drugs, meds, immunization Flashcards
mild sedative used for trt of nausea in pregnancy w/c can cause phocomelia
thalidomide
thalidomide is still used for trt of?
leprosy
multiple myeloma
physiologic changes w/c affects drug mechanism
dec GI motility, inc gastric pH inc plasma vol dec serum albumin, inc alpha-1 acid glycogen inc renal BF inc hepatic microenzyme hyperventilation, inc TV & pulmo BV inc aqueous and fatty tissue spaces
properties of drug that easily cross placenta
highly lipid soluble
non-ionized
LMW
minimally protein bound
fetal pharmacokinetics affecting drugs
protein binding capacity of fetal plasma is lower than maternal
fetal plasma & amniotic fluid are slightly more acidic
metabolizing capacity of fetal liver enzyme is much less
fetal glomerular filtration is markedly reduce
timing and effect of drugs during pregnancy
20 days
all or nothing; fetus is highly resistant to birth defects
timing and effect of drugs during pregnancy
3-8 wks
possibly no effect miscarriage obvious birth defect inc risk of childhood cancer organogenesis
timing and effect of drugs during pregnancy
2nd & 3rd trim
changes in growth & fx of normally formed organs & tissue
unlikely to cause obvious birth defect
unknown long-term effect
FDA drug categories
A - adequate, well-controlled studies no risk of fetal abnormality
B - no risk in animal, no adequate studies in human; risk in animal, no risk in human
C - risk in animal, no adequate studies in human; no adequate studies in animal & human
D - benefit > risk
X - absolute contraindication
Category C
Corticosteroids, Fluconazole, Methylene Blue, Minoxidil
Category D
ACE inhibitors, Aminocaproic acid, ARBs, Aminoglycosides, Atenolol, Carbamazepine, Methimazole, Mifepristone, RU-486, Penicillamine, Potassium iodine, Diatrizoate, Tetracycline, Valproic acid, Antineoplastics (Alkylating agents), Aspirin, Benzodiazepines, Bromides, Colchicine, Phenytoin, Lithium, Mysoline, Phenobarbital or methylphenobarbital, Megesterol, Norethindrone, Tamoxifen
Category X
Antineoplastics (antimetabolites): Methotrexate, Cytaribine, Chlorambucil, Cycolphosphamide Flurazepam, Triazolam, DES, Finasteride, Misoprostol, Raloxifene, Statins, Acetohydroxamin acid, Androrgens (ex. Danazol), Benzodiazepines, Temazepam, Ergotamine, Progestins, Retinoic acid, Isotretinoin (Accutane), Acitretin (Soriatane), Etretinate, Topical tazarotene, Thalidomide, Warfarin
benzodiazepine (DX)
bradypnea or withdrawal symptoms if given late in pregnancy
aminoglycoside (D)
ototoxicity
nephrotoxicity
chloramphenicol (X)
gray baby syndrome
fluoroquinolone
bone & joint abnormalities esp. in 1st trim
nitrofurantoin (B)
hemolytic anemia at term
2-fold risk of cleft lip at 1st trim
contraindicated in G6PD def
TMP-SMX (D)
TMP: interfere w/ folic acid metab
SMX: jaundice & hemolytic anemia
warfarin (X)
schizencephaly, microcephaly, hydrocephalus, blindness, mental disability, fteal hemorrhage
fluconazole (C)
in animals, fetotoxicity, teratogenicity
spironolactone
anti-androgenic
ACE inhibitors (D)
last trim, fetal kidney damage, oligohydramnios, facial, limb & lung defect, fetal hypotension
what anti-hypertensive drugs can be given safely?
nifedipine
methyldopa
beta-blocker (D)
dec HR & fetal growth restriction
calcium channel blocker
1st trim, birth defect of fingers & toes
haloperidol
1st trim, limb defect
3rd trim, extrapyramidal symptoms, restlessness, shaking, dob
phenytoin (D)
inc risk cleft palate & heart defect
valproate (D)
heart, face, skull, limb, and neural tube defect
methotrexate (X)
early, abortion
micrognathia, cleft palate, spinal abnormalities, ear defects, club foot
danazol (X)
early, masculinization
isotretinoin (X)
abortion, heart defect, small ears, hydrocephalus
radioactive iodine (D)
fetal hypothyroidism, mental retardation, inc risk of malignancy
safest & best drug for PPROM
ampicillin
drug for PPROM with complication
clindamycin
cephalosporin is generally safe. T or F?
true
co-amox is associated w/ birth defect if given in 1st trim. T or F?
false
tetracycline (D)
2nd or 3rd trim, dental staining
metronidazole (B)
carcinogenic in rats but no AE in human pregnancy
diphenhydramine & meclizine (B)
not recommended in the last 2 wks d/t risk of retrolental fibroplasia
metoclopramide (B)
inc rate of gastric emptying
high doses: extrapyramidal symptoms
ondansetron (B)
used in postchemo N/V
first line for N/V
emetrol
drugs for heartburn & GERD
antacids (B: Al & Mg; C: Ca)
H2-R blocker (B)
PPI (C): avoided in 1st trim
drugs for constipation
bisacodyl
senna
psyllium
drugs for diarrhea
kaolin & pectin
loperamide
paracetamol (B)
first choice
high dose: embryotoxicity
NSAID (C 30 wks; D >30 wks)
potential orofacial cleft (naproxen) & structural cardiac defect
risk of premature closure of DA if given in 3rd trimester
opiods (C)
chronic use may lead to dependence & withdrawal symptoms
slightly greater risk of spina bifida, gastroschisis, cardiac abnormalities
magnesium sulfate (D)
prevent & treat seizure in preeclampsia
fetal neuroprotection (<32 wks)
short term prolongation of pregnancy (up to 48 hrs)
AE: bone demineralization
nifedipine (C)
SM relaxation
anti-hypertensive & tocolytic
methyldopa (B)
first line anti-hypertensive
alpha adrenergic agonist centrally
not diminish uterin BF
caution in depression
hydralazine (C)
SM relaxation (vasodilator)
lowers BP rapidly
AE: neonatal thrombocytopenia & lupus
isoxsuprine/terbutaline
beta 2 agonist (vasodilator)
uterine muscle relaxation
AE: maternal pulmo edema
recommendation for Hepa A & B vax
A: if needed
B: if high risk
recommendation for TdaP
1 dose >20 wks preferrably 27-36 wks
recommendation for meningococcal vax
given if needed
recommendation for pneumococcal vax
given if needed
recommendation for HPV vax
not given during pregnancy
recommendation for MMR vax
contraindicated
avoid pregnancy <3 months post-MMR vax
recommendation for varicella vax
contraindicated
recommendation for zoster vax
contraindicated
recommendation for dengue vax
contraindicated
recommendation for rabies vax
given if needed
