Chapter 48: Drugs in Pregnancy & Lactation Flashcards
Which lab tests confirms pregnancy
positive hCG
Which trimester is the embryo most susceptible to birth defects caused by teratogens
First trimester
Which organization publishes guidelines for safe and effective drug use in conditions impacting women, including pregnancy
American College of Obstetricians and Gynecologists (ACOG)
Folate deficiency causes
neural tube defects
All women of childbearing age should obtain __ mcg/day of folic acid (folate, vitamin B9) from a combination of dietary supplements, fortified foods, and regular diet
400 mcg/day
Pregnant women require ___ mg/day of calcium and ___ IU/day of vitamin D
1000 Ca
600 Vit D
In the previous pregnancy categories & interpretation, a category A drug describes:
No risk in first trimester
In the previous pregnancy categories & interpretation, a category B drug describes:
Animal studies have not demonstrated a fetal risk
but no well-controlled studies in pregnant women
In the previous pregnancy categories & interpretation, a category C drug describes:
Animal studies have shown harm to the fetus
but there are no well-controlled studies in pregnant women
Use only if potential benefit outweighs the risk
In the previous pregnancy categories & interpretation, a category D drug describes:
Use in pregnancy in contraindicated
In the updated pregnancy category sections in package inserts, section 8.1 on Pregnancy includes
risk of adverse developmental outcomes
Pregnant women are encouraged to participte in registries for select disease states and drugs
In the updated pregnancy category sections in package inserts, section 8.2 on Lactation includes
Whether the drug/metabolites are present in human milk
In the updated pregnancy category sections in package inserts, section 8.3 on Females and Males of Reproductive Potential includes
Any effects on fertility
and
requirements for pregnancy testing and contraception
Which two immunizations are routinely recommended for pregnant patients
Influenza (inactivated)
Single dose of Tdap at each pregnancy
Which key acne drugs are teratogens
Isotretinoin
and
topical retinoids (like tazarotine)
Which key antibiotic drugs are teratogens
Quinolones
tetracyclines
Which key anticoagulants are teratogens
Warfarin
Which key meds for dislipidemia, HF and HTN are teratogens
Statins
ACE
ARBs
aliskiren
sacubitril/valsartan (Entresto)
Which key hormone drugs are teratogens
Most,
including
estradiol
progesterone
raloxifene
Duavee
testosterone
contraceptives
Which key migraine drugs are teratogens
dihydroergotamine
ergotamine
What are other key drugs that are teratogens
Hydroxyurea Lithium MTX Misoprostol NSAIDs Paroxetine Ribavirin Thalidomide Topiramate Weight loss drugs Valproic acid/divalproex
Teratogens are hazardous drugs according to which USP chapter
800
To prevent preeclampsia, ACOG and ADA guidelines recommend adding ___ at the end of the first trimester for pregnant women at risk (e.g., type 1 and type 2 diabetes)
Daily low-dose ASA
Preferred management for morning sickness/nausea/vomiting in pregnant patients
- Lifestyle first
- Pyridoxine (B6) + / - doxylamine
- Ginger is possibly effective
Preferred management for GERD/Heartburn in pregnant patients
- Lifestyle first (smaller, more frequent meals; elevate head of bed and don’t eat 3 hours prior to sleep)
- Calcium carbonate (Tums)
Preferred management for flatulence in pregnant patients
Simethicone
Preferred management for constipation in pregnant patients
lifestyle first
Fiber (psyllium, calcium polycarbophil)
Preferred management for allergies in pregnant patients
First line: cromolyn
Second line: first-generation antihistamines. DOC = chlorpheniramine
Chronic allergy: nasal steroids (Budesonide and beclomethasone)
Preferred management for pain in pregnant patients
APAP
avoid NSAIDs including ASA
Preferred management for asthma in pregnant patients
Maintenance tx: Budesonide (also preferred steroids for infants)
Rescue tx: inhaled albuterol
Preferred management for HTN in pregnant patients
labetalol
methyldopa
nifedipine
Preferred management for diabetes in pregnant patients
insulin
Which antibiotics are generally safe to use in pregnancy
Remember: PEAC
- PCNs (including amoxicillin and ampicillin)
- Erythromycin
- Azithromycin
- Cephalosporins
Preferred antibiotic for vaginal fungal infection in pregnant pt
Topical antifungals
Preferred antibiotics for UTI in pregnant pt
- Keflex
- Ampicillin
- Nitrofurantoin and Bactrim last line during the first trimester & should not be used in the last 2 weeks of pregnancy
Women can be tested for toxoplasmosis prior to pregnancy with a(n)
IgG test
Preferred VTE tx in pregnancy
LMWH
pneumatic compression devices for ppx
Preferred treatment for hypothyroidism in pregnant pt
Levothyroxine (requires 30-50% dose increase)
Preferred treatment for hyperthyroidism in pregnant pt
1st trimester: PTU
2nd & 3rd trimester: methimazole
Babies receiving breast milk partially or exclusively should receive ___ IU of vitamin D daily
400
Breastfed babies require __ mg/kg/day of iron during months __-__
1
4-6
Which pain meds should not be used by breastfeeding mothers due to risk of excessive sleepiness, breathing difficulty and/or death in the infant
Codeine
and
tramadol
Breastfed infants have died from being breastfed, especially in mothers taking certain pain meds who were _____ metabolizers
2D6 ultra-rapid
T/F: a mother who is HIV positive can safely breastfeed
False - not recommended
Which medications should be avoided during lactation
Amphetamines
amiodarone
ergotamines
lithium
metronidazole
phenobarbital
statins
