Ch 22: Drug Use in Pregnancy and Lactation

Question 1

folic acid

Answer 1

400 mcg/d normally. 600 mcg/d during preg

Question 2

calcium/vit d requirement

Answer 2

preg 1000 mg/d ca and 600 iu/d vit d.

Question 3

previous category: A

Answer 3

no risk in 1st trimester

Question 4

previous category: B

Answer 4

animal studies have either no demonstrated a fetal risk + no controlled studies in preg OR animal studies have ADR that was not confirmed in preg women

Question 5

previous category: C

Answer 5

animal studies have shown harm, no controlled studies in humans. OR studies in humans/animals not avail. give only if benefit outweighs risk.

Question 6

previous category: D

Answer 6

pos evid of fetal risk, but benefits may outweigh risk for life-threatening or serious disease

Question 7

previous category: X

Answer 7

use in preg is contraindicated always

Question 8

key teratogens: acne, abx, anticoag

Answer 8

isotretinoin, topical retinoids (including tazarotene). quinolones, tetracyclines. warfarin

Question 9

key teratogens: dyslipidemia, HF, HTN

Answer 9

statins, RAAS inhibitors (ACEIs, ARBs, aliskiren, entresto)

Question 10

key teratogens: hormones, migraine

Answer 10

most - estradiol, proesterone (including megace), raloxifene, duavee, testosterone, contraceptives, etc. (dihydro)ergotamine

Question 11

key teratogens: others

Answer 11

hydroxyurea, lithium, MTX, misoprostol, paroxetine, ribavirin, thalidomide, topiramate, valproic acid/divalproex, wt loss drugs

Question 12

tx in preg: morning sickness, NV

Answer 12

lifestyle first. then pyridoxine (vit b6) +/- doxylamine

Question 13

tx in preg: GERD/heartburn

Answer 13

lifestyle first. then ca carbonate.

Question 14

tx in preg: flatulence

Answer 14

simethicone (gas-x)

Question 15

tx in preg: constipation

Answer 15

lifestyle first. fiber (psyllium, ca polycarbophil, methylcellulose)

Question 16

tx in preg: cough, cold, allergies

Answer 16

first gen anti-histamines (chlorpheniramine is choice or benadryl) are first line. loratidine and cetirizine can be rec in 2nd-3rd trimester. budesonide (rhinocort) or beclomethason (beconase) for chronic allergies. avoid liquid forms with alcohol. PO decongestants not rec.

Question 17

tx in preg: pain

Answer 17

apap first line. avoid NSAIDS and opioids

Question 18

tx in preg: asthma

Answer 18

mx steroid: inhaled budesonide. rescue tx: albuterol.

Question 19

tx in preg: HTN

Answer 19

labetalol, methyldopa, nifedipine. RAAS inhibitors are contraindicated.

Question 20

tx in preg: DB

Answer 20

lifestyle first. insulin preferred. metformin and glyburide are used.

Question 21

tx in preg: VTE/mech valve

Answer 21

LMWH preferred. pneumatic compression devices sometimes used. warfarin is teratogenic

Question 22

tx in preg: hypothyroidism

Answer 22

levothyroxine needs 30-50% inc

Question 23

tx in preg: hyperthyroidism

Answer 23

PTU in 1st trimester. methimazole in 2nd and 3rd trimester.

Question 24

pain in lactation

Answer 24

do not use codeine, tramadol, or opioids d/t risk with 2d6 ultra metabolizers

Question 25

HIV in lactation

Answer 25

not rec to breastfeed

Question 26

specific meds in lactation

Answer 26

avoid: amphetamines, ergotamines, lamotrigine, lithium, statins. metronidazole: milk should be pumped and discarded for 12-24 h after single dose, try to avoid. phenobarbital can result in acute withdrawal effects

Question 27

supplements in lactation

Answer 27

400 iu of vit d daily until baby consuming at least 1 L of vit D fortified formula/day.