Multi-Vitamin Supplementation

Question 1

Folic acid requirement for methotrexate?

Answer 1

Folic acid is used during long-term, low-dose methotrexate therapy to prevent methotrexate toxicity, particularly oral ulceration and gastrointestinal irritation, to treat or prevent folate deficiency and to prevent hyperhomocysteinemia. In rheumatoid arthritis patients the concomitant use of low-dose folic acid (≤7 mg/wk) significantly reduced gastrointestinal toxicity, abnormal serum transaminase elevation and patient withdrawal from methotrexate for any reason. Low-dose folic acid (≤7 mg/wk) should be considered for all rheumatoid arthritis patients taking methotrexate, but there is no standard dose or regimen for folic acid supplementation with methotrexate

Question 2

Folic acid requirement in pre-pregnancy with low-risk of neutral tube defects?

Answer 2

0.4 mg/day beginning at least 2–3 months before conception and continuing until 4–6 wk postpartum or as long as breastfeeding continues

Question 3

Folic acid requirement in pre-pregnancy with High risk of neutral tube defects?

Answer 3

4 mg/day beginning at least 3 months before conception and continuing until 12 wk gestational age; then 0.4–1 mg/day until 4–6 wk postpartum or as long as breastfeeding continues

Question 3

Folic acid requirement in pre-pregnancy with moderate risk of neutral tube defects?

Answer 3

1 mg/day beginning at least 3 months before conception and continuing until 12 wk gestational age; then 0.4–1 mg/day until 4–6 wk postpartum or as long as breastfeeding continues

Moderate Risk?
A)Any of the following (Maternal)
-Personal or family history of folic acid–sensitive congenital anomaly
-Family history of neural tube defects (first- or second-degree relative)
-Diabetes
-Use of teratogenic medications pre- or at the time of conception (e.g., anticonvulsants, methotrexate, trimethoprim)
-GI malabsorption conditions (e.g., Crohn or celiac disease, gastric bypass surgery)

B)Any of the following (*PATERNAL):
Personal or family history of folic acid–sensitive congenital anomaly
Family history of neural tube defects (first- or second-degree relative)

Question 3

Folic acid requirement in phenytoin use?

Answer 3

Avoid folic acid supplements >1 mg/day
*Folic acid may be a cofactor in phenytoin metabolism; decreased serum phenytoin levels with large doses of folic acid and potential increase in seizure frequency.

Question 4

when is 5mg folic acid prescribed in preganancy?

Answer 4

4-5mg to be initiated 3 months prior to conception
** personal history of NTD or NTD pregnancy for either male or female
*Use lithium
*On anti-epileptic drugs:With carbamazepine and valproic acid, prescribe periconceptual folate supplementation: 5 mg daily PO, ideally starting 3 months before trying to conceive and continuing at least until the end of the first trimester

Question 5

T/F: Erythromycin estolate is safe in pregnancy?

Answer 5

FALSE; non-esolate erythromycin is safe

Question 6

non-pharm tip for pt w/ polycystic ovarian syndrome trying to conceive?

Answer 6

HIGH risk of pregnancy complications: gestational diabetes, HTN, preeclampsia, and neural tube
defects if obese & pre-existing DM.
Use folic acid if trying to conceive, or if on metformin & sexually active