Drug Use In Pregnancy Flashcards
Pregnancy category B
No risk was confirmed in controlled studies and women in the first trimester
Pregnancy category A
No risk in the first trimester and possible feel hung is remote
Pregnancy category C
Animal studies have shown adverse events. Give only if potential benefit outweighs the risk
Pregnancy category D
Positive evidence of fetal risk; the benefit may outweigh the risk if life-threatening or serious disease
Pregnancy category X
Use in pregnancy is contraindicated
Try to avoid all drugs if possible during first trimester and use lifestyle recommendations first, if reasonable
Common teratogens
Alcohol, Ace inhibitors, angiotensin receptor blockers, benzodiazepines, carbamazepine, ergot derivatives, isotretinoin, leflunomide, lithium, methimazole, NSAIDs, paroxetine, phenytoin, phenobarbital, propylthiouracil, quinolones, ribavirin, tetracyclines, topiramate, valproic acid, misoprostol, methotrexate, statins, dutasteride, finasteride, warfarin, Thalidomide
Most psychiatric drugs have a risk pregnancy: what to use
And bipolar disorder, lithium and valproate are considered among the highest risk
In depression SSRIs and trycyclic’s are generally used but are considered pregnancy category C
Folic acid
Should recommend at 400-800 µg daily especially one month prior and continued for the first 2 to 3 months of pregnancy
Treatment of nausea and vomiting OTC in pregnancy
Lifestyle: eat smaller more frequent meals and avoid spicy foods
Natural supplements: ginger in tea form or cooked
OTC: pyridoxine or vitamin B6 is first-line with or without a first generation antihistamine
GERD OTC treatment in pregnancy
Calcium antacids are first-line such as calcium carbonate in tums
If gas is the problem gas X or simethicone is safe
H2 antagonist are all pregnancy category B and PPI’s are category B or C
OTC treatment of constipation in pregnancy
Lifestyle: increased fluid intake and fiber in diet as well as physical activity
Otherwise fiber is first-line and psyllium (Metamucil)is pregnancy category B
Treatment of cold/cough/allergies in pregnancy
First-generation antihistamines: chlorpheniramine and diphenhydramine are generally considered safe
Nonsedating second-generation agents such as loratadine and cetirizine are often recommended by obstetricians during the second and third trimester
the safest nasal steroids are considered budesonide or Rhinocort and beclomethasone or Beconase
Decongestants are pregnancy category C and should not be used in the first trimester
Treatment of pain OTC in pregnancy
Acetaminophen is pregnancy category B and is the analgesic and antipyretic drug of choice during pregnancy
Do not recommend OTC NSAIDs in pregnancy
Codeine is considered unsafe and pregnancy and lactation
Most opioids are excreted in breast milk
Vaccine used during pregnancy
- Influenza vaccine is recommending and all stages of pregnancy in the inactivated form
- No live vaccines (MMR, varicella (chickenpox), live influenza nasal
- Pregnant women should receive Tdap between weeks 27 and 36 each pregnancy
Antibiotic use during pregnancy
Generally considered safe to use: penicillins and cephalosporins, erythromycin and azithromycin
Do not use: quinolones due to cartilage damage and tetracyclines due to teeth discoloration, clarithromycin is considered pregnancy category C
If an antifungal is needed use topical agents at least seven days
Treatment of urinary tract infection during pregnancy
Use beta-lactam’s that cover the organism such a cephalexin or ampicillin
Nitrofurantoin 100 mg b.i.d. is used as well but do not use in the last several weeks of pregnancy
Avoid quinolones tetracyclines and Septra (septoria can cause hyperbilirubinemia and kernicterus and third trimester)
Treatment of chlamydia during pregnancy
Azithromycin 1 g for one dose or amoxicillin 500 mg by mouth three times a day for seven days
Treatment of gonorrhea during pregnancy
Cephalosporin or if contraindicated azithromycin 2 g by mouth from one dose
Treatment of bacterial vaginosis during pregnancy
Clindamycin 300 mg by mouth twice a day or metronidazole 500 mg by mouth twice today or metronidazole 250 mg by mouth three times a day all for seven days
Topical therapy for bacterial vaginosis is not recommended during pregnancy
Vaginal trichomoniasis during pregnancy
Metronidazole 2 g by mouth for one dose or 250 mg by mouth three times a day or 500 mg by mouth twice a day for seven days at any stage of pregnancy
Treatment of asthma and pregnancy
Inhaled corticosteroids are first-line controller therapy for persistent asthma during pregnancy
Budesonide is the preferred inhaled corticosteroids for use during pregnancy
Albuterol is the recommended rescue inhaler during pregnancy
VTE and mechanical heart valve treatment during pregnancy
Heparin or low molecular weight heparin converted to shorter half-life unfractionated heparin during last month of pregnancy or when delivery appears imminent otherwise use pneumatic compression devices
Treatment of hypothyroidism during pregnancy
Must test for and treat with levothyroxin which is pregnancy category A
Treatment of hyperthyroidism
Both are pregnancy category D but propylthiouracil is generally used if trying to conceive or in the first trimester then it is generally reasonable to switch to methimazole
Alcohol and tobacco
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