Drug Use in Pregnancy and Lactation Flashcards
When in relationship to pregnancy should teratogenic drugs be stopped
prior to pregnancy
Which trimester is most susceptible to birth defects
first
What is adequate folic acid consumption in women of childbearing age
400-800 mcg daily
What is adequate calcium consumption in women of childbearing age
1000 mg daily
What is adequare vitamin D consumption in women of childbearing age
600 IU daily
When should folate be taken in relation to pregnancy to prevent birth defects of the brain and spinal cord
at least one month prior and continued for the first 2-3 months
vaccine recommendations during pregnancy
inactivated influenza regardless of trimester, Tdap between 27-36 weeks of each pregnancy (3 doses if vaccine history unclear), NO LIVE VACCINES one month before and during pregnancy,
meaning of pregnancy category A
Controlled studies in animals and women have shown no risk in the first trimester, and possible fetal harm is remote
meaning of pregnancy category B
Either animal studies have no demonstrated 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 of women in the 1st trimester
meaning of 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 IF POTENTIAL BENEFIT OUTWEIGHS THE RISK
meaning of pregnancy category D
Positive evidence of fetal risk is available, but the benefits may outweigh the risk of life-threatening or serious disease
meaning of pregnancy category X
studies in animals or humans show fetal abnormalities. USE IN PREGNANCY IS CONTRAINDICATED
Well known teratogens
alcohol, ACE/ARB, benzos, carbamazepine, dutasteride, ergot derivatives, finasteride, isotretinoin, lenalidomide, leflunomide, lithium, methimazole, methotrexate, misprostol, nafarelin, NSAIDs, paroxetine, phenobarbital, phenytoin, propylthiouracil, quinolones, ribavirin, statins, tazarotene, tetracyclines, thalidomide, topiramate, valproate, warfarin
FDA warning about SSRI risk in pregnancy
potential risk of persitent pulmonary hypertension of the newborn
Medications that should not be handled by pregnant women
5-alpha reductase inhibitors, testosterone, mycophenolate, ganciclovir, chemotherapeutics
preferred lifestyle changes for management of morning sickness, N/V in pregnancy
eat smaller more frequent meals, avoid spicy/odorous foods, frequent naps, reduce stress
1st line medications for management of morning sickness, N/V in pregnancy
pyridoxine (B6) +/- doxylamine
preferred lifestyle changes for management of GERD/heartburn in pregnancy
eat smaller, more frequent meals, avoid foods that worsen GERD, elevate the head of the bed and not eating 3 hours prior to sleep
preferred medications for management of GERD/heartburn in pregnancy
Antacids recommended (calcium based), H2RAs - cat B, PPIs - cat B or C
preferred medications for management of flatulence during pregnancy
simethicone
lifestyle changes for management of constipation during pregnancy
increased fluid intake, increased dietary fiber intake, increase physical activity
preferred medications for management of constipation of constipation during pregnancy
fiber (psyllum, calciu polycarbophil, methylcellulose) with adequate amounts of fluid
preferred medications for cough, cold, allergies during pregnancy
first generation antihistamines (chlorpheiramine [Drug of choice] and diphenhydramine); non-sedating 2ng generation antihistamines loratadine and ceterizine during 2nd and 3rd trimesters.
safest nasal steroids in pregnancy
budesonide (Rhinocort) and beclomethasone (Beconase AQ)
preferred management of pain in pregnancy
Acetaminophen (currently investigating risk of ADHD with acetaminophen use)
Risk with NSAIDs during pregnancy
risk of miscarriage
Opioid preference in lactating women
short acting at lowest doses effective taken after feedings
antibiotics generally considered safe during pregnancy
penicillins, cephalosporins, erythromycin, azithromycin
Antibiotics to avoid during pregnancy
quinolones, tetracyclines
preferred treatment for vaginal fungal infections during pregnancy
topical antifungals x 7 days
avoid treatment of vaginal fungal infections with this during pregnancy
fluconazole
consequences of untreated bacteriuria in pregnancy
premature birth, pyelonephritis, neonatal meningitis
preferred treatments for UTI during pregnancy
Cephalexin 500 mg Q6H x 7 days or Ampicillin 500 mg Q6H x 7 days
preferred treatment of asthma during pregnancy
maintanence : inhaled budesonide. rescue: inhale albuterol
preferred treatment of VTE/mechanical valves during pregnacy
LMWH (cat B) / UFH in last month or if delivery is imminent + pneumatic compression devices prior to delviery in women with VTE if getting a C-section
Preferred treatment of hypothyroidism in pregnancy
levothyroxine (Cat A) requiring a 30-50% dose increase
consequences of untreated hypothyroidism in pregnancy
spontaneous abortion/miscarriage, preeclampsia, stillbirth, growth/cognitive impairment, low birth weight
preferred treatment of hyperthyroidism in pregnancy
propylthiouracil when trying to conceive and during the first trimester, methimazole during the 2nd and 3rd trimester
consequences of untreated hyperthyroidism during pregnancy
premature delviery and low birth weight
preferred treatment of iron deficiency anemia during pregnancy
supplemental iron, prenatal vitamins with iron
preferred treatment of HTN in pregnancy
labetalol, methyldopa, nifedipine
HTN drugs contrindicated in pregancy
ACE/ARB and direct renin inhibitors
preferred treatment of diabetes in pregnancy
insulin is preferred. metformin and glybride commonly used
