exam 2 pregnancy and lactation pp Flashcards by kaitlyn blair

healthy behaviors for women of reproductive age

take folic acid (0.4mg/day)
maintain healthy weight and diet
regular physical activity
tobacco cessation
alcohol in moderation
avoid drugs of abuse
screening and chronic disease management
use STI and pregnancy prevention

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folic acid recommendations

0.4-0.8mg/day starting 1 month before planned pregnancy through 12 weeks

high risk- 4mg/day for the with previous pregnancy with neural tube defects or family history start 3 months before planned pregnancy through 12 weeks

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vaccines

flu
covid
TdAP (27-36 weeks)
Hep A and B
Men A and B

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vaccines contraindicated

MMR
VAR
HPV
LAIV

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potential risks of meds

fetal malformations
pregnancy loss
premature
infant death
developmental disability
neonatal withdrawal

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teratogens

tetracycline
paroxetine
lithium
antineoplastics
quinolones
carbamazepine
warfarin
cocaine
isotretinoin (acutane)
topiramate
mercury
alcohol
statins
phenytoin
methotrexate
thalidomide
lead
ACE
valproate

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old FDA label A,B,C,D,X

A- no increased risk
B- not well studied in humans, animal studies showed no harm
C- not well studied in humans, animal studies showed and adverse effect OR human study showed no risk but animal studies did
D- risk to fetus but benefits of therapy outweigh risk to fetus
X- harm

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prior labels (pregnancy, labor and delivery, nursing mothers) was replaced with

pregnancy
lactation
females and males of reproductive age

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pregnancy labeling has

risk summary (risk of fetal abnormalities)
clinical considerations (maternal and fetal risks, dose adjustments, ADR)
supporting data

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lactation labeling has

risk summary (presence in milk, effects on child and milk production)
clinical considerations (counseling info, minimizing exposure, monitoring reactions)
data

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females and males of reproductive age labeling has

pregnancy testing (recommendations and requirements)
conception (before, during, after therapy)
infertility (data on effects on fertility)

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after delivery when do moms change to non-opioid

4 days
use APAP or ibuprofen

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if opioids being used

only for postpartum pain not relieved by APAP or ibuprofen
lowest dose and shortest duration possible
use PRN
watch for baby toxicity (limpness, difficulty feeding or breathing, or sleeping more than usual)
do not use oxycodone, codeine, tramadol, meperidine or hydrocodone
morphine is compatible, does not transfer to breastmilk

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N/V starts when

5 weeks and lasts through 1st trimester

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hyperemesis gravidarum

vomiting causing weight loss of >5% of pre pregnancy weight and ketonuria

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N/V 1st line

nonpharm-
avoid triggers (smells, food, motion)
keep stomach from being empty
salt crackers
small meals
avoid spicy foods
acupressure point on wrist

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ondansetron studies show

increased risk of congenital heart defects and cleft palate
prolonged QT interval

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don’t use antihistamines when and why

last 2 weeks of pregnancy due to risk of retrolental fibroplasia in premature infants

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when treating hemorrhoids what should you avoid

topical anesthetics and steroids

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what occurs later in pregnancy due to enlarged ultras putting pressure on stomach and causing esophageal sphincter to relax

GERD

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when treating GERD what should be avoided

magnesium trisilicate
sodium bicarbonate

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when treating constipation what should be avoided

mineral and castor oil

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when treating headaches what should be avoided

aspirin
NSAIDs

when should they be screened for UTI

12-16 weeks

beta lactase and nitrofurantoin should not be used after when

week 37

avoid sulfa drugs when

last weeks of gestation

avoid trimethoprim when

1st trimester

which 2 antibiotic classes are contraindicated

tetracyclines fluoroquinolones

when should chlorpheniramine for allergic rhinitis not be used

last 2 weeks of pregnancy

what is consider HTN in pregnancy

>140/>90 severe >160/>110

gestational HTN at what week

after week 20

eclampsia

HTN + seizures

preeclampsia

HTN + proteinuria (>300mg in 24 hours) or protein/creatinine ratio >0.3mg/dl OR HTN + 1 of the following: thrombocytopenia impaired liver function renal insufficiency pulmonary edema new onset HA and responding to meds

tight BP control or aggressive BP lowering can do what to the fetus

reduce blood flow and growth

chronic HTN goal

<160/110 but >120/80

sever HTN goal

should be treated urgently (30-60min) 140-150/100

what HTN drugs cannot be used

ACE and ARB eplerenone spironolactone tekturna

what is preferred for anticoagulation

LMWH

for hypothyroidism a dose change of Levothyroxine should be to

increase dose 30-50%

depression in pregnancy is associated with what?

premature delivery and deceased birth weight

what SSRI should be avoided in pregnancy and why

paroxetine, risk of congenital CV malformations

what SSRI is preferred in lactating women?

sertraline

what drug can you use to prevent preeclampsia

low dose aspirin beginning late in the 1st trimester (81mg from weeks 12-28)

when should you screen for gestational diabetes

at first visit if they have risk factors OR at weeks 24-28 gestation at weeks 4-12 postpartum if diagnosed with GDM you should screen lifelong every 3 years

diagnosing methods

one step 2hr 75g OGTT (positive test 135-140) two step 1h 50g non fasting followed by 3h 100g OGTT (positive test fasting >95, 1h >180, 2h>155, 3h>140)

gestational diabetes treatment of choice

insulin

what oral agents can be used but cross placenta

metformin and glyburide

GDM goals

preprandial <95 1h postprandial <140 2h postprandial <120

when is group B strep screened for

weeks 36-37 of gestation

when using anticoagulants

don't us multi dose vials due to preservatives LMWH is dosed based on current body weight use UH if patient has renal dysfunction

enoxaparin dosing

therapeutic dose (treatment) 1mg/kg q12h SQ (stop 24-36 hours before delivery) intermediate dose 40mg q12h SQ prophylactic dose 40mg daily (stop 12-24 hours before delivery)

preterm labor

contractions with cervical changes before week 37

preterm birth

20-36 weeks

don't use tocolytic therapy when

before weeks 23-24 and not used after week 34

tocolytic used when

contractions AND cervical ripening is occurring postpones delivery long enough to allow for the max effect of antenatal steroids

when to induce labor

sever infection uterine bleeding preeclampsia and eclampsia DM marcosomia renal insufficiency premature rupture of membrane after week 36 placenta not functioning well greater than 42 weeks

narcotics are associated with

neonatal respiratory depression