Drug Use in Pregnancy & Lactation

Question 1

what does G2P1

Answer 1

patient has been pregnant twice and given birth once

Question 2

what supplementation and at what doses are recommend while preg

Answer 2

folate 600mcg/day
calcium 1000mg/day
Vit D 600IU/15mcg a day

Question 3

what is preg category A

Answer 3

tested in animals and women and deemed safe in first trimester

Question 4

what is preg category B

Answer 4

animal studies showed no risk but there are no studies in preg women

Question 5

what is preg category C

Answer 5

animal studies showed harm, but no well controlled studies in humans

Question 6

what is preg category X

Answer 6

animal and human studies showed fetal abnormalities
contraindicated in pregnancy

Question 7

what drugs are teratogens

Answer 7

ABX: FQs, TTC, AGs
acne: tretinoins
anticoag: warfarin
HLD/HTN/HF: RAASi, statins
all hormones
amiodarone
Li
VPA
hydroxyurea
MTX
topamax
paxil
misoprostol
benzos
opiates
NSAIDs

Question 8

preeclampsia definition

Answer 8

HTN with possible end organ damage between 20 weeks gestation and delivery

Question 9

eclampsia definition

Answer 9

epilepsy between 20 weeks gestation and delivery

Question 10

why and when should ASA 81mg be initiated during gestation

Answer 10

preeclampsia + DM, kidney disease, hx preeclampsia, chronic HTN
in second and third trimesters

Question 11

what are the trimesters in pregnancy

Answer 11

First trimester: Weeks 1–12 (3mo)
Second trimester: Weeks 13–28
Third trimester: Weeks 29–40, the shortest trimester

Question 12

morning sickness/N/V tx in pregnancy

Answer 12

doxylamine and B6 (pyridoxime)
brand = Bonjesta or Diclegis

ginger

Question 13

GERD/heartburn tx in pregnancy

Answer 13

lifestyle + TUMS first line

H2RA and PPI second line

Question 14

flatulence tx in pregnancy

Answer 14

simethicone (GasX)

Question 15

constipation tx in pregnancy

Answer 15

2 = PEG, docusate

lifestyle and inc fiber

Question 16

cough, cold, allergies tx in pregnancy

Answer 16

cromolyn x 3d

budesonide (Rhinocort)
beclometasone
avoid liquids with alcohol

Question 17

pain tx in pregnancy

Answer 17

APAP and non-pharm
ASA only ok for preeclampsia

Question 18

asthma tx in pregnancy

Answer 18

budesonide (Rhinocort) and albuterol

Question 19

IDA tx in pregnancy

Answer 19

prenatal with iron

Question 20

HTN tx in pregnancy

Answer 20

labetalol, methyldopa, nifedipine

Question 21

DM tx in pregnancy

Answer 21

insulin

Question 22

ABX safe in preg

Answer 22

penicillins
cephalosporins
macrolides

Question 23

vaginal fungal infxn tx in pregnancy

Answer 23

topical antifungals x 7d

Question 24

UTI tx in pregnancy

Answer 24

always tx bacteruria even if asx and (-)UA
cephalexin 500mg PO 4x/day x7d
ampicillin 500mg PO 4x/day x7d

SMX and Macrobid are last line in first trimester and last 2 weeks of pregnancy

Question 25

anticoag tx in pregnancy

Answer 25

LMWH

Question 26

hypothyroidism tx in pregnancy

Answer 26

levothyroxine, dose may need to be increased 30-50%

Question 27

hyperthyroidism tx in pregnancy

Answer 27

PTU in first trimester MMZ in second and third trimesters

Question 28

which vaccines should pregnant patients receive

Answer 28

inactivated influenza vaccine TdaP

Question 29

how much vitamin D do babies receive in breastmilk

Answer 29

10mcg/400IU a day

Question 30

iron supplementation in newborns when to supplement, how much to supplement and why do we start at that time

Answer 30

1mg/kg/d in months 4-6 iron stores in newborn can last them for 4 months!

Question 31

while breastfeeding, how should mom use supplements

Answer 31

inc diet by 450-500kcal/day continue omega 3 FAs continue prenatal vitamin

Question 32

what drug characteristics increase excretion into breastmilk

Answer 32

low Vd unionized lipophilic low MW

Question 33

what drugs should NOT be taken by the mom while breastfeeding

Answer 33

tramadol codeine and ANY opiate tobacco amiodarone ergotamines statins phenobarb amphetamines Li

Question 34

can a mom breastfeed until suspected HIV results come back negative

Answer 34

no, should not breastfeed if there is even a slight possibility of HIV