Drug Use in Pregnancy Flashcards
Pregnancy Category A
Controlled studies in animals and women have shown
no risk in the 1st trimester, and possible fetal harm is remote.
Pregnancy Category B
Either animal studies have not demonstrated a fetal
risk but there are no controlled studies in pregnant
women, or animal studies have shown an adverse effect
that was not confirmed in controlled studies in women in the 1st trimester.
Pregnancy Category C
No controlled studies in humans have been performed
and animal studies have shown adverse events, or studies in humans and animals are not available; give only if potential benefit outweighs the risk.
Pregnancy Category D
Positive evidence of fetal risk is available, but the benefits may outweigh the risk if life-threatening or serious disease.
Pregnancy Category X
Studies in animals or humans show fetal abnormalities; use in pregnancy is contraindicated.
As a General rule: Try to avoid all drugs if possible during 1st trimester (organogenesis) and use lifestyle recommendations first, if reasonable.
Encourage Enrollment in the Pregnancy Registries
They are designed to collect health information from women who take various drugs when they are pregnant and breastfeeding. Information is also collected on the newborn baby. This information is compared with women who have not taken medicine during pregnancy and the health of their babies.
Common Teratogens
hCG+, the patient is pregnant and teratogenic drugs should be d/c, if possible.
Alcohol ACE inhibitors, Angiotensin receptor blockers, Benzodiazepines, Carbamazepine, Ergot-derivatives, Isotretinoin, Leflunomide, Lithium, Methimazole, Nafarelin, NSAIDs, Paroxetine, Phenytoin, Phenobarbital, Propylthiouracil, Quinolones, Ribavirin, Tazarotene, Tetracyclines, Topiramate, Valproic acid, Misoprostol, Methotrexate, Statins, Dutasteride, Finasteride, Warfarin, Lenalidomide and Thalidomide.
Psychiatric drugs risk in pregnancy
The drug’s potential harm must be weighed against the risk of the condition not being treated adequately.
In bipolar disorder, lithium and valproate are considered among the highest risk.
December of 2011 the FDA issued a warning regarding
SSRI use during pregnancy and the potential risk of persistent pulmonary hypertension of the newborn (PPHN). Paroxetine is considered to have the highest risk in the class.
Tricyclics also pregnancy category C, are the second group most commonly used.
Folic Acid in Women of Child-Bearing Age
Help prevent birth defects of the brain and spinal cord (neural tube defects). At least one month prior to pregnancy and continued for the first 2-3 months of pregnancy.
Adequate folic acid (400-800 mcg daily, which is 0.4-0.8 mg/day),
Calcium (1000 mg daily)
Vitamin D 600 IU daily)
RX Prenatal Vitamins: Primacare One, Zenate, others (800 mcg)
Folio acid in foods: fortified cereals, dried beans, leafy green vegetables and orange juice.
Nause/Vomiting in Pregnancy
Eating smaller, more frequent meals, avoiding spicy or odorous foods, taking more frequent naps, and reducing stress, including working long hours.
1st Line: Pyridoxine (vitamin B6) with/out doxylamine.
Ginger, in tea form, or cooked, but do not recommend supplements. Dried, salted plums
Hyperemesis gravidarum is severe N/V in pregnancy and
causes weight loss, dehydration and electrolyte imbalance. May need hospitalization
GERD/Heartburn
GERD = smaller, more frequent meals, avoiding foods that worsen GERD,
If symptoms occur while sleeping, recommend elevating the head of the bed and not eating 3 hours prior to sleep.
Calcium antacids are 1st-line, such as calcium carbonate in Tums or store brands. This is a good antacid choice since calcium intake is often deficient in pregnancy.
Use caution with excessive use of antacids containing
aluminum or magnesium if renal disease is present. Do not recommend sodium bicarbonate or magnesium trisilicate (which comes in combination with aluminum hydroxide in Gaviscon).
Gas Pains
simethicone is considered safe (Gas-X, Mylicon.) - and the Mylicon.
Infant drops are considered safe for infants.
H2 antagonists (Pepcid, Tagamet, AXid, Zantac) are all pregnancy category B); many doctors recommend OTC or Rx doses.
PPIs are B’s or C’s.
Constipation
First recommend increasing fluid intake, increasing fiber in the diet, increasing physical activity, such as walking.
If this does not work fiber is 1“-line and psyllium is pregnancy category B (Metamucil, store brands).
Cough/Cold/AIlergies
The first-generation antihistamines are the usual first-line recommendation. Chlorpheniramine (drug of choice) and diphenhydramine are pregnancy category B.
The non-sedating 2nd generation agents loratadine and cetirizine are often recommended by obstetricians during the second and third trimesters.
If nasal steroids are needed for chronic allergy symptoms, budesonide (Rhinocort) and beclomethasone (Beconase AQ) are considered safest; both are prescription only.
Decongestants (pseudoephedrine, phenylephrine, oxymetazoline), the cough-suppressant dextromethorphan and the mucolytic guaifenesin are pregnancy category C, but may be recommended by the physician.
The oral decongestants should not be recommended during the first trimester.
Pain
Acetaminophen is pregnancy category C and is the analgesic and antipyretic drug of choice during pregnancy.
Ibuprofen is pregnancy category C/D :> 30 weeks gestation, and naproxen is pregnancy category C;
pharmacists should not recommend OTC NSAIDs in pregnancy.
Codeine is considered unsafe in pregnancy and lactation.
Most opioids are excreted in breast milk. While this use may be acceptable in small amounts, the risk to the infant must be considered.
Do not dispense codeine (in Tylenol #3, others) to a woman who is breastfeeding since rapid metabolizers of the CYP450 2D6 enzyme will produce excessive amounts of morphine rapidly, which could be fatal to the infant.
