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Antepartum4 (UPENN) > Pharmacology -- Happy prescribing! > Flashcards

Pharmacology -- Happy prescribing! Flashcards

1
Q

What would you prescribe a pregnant person with the common cold or suffering w/ allergies?

A

Antihistamiens-chlorpheniramine, diphenhydramine, doxylamine, Zyrtec (Cetirizine), Allegra (Fexofenadine), Claritin (Loratadine)
Decongestants: Phenylephrine, pseudoephedrine
Cough: Robitussin (dextromethorphan), mucinex (Guaifenesin) codeine
Allergic rhinitis: nasal corticosteroids, intranasal cromolyn (Mast cell stabilizer)
Fever/pain: Tylenol
AVOID POLYPHARM

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2
Q

Common treatment for depression:_______

What to absolutely avoid:_________

A

1st line: SSRIs–Zoloft (sertraline), Prozac (Fluoxetine), Lexapro, escitalopram
***AVOID Paroxetine (Paxil) if pregnant–okay in BF

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3
Q

What drug is commonly prescribed in hypothyroidism? Does it usually need to lowered or raised? WHY?

A

SYNTHROID (Levothyroxine)
RAISED
Development (via mRNA) of fetus requires inc. in T3/T4 (hCG acts like weak TSH)

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4
Q

How do treat hyperthyroidism in pregnancy?

A

PTU (propylthiouracil) first (most preferred) and then switch to methimazole later.
Thyroidectomy may be considered, but do NOT use ablation (will ablate fetus’s thyroid too)

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5
Q

How do you treat HTN?

A

**Discont. thiazide diuretics if on them
may not need meds w/ pregnancy
1st line: Methyldopa (A2A)-250mg TID (up to 500mg qid)
& Labetalol (BB)
2nd Line/+: Hydralazine-Vasodilator, nifedipine (procardia)-CCB, other BB and A2A-Clonodine (max 1.2mg/d)

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6
Q

Tx. of DM in pregnancy

A

DM1: Insulin–Lispro (homolog)
DM2/GDM:
-INSULIN (preferred)-0.7-1U/kg/d, short and long acting combo
-GLYBURIDE-2.5-30mg
-METFORMIN-start w/500mg at night w/meals, check crtn & glucose–> inc. to BID if needed after 1wk

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7
Q

Tx. of Asymptomatic Bacturia, uncomplicated UTI,

A

Amox, Augmentin (amox+CA), Ampicillin, Cephalexin (Keflex), Clindamycin
For suppression therapy: Bactrim (sulfa) & macrobid (nitrofurantoin) –but avoid if G6PD, 1st Tri, and near term:

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8
Q

Tx. for pyelonephritis

A

1g IV abx- Ceftriaxone (q24hr) Cefepime (q12hr), Cefazolin, Gentamicin, Cefuroxime, Severe-Ertapenem

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9
Q

Tx for sinusitis

A 
Augmentin
Cefprozil
Cefuroxime
\+
Saline nasal spray
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10
Q

Tx. for strep throat

A

Penicillin

Macrolides (azithro/clarithro)

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11
Q

Tx. for strep pneumoniae or H. influenza

A

3rd gen Cephalosporins (Cefixime) or augmentin
+
Macrolide (azithro/clarithro)
AVOID QUINOLONES if possible

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12
Q

Tx. for influenza

A

1st: PREVENTION: vaccine
Tx: Antivirals: Tamiflu (Oseltamivir)-75mg PO BID x5d
Relenza (Zanamivir) 10mg 2-inhalations BID x5d

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13
Q

Tx. for asthma

A 
Step up/down approach: 
ALL asthmatic women: B2Agonists- Albuterol, 
Low dose ICS (Budesonide)
High dose ICS
\+/- Bronchodilators (Theophylline) 
\+/-Leukotriene modifiers (-lukast)
*PO CS (only if benefits>risks)
*Avoid Omalizumab/Xolair)
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14
Q

Tx for GERD

A

1st line: Antacids (TUMs), lifestyle

2nd: H2-receptor blockers: (Famotidine/pepcid & ranitidine/zantac)
3rd: PPIs: (Ome/ianso-prazole) …least studied

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15
Q

Tx for mild, moderate, and severe N/V

A

MILD: 1. Replace PNvitamin w/folic acid alone; 2. B6/pyridoxine 25mg PO TID 3. Ginger 250mg PO qid; 4. P6 acupressure (sea-bands)
MOD:
1. Dicligis: B6 + doxylamine (unisom) 12.5mg PO qid 2. Antipsych-Compazine (prochlorperazine)-5-10mg PO q6-8hr, Thorazine (chlorpromazine)-10-25mg PO q4-6h, 3. 5-ht3 antag: Odansetron (Zofran) 8mg PO q12hr 4. gut motility stimulator: Reglan (metoclopramide -5-10mg PO q8hr; Antihistamine: Dramamine, Unisom, Phenergan (promethazine)-25mg PO q4-6hr; SEVERE-IV hydration, IV Benadryl-50mg + IV PB of the above (consider IV nutrition)

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16
Q

Tx of PTL:

A

Corticosteroids: (22-36 & 6/7wks) Betamethasone-12mg IM x2- 48hrs apart, 1st course given less than 28wks; rescue course is beneficial OR dexamethasone 6mgx4doses q12hr <48hr
CCB: Nifedipine
Mag Sulfate 6g bolus (24-31wks)
NSAID: Indomethacin 25-50mg q 6hr for <48hrs

17
Q

PPROM/PROM

A

GBS + =penG,

18
Q

Drugs that are contraindicated in ALL TRIMESTERS

A 
Ergots
Aminoglycosides (-mycin) *deaf
Androgenic steroids *clitoromegaly
ACE/ARBs *renal, HOTN, CNS
Iodine/Iodide &amp; ATD *Goiter, hypothyroid
Benzos *cleft, w/drawal
Cocaine (DUH) *abruption
EtOH
Isotretinoin
Lindane
Mifepristone
Misoprostol
Nicotine
Statins
Vit A >8000
Warfarin *SAB/CNS/hemorrhage
19
Q

Drugs that are contraindicated in the 1st TRIMESTER

A 
Anticonvulsants (carbamazepine) *NTD
Cyclophosphanide *CNS/IUGR
DES *SAB/stillbirth
Lithium *toxicity/ebstein's anomaly
Methotrexate (prob all Ts?)
Phenytoin
Thalidomide
Trimethoprim
Valproic acid
20
Q

Drugs that are contraindicated in 2nd & 3rd TRIMESTERS

A

Amiodarone * hypothyroid
NSAIDs *closure of DA
Sulfanomides *hyperbilirubin
Tetra/doxycycline *teeth stain, maternal liver

21
Q

Tx to inc. breastmilk=galactogues

A

L2-Metoclopramide

L3-Fenugreek, Blessed thistle, domperidone, sulpiride…not a whole lot of choices, inc H2O & stimulate breasts

22
Q

Tx. of mastitis

A 
10-14d Abx: 
Dicloxacillin (Dynapen) 250-500mg q6hr
Keflex (caphalexin)-500mg q6h
Erythromycin 
Milk c/s if unresponsive to Abx after 2d.--> IV Unipen (Nafcillin)  or Oxacillin 2g q4h
MRSA-Bactrim BID, Vaco, or Linda
23
Q

GFR increases or decreases? By what %?

A

Increases 50% by term (majority during 1st try)

24
Q

Explain changes in pregnancy r/t 1st pass through the liver

A

Activity is unchanged/blood flow to the liver remains the same TRICKED yah

25
Q

BV tx in pregnancy

A

Probiotics-intravaginal
Flagyl/metronidazole 500 BID or 250 TID x7d
Clindamycin/Cleocin 300mg BID x7d
Reduce stress, quit smoking & douching

26
Q

Tx for headaches

A

Tylenol 650mg q4-6h +/- caffeine or codeine or aspirin
Magnesium for prevention (350mg max)
Fioricet <4-5x/month

27
Q

Tx. for dermatitis eczema

A

Antihistamines, topical steroids, and emollients

28
Q

Tx. for dermatitis poison ivy

A

Diphenydramine, calamine lotion, 1% hydrocortisone, prednisone 1mg/kg/day (2-3wk taper)

29
Q

Tx for scabies

A

Permethrin 5% (apply neck down and wash off 8-14h)
Ivermectin 200mcg/kg (repeat in 2 wks)
Lindane 1% 1oz (30g apply and wash off after 8h)

30
Q

Tx. for lice

A

Permethrin 1% cream-wash after 10min
Pyrethrins wash after 10min
Malathion 0.5% lotion -wash after 8-12h

31
Q

Tx. for constipation

A
  1. Colace 2. Senna 3. Dulcolax (PO or suppository)

Antepartum4 (UPENN) (1 decks)

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