GI Issues in Pregnancy

Question 1

How to treat mild N/V

Answer 1

Ginger
Acupressure bands
Discontinue vitamins but continue with folic acid
B6 (pyridoxine) 10-25mg q8hrs

Question 2

How to treat moderate N/V

Answer 2

Dicligis (10mgB6/10mg doxylamine succinate) 2-4 tablets at night (anticholinergic—May cause drowsiness)

Question 3

How to treat moderate n/v without success with dicligis?

Answer 3

• Diphenhydramine (Benedryl) 50-100g q4-6hr
• Metoclopramide (Reglan) 5-10mg q6-8hrs
• –(BBW: agitation and anxiety)
• Odanesetron (Zofran) 4-8mg q6-8h
• –(ADE: headaches, QT prolongation)
• Promethazine (Phenergan) 12.5-25mg q4-6 hrs (anticholinergic)
• –May decrease opioid effects
• Prochlorperazine (Compazine) 5-10mg q6-8h (anticholinergic)

Question 4

1st line for infrequent stools

Answer 4

Bulk-forming laxatives (e.g., Calcium polycarbophil or Carboxymethylcellulose)

Question 5

1st & 2nd line for hard stools (or to prevent strain in perineal surgeries)

Answer 5

1st-stool softeners (e.g. Docusate sodium/Colace or Senna)

2nd-Lubricants (mineral oil)

Question 6

Tx for chronic constipation

Answer 6

nonabsorbable sugars and osmotic agents (Lactulose and milk of mag)

Question 7

Dosage for Colace and Peri-Colace

Answer 7

Colace: 50-100 mg 1-2x/day

Peri-colace: 50 mg colace/8.6 mg Senna 1-2 tabs 1-2x/day

Question 8

Dosage for mineral oil

Answer 8

15-45 mL 1-2x/day

Question 9

What is the safest drug for constipation in pregnancy/BF?

Answer 9

Glycerin suppository 3g (works w/in 30 mins)