Lecture 5 - Pregnancy Flashcards
The should pt take preg test to be accurate?
1 week after missed period
morning
follow up with PCP to confirm
Gravida
number of times person pregnant, regardless of outcome
PARA
number of births carried to viability (20 weeks)
TPAL
T = number of term deliveries
P = number of preterm deliveries
A = number of abortions/miscarriages/ectopic pregnancies
L = number of living children
Trimester
1st = 1-13
2nd = 14-26
3rd = 27-40
Duration of pregnancy
9.5 months, ~ 40 weeks
add 7 days to last day of period for conception and ~ 9months for due date
Passive diffusion drug properties?
Mw < 500
High lipid solubility
Low Degree of ionization
Low protein binding
Ways to prevent neural tube defects
Folic acid (B9) supplement
Smoking cessation
Avoid/limit caffeine intake
vaccination
Folic Acid dosing for neural tube defect prevention
400mcg = daily non preg
600-800mcg/day if preg
4mg/day if have a NTD, prev preg had NTD, type 1 DM, on anti-seizure meds
Smoking cessation that can be used during preg?
Patches or gum can be used, replacement therapy less harmful than smoking cigs
Vaccines during preg
Flu
Tdap = after 20weeks, ideally 27-36
Covid-19
Vaccines before pregnancy
ideally up to date
give any live req vaccines before preg
Vaccines after pregnancy
Tdap if didn’t get
MMR/Varicella if not already immune
Non-pharm morning sickness treatments
Slowly rise from bed
Eat small snack in bed before getting up
Ginger (up to 1g/day)
Eat multiple, small meals/snacks throughout the day
Pharm Treatments morning sickness
Pyridoxine (B6) +/- doxylmine
Unisom = OTC
Diclegis = RX
Boniest = RX
Metoclopramide
Prochlorperazine
Diclegis info
10mg Doxylamine/pyridoxine
Day 1/2 = 2 tab QHS
Day 3 = tab AM and 2 QHS if still have symptoms
Day 4+ = 1 QAM/QPM/ 2QHS (4QD Max)
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Bonjest info
20mg Doxylamine/pyridoxime…its ER
Day 1 = 1 QHS
Day 2 = 1QAM/QHS
Antihistamines safe for allergies
1st gen = chlorpheniramine/diphenhydramine
2nd gen = loratadine/cetirizine
Intranasal = fluticasone furoate, mometasone, budesonide
Caution: oral and nasal decongestant such as phenylephrine
non-pharm constipation treatments
Inc dietary fiber
inc fluid intake
Exercise
Sits bath for hemorrhoids
Pharm treatment options for constipation
Bulk forming lax = psyllium or methyl cellulose = 1st line
Stool softeners = docusate
Stimulant lax = Senna (pref) or bisacodyl =use if dont respond to others
Osmotic lax = Poly gly or lactulose = only use short term if nothing else work
Lubricant lax = mineral/castor oil = AVOID
Non-pharm back pain options
Heating pad/ice
Massage/chiropractor
Acupuncture
Exercise
Elevate when sit
Tips for prevention of preg back pain
wear low heeled shoes
maintain good posture
sleep on side with pillow between legs
squat when picking up
Pharm treatment for backpain
Tylenol = go to all trimesters
NSAIDS = avoid after weeks 20
Can use topical analgesics such as Lido patch or capsaicin cream
Non-pharm heartburn/indigestion treatment
Multiple small meals/snacks
Avoid caffeine
no food prior to bed
raise head of bed
traffic light diet
Pharm Heartburn/indigestion treatment
Ca/Mg/AL antacids…avoid taking within 2hrs of iron or folic acid supplement
Mod-Severe symptoms = H2RA or PPI
Avoid sodium bicarb
Nonpharm Cold/cough treatments
Rest
inc fluid intake
elevate head while sleep
humidifier
throat lozenge
gargle with salt
Pharm Cold/cough Treatments
avoid combo, often have alc in them
fever/pain = tylenol
Runny nose = anti hist
Cough = guaifenesin/dextromethorphan safe
Congestion = avoid Sudafed 1st trimester, phenylephrine in preg
Screening for DM in pregnancy
OGTT does between weeks 24-28
indicated for those with BMI > 25 and 1 additional risk factor for DM
Nonpharm DM in preg management
Diet modifications
light or moderate exercise
weight management
Pharm management for DM in preg
Insulin = drug of choice
Metformin
Glyburide = cross placenta, fallen out of favor
Gestation HTN
HTN during preg after 20th week without pre-eclampsia
no proteinuria
can develop into pre-eclampsia
Pre-eclampsia is…
new onset of hypertension after 20 weeks of gestation in previously normotensive patient
Criteria for Pre-eclampsia
SBP > 140 or DBP > 90 on 2 occasions atleast 6hrs apart OR SBP > 160/ DBP > 110 plus….
Proteinuria
platelets < 100K
LFTs 2X ULN
Renal dysfunction ( Scr > 1.1 or dble previous)
Pulmonary edema
Cerebral or visual disturbances
Who is at risk for Pre-eclampsia
1st preg
obese
family or personal history
< 20 or 35-40yrs old
Gestational DM
Multiple gestation = twin or triplets
HTN, Kidney disease, Lupus, DM prior to preg
Risk reduction for at risk for Pre-eclampsia
Low dose aspiring from weeks 12-36
Pharm HTN management
Labetalol = caution asthma
Hydralazine = Lookout for lupus like symptoms
Nifedipine = Use ER, IR associated with hypotension
Methyldopa = safe, not really used
HCTZ = look out for orthostatic hypotension
Pharm HTN agents to avoid pregnancy
ACEi
ARBs
Spironolactone
What to do if pt has pre-eclampsia
Delivery is only cure
Consider betamethasone if 24-34 weeks
Treat HTN acutely (IV labetalol or hydralazine)
prevent seizures w/ IV mag
Hyperemesis Gravidarum
severe nausea and vomiting
Dif from morning sickness by….
Dehydration
Electrolyte/metabolic disturbances
Nutritional deficiency
Weight loss > 5%
Hyperemesis Gravidarum treatment
IV fluids
Nutrition via tube
Antiemetics
Vitamin and electrolyte repletion
VTE in pregnancy
inc throughout preg, highest 6 weeks post party
VTE Management in pregnancy
Heparin
Enoxaparin = 1mg/kg BID
Dalteparin 100unit/kg BID
generally avoid warfarin and direct acting anticoagulants
Duration = remainder of therapy and + 6 weeks post part (minimum duration 3 month)
