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Naplex Drug Card > Drug Use In Pregnancy And Lactation > Flashcards

Drug Use In Pregnancy And Lactation Flashcards

1
Q

Average pregnancy cycle

A

37-40 weeks

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2
Q

Time for most organ development

A

0-12 weeks

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3
Q

Most likely time for teratogenicity to occur

A

0-12 weeks

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4
Q

What drives drug dose or regimen adjustment during pregnancy

A

Pharmacokinetics changes that occur during pregnancy

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5
Q

Gravida (G)

A

Number of pregnancies

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6
Q

Para (P)

A

Number of births

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7
Q

Folic acid dose in pregnancy

A

600 DFE/day

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8
Q

Calcium dose in pregnancy

A

1000 mg/day

(Babies will consume mothers bone for calcium during development)

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9
Q

Vit D dose in pregnancy

A

600 IU/day

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10
Q

Recommended vaccination during pregnancy

A

Inactive influenza

Single dose Tdap/pregnancy

Avoid live vaccination

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11
Q

Drug information resources for pregnant

A

Briggs drugs in pregnancy and lactation

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12
Q

Key teratogenic drugs in pregnancy: Acne

A

Isotretinoin

Topical retinoids

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13
Q

Key teratogenic drugs in pregnancy: antibiotics

A

Fluoroqunolone

Tetracycline

Aminoglycosides

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14
Q

Key teratogenic drugs in pregnancy: anticoagulants

A

Warfarin

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15
Q

Key teratogenic drugs in pregnancy: Dyslipidemia/HF/Cardio

A

Statins

ACEi/ARB/Aliskeren/Entresto

Amiodarone/Dronedarone

Atenolol

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16
Q

Key teratogenic drugs in pregnancy: Hormones

A

All hormone containing agent

Duavee

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17
Q

Key teratogenic drugs in pregnancy: Migraine

A

Digydroergotamine

Ergotamine

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18
Q

Key teratogenic drugs in pregnancy: AED

A

Topiramate

VPA/Divalproex

Carbamazepine

Phenobarbital

Phenytoin

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19
Q

Key teratogenic drugs in pregnancy: others

A

Hydroxyurea

Lithium

Methotrexate

NSAIDs

Misoprostol

Paroexetine

Weight loss drugs

Ribavirin

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20
Q

Key teratogenic drugs in pregnancy: others part 2

A

BZD

Dutasteride

Finasteride

Fluconazole

Voriconazole

MMI/PTU

Radioactive iodine

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21
Q

Elevated BP + organ failure

A

Preeclampsia

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22
Q

Elevated BP + organ failure + seizure + death

A

Eclampsia

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23
Q

Low dose aspirin at the end of the first trimester

A

To prevent preeclampsia

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24
Q

Risk factors for preeclampsia

A

HTN

T1/2D

Renal disease

Hx of preeclampsia

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25
Q

Nausea/Morning Sickness/Vomiting tx

A

Lifestyle

Pyridoxine (B6) +- doxylamine

Ginger

26
Q

Hyperemesis gravidium tx

A

OB to treat

27
Q

Bonjesta

Diclegis

A

B6 + doxylamine

28
Q

GERD-Heartburn treatment

A

Lifestyle

Avoid meals 3h prior to sleep

Antacid (Calcium carbonate)

Last: H2RA/PPI

29
Q

Flatulence treatment

A

Simethicone

30
Q

Gas-X

Mylicon

A

Simethicone

31
Q

Constipation treatment

A

Lifestyle

Fiber (psyllium, calcium polycarbophil, methyl cellulose)

Docusate

PEG

32
Q

Cough, Cold, Allergies

A

Cromolyn

First generation antihistamine (chlorphemriamine, diphenyhyramine)

Second gen: second and third trimester

Avoid decongestant in first trimester

Avoid alcohol based liquid formulation

Intranasal steroid preferred for severe allergies (budesonide or beclomethasone)

33
Q

Rhinocort allergy

A

Budesonide

34
Q

Beconase AQ

A

Beclomethasone

35
Q

Pain treatment

A

Non-drug options

Acetaminophen first line agent

Avoid NSAID/Opioid

36
Q

Asthma treatment

A

Budesonide (control)

Albuterol (rescue)

37
Q

Respules

A

Budesonide nebulizer for infants

38
Q

Iron deficiency treatment

A

Iron

Monitor for constpation

39
Q

Hypertension

A

Methyldopa

Nifedipine

Labetalol

40
Q

Diabetes

A

Insulin

Metformin

Glyburide

41
Q

General safe antibacterial

A

Beta lactams

Macrolide

42
Q

Vaginal fungal infection

A

Topical antifungal for 7 days

Avoid fluconazole

43
Q

UTI

A

Keflex/Ampicillin 500mg QID x7 days

Bactrim/Macrobid last line during first trimester. Avoid in last 2 weeks of pregnancy

44
Q

Treat asymptomatic bacteuria in pregnancy

45
Q

How to test for toxoplasmosis

46
Q

Anticoagulants for pregnant

A

Tx: LMWH

Ppx: IPC +/- LMWH

47
Q

Pregnant woman with mechanical valve on warfarin prior to pregnancy

A

Switch to LMWH until 14th week and switch back to warfarin and switch back to LMWH close to delivery

48
Q

When to draw anti-Xa level in pregnancy

A

4hrs post dose of LMWH

49
Q

Hypothyroidism Treatment

A

Levothyroxine

May require higher dose than normal (30-50% increase)

Pregnancy is a hypermetabolic state

50
Q

Hyperthyroidism

A

Achieve euthyroidism prior

PTU preferred if trying to conceive or first trimester

Switch to MMI for remainder of pregnancy

Both can be teratogenic and both carry risk of hepatotoxicity

Avoid radioactive iodine (teratogenic)

51
Q

American Academy of Pediatrics recommendations for breastfeeding

A

First 6 months should be exclusively breast feeding

52
Q

AAP Vitamin D recommendations

A

10 mcg (400 IU) daily until can consume at least 1L of Vit.D fortified formula/day

53
Q

AAP Iton recommendations

A

1 mg/kg/day during months 4-6

54
Q

Lactating mother calories intake

A

Increase diet calories by 450-500 kcal/day

Continues prenatal vitamins and omega-3 supplements

55
Q

Characteristics of drugs that can cross breast milk

A

Non-ionized

Smaller molecular weight

Low volume of distribution

High lipid solubility

56
Q

Lactation drug references

A

Briggs

LactMed

57
Q

Pain meds to avoid with lactation

A

Codeine

Tramadol

58
Q

HIV and breastfeeding

A

Breastfeeding is not recommended

59
Q

HIV positive but on ARV therapy and breastfeeding

A

Breastfeeding not recommended

60
Q

Drugs that should be completely avoided with lactation

A

Chemo

Illicit drug

Radioactive drugs

61
Q

Drugs that require pumping and disposing of breast milk when levels are higher

A

Amphetamines

Amiodarone

Ergotamine

Lithium

Flagyl

Phenobarbital

Statins

Naplex Drug Card (6 decks)

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