drug use in pregnancy and lactation Flashcards
which trimester is crucial to avoid teratogenic drugs
1st trimester
what defeciency cause brain and spinal cord defects
Folate or B9
flour, cereals dried beans green leafy vegtables orange juice
400mcg and 600 for pregnancy
how much vit D or calcium is needed
1000mg/ day of calcium and 15mcg of VIt D or 600 IU/day
Pregnancy category A
no risk from controlled study on 1st trimester
pregnancy cat B
no fetal risk but no studies
preg cat C
harm to fetus with no studies
preg cat D
harm to fetus with evidence but benefit may outweigh risk
pregnancy cat X
contraindicate for use in pregnancy
what are the two immunizations recommended for pregnancy
influenza and Tdap
what are some common teratogens
USP 800
what are teratogenic drugs 8 classes
Acne= isotretnoin, topical retinoids
abx= quinolones tetracyclins
anaticoags = warfarin
dyslipedimia/ HF/ HPT= statins, RAAS inhibitors (ACE/ARBS/Aliskiren, ARNI)
Hormones = estradiol, progesterone (megesterol), raloxifene, Duavee, testosterone, contraceptives
Migraine= dihydroergotamine, ergotamine
Other= hydroxea, lithium, MTX, misoprostol, NSAIDS, Paroxetine, Ribavirin, Thalidomide, Topiramate, Weight loss, Valporic acid
what is preeclampsia
elevated blood pressure and organ damage (kidney/liver)
if eclamsia can cause seizure or death
only cure is delivery of baby
low dose aspirin for prevention
morning sickness, nausea vomiting
eat smaller, frequent meals and lots of water
avoid spicy food take more naps and reduce stress and reduce long working hours
tx- pyridoxine (B6) doxylamine
ginger
GERD/Heartburn
eat smaller, frequent meals with less spicy
avoid eating 3 hours before sleep
tx- calcium carbonate Tums, PPI or H2ra
flatuance
simethicone
constipation
increase fluid intake, fiber and physical activity
tx- ffiber (psyllium, calcium polycarbophil, methylcellulose
docusate and polyehthylene glycol
many prenatal contains docusate
cough cold allergies
TX- cromolyn
2nd line- 1st gen antihistamine chlorpeniramine amd diphenhydramine
2nd gen can be used in 2nd and 3rd trimester
oral decongestant should be avoided in 1st trimester Pain
cough cold allergies
TX- cromolyn
2nd line- 1st gen antihistamine chlorpeniramine amd diphenhydramine
2nd gen can be used in 2nd and 3rd trimester
oral decongestant should be avoided in 1st trimester
cough cold allergies
TX- cromolyn
2nd line- 1st gen antihistamine chlorpeniramine amd diphenhydramine
2nd gen can be used in 2nd and 3rd trimester
oral decongestant should be avoided in 1st trimester Pain
pain
tylenol is 1st line
avoid NSIAD
asthma
budesonide is preffered but all inhaled corticosteroids are cosidered safe
rescue therapy- inhaled albuterol
iron defeciency anemia
supplement iron and prenatals with iron
watch out for constipation
HPT
labetalol
methyldopa
nifedipine
** ace arbs arni aliskiren contraindicated
diabetes
insulin preferred
metformin and glyburide considered safe
- low dose aspirin to prevent preeclampsia
what abx are safe during pregnancy
penicillins- amox, ampicillin cephalosporin erythromycin and azithromycin
what anti fungals are safe in pregnancy
topical antifungals X days
** avoid fluconazole
for UTI what is considered safe in pregnancy
cephalexin
ampicillin
nitrofurantoin and bactrim are last line and should not be used in last 2 weeks of pregnancy
toxoplasmosis
IgG test
- avoid dirty water and food, unpasteurized dairy products and cat feces (avoid cat litter boxes)
anticoags safe during pregnancy
LMWH>UFH
compression device with LMWH
** warfarin use should be avoided during the 1st trimester
hypothyroidism
levothyroxine is safe might need a 30-50% increase in dose
hyperthyroidism
propylthiouracil is preferred
switch to methimazole after 1st trimester
lactaion
lactmed or briggs
low VD and high lipid soluble drugs can pass breastmilk
Vit d and iron supplement is required during lactation
child needs 1mg/kg daily
what pain meds should be used postpartum
Ibuprofen or tylenol
** avoid codeine and tramadol as it passes through breast milk
what drugs should be avoided completely while breast feeding
chemo
illicit drugs and radioactive
some meds should be avoided- amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital and statins
