Drug Use in Prego & Lactation

Question 1

hCG

Answer 1

prego hCG+

Question 2

foliolate

Answer 2

400mcg DFE daily
then prego 600mcg DFE daily = 360mcg RDA

Question 3

prego Ca

Answer 3

age: 19-50 require
1,000mg/day of Ca and 15mcg/day (600IU/day) of vitamin D

Question 4

teratogens: key drugs
acne

Answer 4

isotretinoin, topical retinoids

Question 5

teratogens: key drugs
antibiotics

Answer 5

quinolones, tetracyclines

Question 6

teratogens: key drugs
anticoagulants

Answer 6

warfarin

Question 7

teratogens: key drugs
dyslipidemia, HF, and hypertension

Answer 7

Statins
RAAS inhibitors (ACE & ARB inhibitors, aliskiren, sacubitril/valsartan)

Question 8

teratogens: key drugs
hormones

Answer 8

most, including estradiol, progesterone (including megestrol), raloxifene, Duavee, testosterone, contraceptives

Question 9

teratogens: key drugs
migraine

Answer 9

dihydroergotamine, ergotamine

Question 10

teratogens: key drugs
other!

Answer 10

hydroxyurea
ribavirin
lithium
thalidomide
methotrexate
topiramate
misoprostol
weight loss drugs
NSAIDs
Paroxetine
Valproic Acid/Divalproex

Question 11

prego reputable resource

Answer 11

Briggs’ Drugs in Prego and Lactation

Question 12

pre-eclampsia

Answer 12

elevated BP and evidence of organ damage
untreated can lead to seizures and death

low-dose aspirin end of 1st trimester of prego! sketchy

Question 13

morning sickness, N/V

Answer 13

lifestyle 1st!: smaller meals, avoid spicy foods, etc. Ginger is an option
if lifestyle measures fail: pyridoxine (B6) +/- doxylamine

Question 14

GERD/Heartburn

Answer 14

Lifestyle: Avoid spicy foods, small meals, do not eat 3 hrs prior to sleep
if lifestyle measures fail: antacids (Ca carbonate Tums) are a good option

Question 15

Flatulence

Answer 15

simethicone (Gas-x, Mylicon)

Question 16

constipation

Answer 16

lifestyle: Increase fluid intake, fiber, and physical activity

if lifestyle measures fail: fiber (psyllium, Ca polycarbophil, etc. ) preferred
Docusate and polyethylene glycol are used.. docusate does come in most prenatal vitamins

Question 17

Cough, Cold, Allergies

Answer 17

first-line: cromolyn
Second-line: 1st-gen antihistamines (chlorpheniramine- drug of choice, and diphenhydramine are commonly used)

non-sedating 2nd-gen loratadine and cetirizine are often recommended by during 2nd and 3rd trimester

avoid -OH
nasal steroid if needed: budesonide and beclometasone

Question 18

Pain

Answer 18

non-drug: massage or Physical therapy
acetaminophen 1st line
Avoid NSAIDs

Question 19

Asthma

Answer 19

maintenance therapy: budesonide is preferred (all inhaled corticosteroids are considered safe)
rescue: inhaled albuterol

Question 20

iron deficiency anemia

Answer 20

prenantal w/iron
iron worsens constipation

Question 21

hypertension

Answer 21

labetalol, methyldopa, nifedipine

Question 22

diabetes

Answer 22

insulin preferred

Question 23

vaginal fungal infection

Answer 23

avoid fluconazole, voriconazole
- topical antifungals (cream, suppositories) x 7 days

Question 24

UTI

Answer 24

Cephalexin 500mg PO Q6H x 7 days
Ampicillin 500mg PO Q6H x 7 days
Nitrofurantoin and SMX/TMP should be considered last line, during the 1st trimester and should not be used in the last 2 weeks of prego!

Question 25

anticoagulation

Answer 25

tx w/ LMWH preferred over UFH

Question 26

hypothyroidism

Answer 26

levothyroxine (30-50% dose increase)

Question 27

Hyperthyroidism

Answer 27

mild case do not tx
if drugs are neccessary, graves’ disease- propylthiouracil (PTU) is preferred 1st trimester

PTU and methimazole both care for fetal tox, history pt switch to methimazole for the remained of prego
Methimazole less liver damage but both can cause liver damage

Question 28

breastfeeding HIV

Answer 28

not recommended HIV pts