medications during pregnancy Flashcards
When is the classic teratogenic period?
31-81 days following LMP
what are effects of lithium during pregnancy?
cardiac defect
Can someone take a teratogen before 31 days of LMP?
yes! no organ systems are developing. after 81 risk decreases
how do substances pass through placenta?
passive diffusion, prefer highly lipohilic drugs
what molecular weight can cross placenta BB?
500 daltons
what molecular weight rarely pass through placenta?
> 1000 daltons
what are examples of drugs that have poor placenta diffusion?
heparin and insulin
claritin (loratadine)
high risk drugs for placenta diffusion are what?
OTC and prescriptions sedation
Best - no studies on people. but no to little risk in animals or show some in animals but no risk in pregnant women
category B
Caution - shown risk in animal models, non found in people
Category C
Danger - shown risk in human pregnancy nit used occasionally if life threatening
Category D
X - Cross these drugs off the list - teratogenic effects and no therapeutic conditions
Category X
A okay - studies done in pregnant women and no risk.
Category A
examples of Category X drugs?
accutane, warfarin, misoprostol, thalidomine
How to treat cold?
symptom management, cholorphniramine or pseudofed.
nasal spray
oxymetazolie (vixks sinez) or phenyllephrine
cough –> gauifenesin and dextropmethrophan (robitussin DM)
Headaches tx?
No ibuprofen
YES tylenol and ONLY
triptans are category C so not really good option
lidocaine 4% as nasal spray can help a little
allergies tx?
benadryl or loratadine.
yeast infections tx?
vaginal cream clotrimazole, monistat
Heartburn tx?
tums or maalox
constipation tx?
docusate, metamucil
diarrhea tx?
kaopectate and omodium
Category A examples?
vitamins at RDA (vitamin A)
levothyroxine
Category B examples ?
- beta lactam antimicrobials (PCN, cephalosporins)
- select macrolides (azithromycine, erythromycin)
- acetiminophen
Category C examples?
clarithromycin
flouroquinolone
TMP-SMX
Most SSRIs, corticosteroid, antihypertensives
Category D examples?
gentamicin
ACEI, ARB
Tetracyclines (doxycycline, minocycline)
paroxetine
When are bronchospasms the worst in GA?
29-36 weeks r/t GERD
asthma tx in pregnancy?
- 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
tx of H pylori in pregnancy?
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
What risks associated with NSAID?
premature closure of ductus arteriosis and persistent detal circulation
Depression tx?
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
risk of paroxetine?
cardiac defects - ASD and VSD, category D
Withdrawl of benxo or TCA?
tremors, hallucination, siezures, delerium tremors (few days to weeks)
S&S PP blues?
weepiness, crying, fatigue, anxiety, sadness, insomnia, restlessness irritability . lessen within 14 days after delivery.
S&S PP depression
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.
Tx of depression?
counseling, antidepressants, estrofen replacement or OCPs
S&S PP psychosis?
rare and within few weeks
confusion, disorientatoin, hallucinations, delusions, paranoia, attempt to harm. bipolar is risk.
tx for PP psychosis?
admission, combination antidepressants, antipsychotics, mood stabilizrs. ECT also common.
tx asymptomatic bacteriuria?
3-7 day antimicrobial. guideded by culture susceptability.
include: beta lactams (AMX, cephalexin, cefpodoxime, cefixime, amc/clauv) and nitro
AVOID NITRO after 36th week
tx symptomatic UTI?
7 days antimicrobial. evidence of 2 days of symptomatic UTI or persistent consider prophylaxis.
