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