Drug Use in Pregnancy and Lactation

Question 1

All woman of childbearing age should take what supplement and how much of it?

Answer 1

Folic acid 400 mcg/day

Question 2

During pregnancy, how much Folic Acid should the mother take?

Answer 2

600 mcg/day

Question 3

During pregnancy, how much Calcium and Vitamin D should the mother take?

Answer 3

1,000 mg/day of Calcium

600 IU/day of Vitamin D

Question 4

What is the first line treatment for morning sickness, nausea, and vomiting in pregnant woman?

Answer 4

OTC: Pyridoxine (Vitamin B6) + Doxylamine (Unisome)

Rx: Diclegis, Bonjesta

Question 5

What is the first line treatment for Heartburn in pregnant woman?

Answer 5

Lifestyle changes

Tums

Question 6

What is the first line treatment for Flatulence in pregnant woman?

Answer 6

Simethicone

Question 7

What is the first line treatment for Constipation in pregnant woman?

Answer 7

Lifestyle changes: increase water and dietary fiber intake, increase physical activity

Fiber (psyllium, calcium polycarbophil)

Question 8

What is the first line treatment for Cough, Cold, Allergies in pregnant woman?

Answer 8

First generation antihistamines: Chlorpheniramine is drug of choice

Chronic allergy: Budesonide (Rhinocort) or Beclomethasone (Beconase AQ)

note: avoid alcohol containing products

Question 9

What is the first line treatment for Pain in pregnant woman?

Answer 9

Acetaminophen

Avoid NSAIDs and Aspirin

Question 10

What is the first line treatment for Asthma in pregnant woman?

Answer 10

Maintenance: Budesonide (Pulmicort)

Rescue: Albuterol

Note: Budesonide also preferred in infants

Question 11

What is the first line treatment for HTN in pregnant woman?

Answer 11

• Labetalol
• Methyldopa
• Nifedipine

Note: ACEI/ARBs/ARNI are contraindicated

Question 12

What is the first line treatment for DM in pregnant woman?

Answer 12

Insulin is preferred

Metformin and Glyburide are commonly used

Question 13

What is the first line treatment for UTI in pregnant woman?

Answer 13

• Cephalexin 500mg PO Q6hrs for 7 days
• Ampicillin 500mg PO Q6hr for 7 days

***Note: MUST treat bacteriuria even if asymptomatic with negative urinalysis. Untreated bacteriuria can lead to premature birth with **Augmentin or Cephalosporin

Note: Nitrofurantoin and SMX/TMP should be considered last line during the 1st trimester and should not be used in the last 2 weeks of pregnancy

Question 14

Which antibiotics are considered safe to use in pregnancy?

Answer 14

• Penicillins
• Cephalosporins
• Erythromycin
• Azithromycin

Question 15

What 2 antibiotics are contraindicated in with pregnancy?

Answer 15

• Tetracyclines (due to teeth discoleration)

- Quinolones (due to cartilage damage)

Question 16

What is the first line treatment for VTE/Mechanical Valved in pregnant woman?

Answer 16

Low molecular wight heparin (LMWH) is preferred over all others

Note: Warfarin is teratogenic

Question 17

What is the first line treatment for Hyperthyroidims in pregnant woman?

Answer 17

Propylthiouracil is preferred if tying to conceive and in the 1st trimester.

After that, the patient would be switched to Methimazole for the remainder of the pregnancy but other treatments can be individualized also.

Question 18

What is the first line treatment for Hypothyroidism in pregnant woman?

Answer 18

Levothyroxine but the dose needs to be increased by 30 - 50% during pregnancy

Question 19

What drugs should be avoided during lactations?

Answer 19

• Metronidazole
• Amphetamines
• Amiodarone
• Ergotamines
• Lithium
• Statin
• Codeine
• Tramadol