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Therapeutics > 52-53: medications in preg and lactation NOT DONE > Flashcards

52-53: medications in preg and lactation NOT DONE Flashcards

1
Q

inc what in prenatal diet

A

-300-400 calories
-folate and folic acid
-calcium intake
-vitamin D
-protein

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2
Q

dec what in prenatal diet

A

-artificial sweeteners
-unpasteurized foods
-alcohol
-unwashed fruits and veggies
-herabl teas
-undercooked meat
-caffeine

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3
Q

Caffeine intake during pregnancy

A

-takes longer to be metabolized
-less than 200 mg/day

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4
Q

Benefits of prenatal supplements

A

-help w fetal development
-prevent fetal and maternal complications

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5
Q

Timing of prenatal supplements

A

-ideally start 3 months before conception
-folic acid at least one month before getting preg

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6
Q

Prenatal vitamins and minerals

A

-calcium
-iron
-iodine
-choline
-Vit A, B6, B12, C, D
-folic acid

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7
Q

Vaccine recommendations for pregnant women

A

-inactivated influenza
-Tdap during each pregnancy
-RSV weeks 32-36
-covid-19

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8
Q

Vaccines to AVOID in pregnant women

A

-HPV
-MMR
-LIVE influenza
-Varicella
-yellow fever
-typhoid fever

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9
Q

Fetal alcohol syndrome

A

-CNS abnormalities
-growth defects
-facial dysmorphia

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10
Q

Fetal alcohol syndrome birth defects

A

-growth deformities
-facial abnoramlities
-CNS impairment
-behavior disorders
-impaired intellectual development

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11
Q

Tobacco use during pregnancy

A

-preterm birth
-low birth weight
-birth defects
-sudden infant death syndrome

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12
Q

Marijuana use during pregnancy

A

-low birth weight
-brain development disruption
-decreased attention span
-behavioral problems
-marijuana use in child by 14

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13
Q

Opioid use during pregnancy

A

-maternal death
-poor fetal growth
-preterm birth
-still birth
-neonatal withdrawal

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14
Q

medication for substance abuse

A

-methadone
-buprenorphine

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15
Q

Neonatal Opioid Withdrawal Syndrome

A

-72 hours after birth
-tremors
-sleep problems
-reflexes
-seizures
-poor feeding
-shit and vomit

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16
Q

Neonatal opioid withdrawal syndrome treatment

A

-buprenorphine, morphine, methadone
-IV fluids
-higher calorie formula

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17
Q

Absorption in pregnancy

A

-slower GI
-inc extent of absorption
-dec rate of absorption

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18
Q

Distribution in pregnancy

A

-inc Vd of hydrophillic drugs
-dec protein binding

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19
Q

Metabolism in pregnancy

A

-inc CYP3A4 activity
-dec CYP2C19 activity

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20
Q

Excretion in pregnancy

A

-inc renal hepatic blood flow
-inc CrCl

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21
Q

Teratogen

A

-drug or environmental agent with potential to cause abnormal fetal growth and development
-hazardous medication and require special handling

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22
Q

Common teratogens

A
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23
Q

Short-term complications in pregnancy

A

-nausea
-heartburn
-constipation
-pain, fever, headache
-cough and cold
-UTI

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24
Q

Nausea and vomiting risk factors in pregnancy

A

-h/o motion sickness
-GERD
-high fat diet
-younger patients

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25
Hyperemesis gravidarum
-severe formm of nausea and vomiting -weight loss, electrolyte imbalances, dehydration
26
Nausea and vomiting treatment
1st nonpharmacologic 2nd pharmacologic
27
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
28
Pharmacological treatment
1. Pyridoxine (Vit B6) 2. Doxylamine and Pyridoxine 3. Meclizine, Dimenhydrinate, diphenhydramine 4. ondansetron, metoclopramide
29
GERD/Heartburn in pregnancy
-usually 3rd trimester -hormone changes -esophageal sphincter relaxing -uterus enlarging
30
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
31
GERD pharmacological treatment
1. antacids 2. sucralfate (not absorbed in GI tract) 3. Histamine- 2 receptor antagonists, proton pump inhibitors
32
Constipation non-pharmacological treatment
-eat 25-30g fiber -inc fluid intake -exercise
33
constipation pharmacological treatment
-fiber -osmotic lax -stool softeners -avoid castor oil or mineral oil
34
Pain fever headache non-pharma treatment
-cool compress -manage stress -inc relaxation techniques -get at least 8 hours of sleep each night
35
pain, fever, headache pharmacological treatment
-acetaminophen -AVOID NSAIDs and aspirin
36
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
37
UTI and adverse pregnancy outcomes
-preterm delivery -low birth weight -sepsis
38
UTI prevention
-hydration -proper wiping and voiding before and after sex -wear cotton undies -avoid tight clothes
39
UTI recommended treatment
-cephalexin -nitrofurantoin and sulfa with trimethoprim -amoxicillin -fosfomycin and nitrofurantoin
40
What to avoid in UTI treatment
-fluoroquinolones -tetracyclines -sulfamethoxazole with trimethoprim
41
chronic disease states during pregnancy
-depression and anxiety -gestation diabetes -HYPO/HYPERthyroidism -thromboembolism -preeclampsia and eclampsia -epilepsy -group B strep
42
Depression and anxiety treatment in pregnancy
-treat w psychotherapy, antidepressants or both -SSRIs do not inc risks of birth defects
43
Gestational Diabetes
-24-28 weeks for first time in pregnancy
44
Gestational diabetes treatment
-diet and exercise -regular self-monitoring of blood glucose -monitoring baby -insulin -metformin and sulfonylureas
45
Hypothyroidism
-tiredness -weight gain -intolerance to cold temps -dry, course hair
46
Hypothyroidism treatment
-levothyroxine -inc dose when pregnant
47
Hyperthyroidism treatment
-propylthiouracil preferred during the first trimester -consideration should be given to switching to methimazole after 1st trimester
48
Thromboembolism
-4-5x risk of blood clots -can happen due to status of blood flow, endothelial injury, or hypercoagulability
49
Thromboembolism nonpharmacological treatment
-inferior vena cava IVC filter -compression stockings
50
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
51
Preeclampsia
-a sudden spike in BP plus proteinuria -usually 3rd trimester -may develop after delivery of baby
52
preeclampsia symptoms
-thrombocytopenia -LFT elevation -headaches -vision changes -SOB -N/V
53
preeclampsia complications
-maternal complications -placental abruption -fetal or newborn death -eclampsia
54
Preeclampsia prevention
-aspirin 60-80mg in late 1st trimester -calcium supplementation -exercise -early delivery is often recommended
55
Preeclampsia treatment
-hydralazine (IV or IM) -labetalol -Nitroprusside -Nifedipine -avoid ACE/ARBs
56
Eclamsia
-seizures that occur in pts with preeclampsia -can lead to stroke or death
57
Eclasmia treatment
-magnesium sulfate 4-6g bolus -relaxes blood vessels in cerebrum -alternatives: phenytoin, benzodia
58
Group B strep
-baby infection from vagina
59
Group B strep treatment
1. penicillin G or ampicillin IV once labor has started -Cefazolin if mild PCN allergy -Clindamycin and vancomycin if severe PCN allergy
60
Preterm labor
-before 37 weeks
61
Medications for preterm labor
-Progesterone 200mg vag suppository if NO history -250 mg IM if history
62
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
63
Deliver baby after
37 weeks premature membrane rupture
64
Stages of Labor
1. early and active labor 2. birth of baby 3. delivery of the placenta
65
Labor Dystocia
-below minimal normal rate of change or descent
66
Labor Dystocia complications
-fetal distress -infection risk -postpartum hemorrhage -uterine rupture -inc risk of trauma
67
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
68
Treatment of labor dystocia
-oxytocin -cesarean section
69
When to induce labor
-over 41-42 weeks -preeclampsia -infection -fetal compromise -diabetes, renal disease, pulmonary disease, HTN
70
Risk of induction
-low fetal HR -failed induction -

Therapeutics (78 decks)

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