Drug Use In Pregnancy

Question 0

Pregnancy category B

Answer 0

No risk was confirmed in controlled studies and women in the first trimester

Question 1

Pregnancy category A

Answer 1

No risk in the first trimester and possible feel hung is remote

Question 2

Pregnancy category C

Answer 2

Animal studies have shown adverse events. Give only if potential benefit outweighs the risk

Question 3

Pregnancy category D

Answer 3

Positive evidence of fetal risk; the benefit may outweigh the risk if life-threatening or serious disease

Question 4

Pregnancy category X

Answer 4

Use in pregnancy is contraindicated

Try to avoid all drugs if possible during first trimester and use lifestyle recommendations first, if reasonable

Question 5

Common teratogens

Answer 5

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

Question 6

Most psychiatric drugs have a risk pregnancy: what to use

Answer 6

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

Question 7

Folic acid

Answer 7

Should recommend at 400-800 µg daily especially one month prior and continued for the first 2 to 3 months of pregnancy

Question 8

Treatment of nausea and vomiting OTC in pregnancy

Answer 8

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

Question 9

GERD OTC treatment in pregnancy

Answer 9

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

Question 10

OTC treatment of constipation in pregnancy

Answer 10

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

Question 11

Treatment of cold/cough/allergies in pregnancy

Answer 11

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

Question 12

Treatment of pain OTC in pregnancy

Answer 12

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

Question 13

Vaccine used during pregnancy

Answer 13

1. Influenza vaccine is recommending and all stages of pregnancy in the inactivated form
2. No live vaccines (MMR, varicella (chickenpox), live influenza nasal
3. Pregnant women should receive Tdap between weeks 27 and 36 each pregnancy

Question 14

Antibiotic use during pregnancy

Answer 14

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

Question 15

Treatment of urinary tract infection during pregnancy

Answer 15

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)

Question 16

Treatment of chlamydia during pregnancy

Answer 16

Azithromycin 1 g for one dose or amoxicillin 500 mg by mouth three times a day for seven days

Question 17

Treatment of gonorrhea during pregnancy

Answer 17

Cephalosporin or if contraindicated azithromycin 2 g by mouth from one dose

Question 18

Treatment of bacterial vaginosis during pregnancy

Answer 18

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

Question 19

Vaginal trichomoniasis during pregnancy

Answer 19

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

Question 20

Treatment of asthma and pregnancy

Answer 20

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

Question 21

VTE and mechanical heart valve treatment during pregnancy

Answer 21

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

Question 22

Treatment of hypothyroidism during pregnancy

Answer 22

Must test for and treat with levothyroxin which is pregnancy category A

Question 23

Treatment of hyperthyroidism

Answer 23

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

Question 24

Alcohol and tobacco

Answer 24

ENCOURAGE CESSATION