medications during pregnancy

Question 1

When is the classic teratogenic period?

Answer 1

31-81 days following LMP

Question 2

what are effects of lithium during pregnancy?

Answer 2

cardiac defect

Question 3

Can someone take a teratogen before 31 days of LMP?

Answer 3

yes! no organ systems are developing. after 81 risk decreases

Question 4

how do substances pass through placenta?

Answer 4

passive diffusion, prefer highly lipohilic drugs

Question 5

what molecular weight can cross placenta BB?

Answer 5

500 daltons

Question 6

what molecular weight rarely pass through placenta?

Answer 6

> 1000 daltons

Question 7

what are examples of drugs that have poor placenta diffusion?

Answer 7

heparin and insulin

claritin (loratadine)

Question 8

high risk drugs for placenta diffusion are what?

Answer 8

OTC and prescriptions sedation

Question 9

Best - no studies on people. but no to little risk in animals or show some in animals but no risk in pregnant women

Answer 9

category B

Question 10

Caution - shown risk in animal models, non found in people

Answer 10

Category C

Question 11

Danger - shown risk in human pregnancy nit used occasionally if life threatening

Answer 11

Category D

Question 12

X - Cross these drugs off the list - teratogenic effects and no therapeutic conditions

Answer 12

Category X

Question 13

A okay - studies done in pregnant women and no risk.

Answer 13

Category A

Question 14

examples of Category X drugs?

Answer 14

accutane, warfarin, misoprostol, thalidomine

Question 15

How to treat cold?

Answer 15

symptom management, cholorphniramine or pseudofed.

nasal spray

oxymetazolie (vixks sinez) or phenyllephrine

cough –> gauifenesin and dextropmethrophan (robitussin DM)

Question 16

Headaches tx?

Answer 16

No ibuprofen

YES tylenol and ONLY

triptans are category C so not really good option
lidocaine 4% as nasal spray can help a little

Question 17

allergies tx?

Answer 17

benadryl or loratadine.

Question 18

yeast infections tx?

Answer 18

vaginal cream clotrimazole, monistat

Question 19

Heartburn tx?

Answer 19

tums or maalox

Question 20

constipation tx?

Answer 20

docusate, metamucil

Question 21

diarrhea tx?

Answer 21

kaopectate and omodium

Question 22

Category A examples?

Answer 22

vitamins at RDA (vitamin A)

levothyroxine

Question 23

Category B examples ?

Answer 23

• beta lactam antimicrobials (PCN, cephalosporins)
• select macrolides (azithromycine, erythromycin)
• acetiminophen

Question 24

Category C examples?

Answer 24

clarithromycin
flouroquinolone
TMP-SMX

Most SSRIs, corticosteroid, antihypertensives

Question 25

Category D examples?

Answer 25

gentamicin

ACEI, ARB

Tetracyclines (doxycycline, minocycline)
paroxetine

Question 26

When are bronchospasms the worst in GA?

Answer 26

29-36 weeks r/t GERD

Question 27

asthma tx in pregnancy?

Answer 27

• continue bc risk of fetal hypoxia more pertinent
• ICS category C (pulmicoryt or budesonide category B) tx asthma flare
• Beta agonists category C (rescue drug for pregnant women)
• leukotreine modifiers no studies really but category B and C

Question 28

tx of H pylori in pregnancy?

Answer 28

if recurrent n/v and GI issues.

ginger and lemon, ca Q 2 hours 2-3 days, vitamin B 25 mg BID. Zofran or %ht receptor agonist ok for acute symptoms

Question 29

What risks associated with NSAID?

Answer 29

premature closure of ductus arteriosis and persistent detal circulation

Question 30

Depression tx?

Answer 30

SSRI, SNRI, TCA, benzo (rarely prescribe TCA and benzo)

• SSRI - category C, paroxetine category D
• SNRI (venlafaxine, duloxetine) - category C
• buproprion - dopamine receptor modulator category C

can taper 25% per week if want to discontinu
withdrawal symptom bothersome but not lethal

Question 31

risk of paroxetine?

Answer 31

cardiac defects - ASD and VSD, category D

Question 32

Withdrawl of benxo or TCA?

Answer 32

tremors, hallucination, siezures, delerium tremors (few days to weeks)

Question 33

S&S PP blues?

Answer 33

weepiness, crying, fatigue, anxiety, sadness, insomnia, restlessness irritability . lessen within 14 days after delivery.

Question 34

S&S PP depression

Answer 34

presents around 2-4 mo

more severe and include, mood swinfs, thoughts of harming self and baby, lack of sexual drive and joy for life.

Question 35

Tx of depression?

Answer 35

counseling, antidepressants, estrofen replacement or OCPs

Question 36

S&S PP psychosis?

Answer 36

rare and within few weeks

confusion, disorientatoin, hallucinations, delusions, paranoia, attempt to harm. bipolar is risk.

Question 37

tx for PP psychosis?

Answer 37

admission, combination antidepressants, antipsychotics, mood stabilizrs. ECT also common.

Question 38

tx asymptomatic bacteriuria?

Answer 38

3-7 day antimicrobial. guideded by culture susceptability.

include: beta lactams (AMX, cephalexin, cefpodoxime, cefixime, amc/clauv) and nitro

AVOID NITRO after 36th week

Question 39

tx symptomatic UTI?

Answer 39

7 days antimicrobial. evidence of 2 days of symptomatic UTI or persistent consider prophylaxis.