drug use in pregnancy and lactation

Question 1

which trimester is crucial to avoid teratogenic drugs

Answer 1

1st trimester

Question 2

what defeciency cause brain and spinal cord defects

Answer 2

Folate or B9
flour, cereals dried beans green leafy vegtables orange juice
400mcg and 600 for pregnancy

Question 3

how much vit D or calcium is needed

Answer 3

1000mg/ day of calcium and 15mcg of VIt D or 600 IU/day

Question 4

Pregnancy category A

Answer 4

no risk from controlled study on 1st trimester

Question 5

pregnancy cat B

Answer 5

no fetal risk but no studies

Question 6

preg cat C

Answer 6

harm to fetus with no studies

Question 7

preg cat D

Answer 7

harm to fetus with evidence but benefit may outweigh risk

Question 8

pregnancy cat X

Answer 8

contraindicate for use in pregnancy

Question 9

what are the two immunizations recommended for pregnancy

Answer 9

influenza and Tdap

Question 10

what are some common teratogens

Answer 10

USP 800

Question 11

what are teratogenic drugs 8 classes

Answer 11

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

Question 12

what is preeclampsia

Answer 12

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

Question 13

morning sickness, nausea vomiting

Answer 13

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

Question 14

GERD/Heartburn

Answer 14

eat smaller, frequent meals with less spicy
avoid eating 3 hours before sleep

tx- calcium carbonate Tums, PPI or H2ra

Question 15

flatuance

Answer 15

simethicone

Question 16

constipation

Answer 16

increase fluid intake, fiber and physical activity

tx- ffiber (psyllium, calcium polycarbophil, methylcellulose
docusate and polyehthylene glycol

many prenatal contains docusate

Question 17

cough cold allergies

Answer 17

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

Question 18

cough cold allergies

Answer 18

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

Question 19

cough cold allergies

Answer 19

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

Question 20

pain

Answer 20

tylenol is 1st line
avoid NSIAD

Question 21

asthma

Answer 21

budesonide is preffered but all inhaled corticosteroids are cosidered safe
rescue therapy- inhaled albuterol

Question 22

iron defeciency anemia

Answer 22

supplement iron and prenatals with iron
watch out for constipation

Question 23

HPT

Answer 23

labetalol
methyldopa
nifedipine

** ace arbs arni aliskiren contraindicated

Question 24

diabetes

Answer 24

insulin preferred
metformin and glyburide considered safe

• low dose aspirin to prevent preeclampsia

Question 25

what abx are safe during pregnancy

Answer 25

penicillins- amox, ampicillin cephalosporin erythromycin and azithromycin

Question 26

what anti fungals are safe in pregnancy

Answer 26

topical antifungals X days

** avoid fluconazole

Question 27

for UTI what is considered safe in pregnancy

Answer 27

cephalexin
ampicillin
nitrofurantoin and bactrim are last line and should not be used in last 2 weeks of pregnancy

Question 28

toxoplasmosis

Answer 28

IgG test
- avoid dirty water and food, unpasteurized dairy products and cat feces (avoid cat litter boxes)

Question 29

anticoags safe during pregnancy

Answer 29

LMWH>UFH

compression device with LMWH

** warfarin use should be avoided during the 1st trimester

Question 30

hypothyroidism

Answer 30

levothyroxine is safe might need a 30-50% increase in dose

Question 31

hyperthyroidism

Answer 31

propylthiouracil is preferred
switch to methimazole after 1st trimester

Question 32

lactaion

Answer 32

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

Question 33

what pain meds should be used postpartum

Answer 33

Ibuprofen or tylenol
** avoid codeine and tramadol as it passes through breast milk

Question 34

what drugs should be avoided completely while breast feeding

Answer 34

chemo
illicit drugs and radioactive

some meds should be avoided- amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital and statins