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OBGYN Clerkship- Amboss Study Plan > Pharmacotherapy During Pregnancy > Flashcards

Pharmacotherapy During Pregnancy Flashcards

1
Q

ABX of choice

A
  • Penicillin group : ampicillin, amoxicillin, flucloxacillin, penicillin V, propicillin
  • Cephalosporins (not in 1st trimester)
  • Macrolides: erythromycin, azithromycin
  • Metronidazole (not in 1st trimester or breastfeeding)
  • Nitrofurantoin
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2
Q

ABX to avoid:

Teracyline

A
  • bone damage
  • malformations and yellow discoloration of primary teeth
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3
Q

ABX to avoid:

aminoglycosides

A
  • under strict indication during breastfeeding
  • Ototoxicity (CN VIII toxicity) and hearing loss
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4
Q

ABX to avoid:

TMP SMS

A
  • Crdiovascular birth defects
  • neonatal jaundice
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5
Q

ABX to avoid:

chloramphenicol

A

Gray baby syndrome: syndrome associated with chloramphenicolaccumulation in the body, caused by a lack of glucuronidation reactions.

  1. ashen gray color of the skin
  2. cardiovascular collapse
  3. abdominal distention
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6
Q

ABX to avoid:

clarithomycin

A

embryotoxic

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7
Q

ABX to avoid:

Floroquinolones

A

bone and cartilage damage

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8
Q

Antihypertensives of choice

A
  1. Methyldopa in arterial hypertension and hypertensive crisis
  2. Beta blockers: metoprolol and labetalol (not in 3rd trimester- IUGR)
  3. Dihydralazine in uncontrolled hypertension
  4. Nifedipine
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9
Q

Antihypertensives to avoid:

Diuretics

A

reduction of placental perfusion, particularly in the 3rd trimenster

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10
Q

Antihypertensives to avoid:

ACE inhibitors

A
  • First trimester:
    • cardiovascular and CNS malformations
  • Second and Third
    • Fetal Kideny Damage or death
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11
Q

Antihypertentensives to avoid:

ARBS

A

Severe renal malformations

oligohydramnios

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12
Q

antihypertensives to avoid:

atenolol

A

IUGR

decreased placental growth

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13
Q

Antifungals of choice

A
  • Topical: imidazoles
  • Vaginal: nystatin
  • Systemic: amphotericin B
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14
Q

Antifungals to avoid:

ketoconazole, flucytosine, and griseofulvin

A

Teratogenic

embryotoxic

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15
Q

Antifungals to avoid:

itraconazole, fluconazome (>300mg)

A

use of low-dose fluconazolein very select situations after the first trimester is deemed to be safe.

  • teratogenic
  • embryotoxic
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16
Q

Antifungals to avoid:

iodides

A

congenital goiter

17
Q

Antivirals of Choice

A
  1. Acyclovir and valacyclovir for herpes
  2. Oral oseltamivir and zanamivir for influenza
  3. Zidovudine + lamivudine + nevirapine + atazanavir for HIV infection
18
Q

Antivirals to avoid:

efavirenz

A

1rst trimester

fetal neural tube defects

19
Q

Antivirals to avoid:

ribavirin, interferon a or (combintation)

A

preterm birth

significant teratogenic and/or embryocidal effects

20
Q

antivirals to avoid:

dianosine and stavudine combination

A

lactic acidosis and hepatic failure leading to death

21
Q

antivirals to avoid:

nevirapine

A

potentially fatal hepatotoxicity

22
Q

Anticoagulants of choice

A
  1. Heparin: anticoagulant of choice (doesn’t cross placental blood barrier)
  2. Aspirin (ASA)
    • Low doses may be prescribed for high-risk preeclampsia.
    • High doses should be especially avoided in the 3rd trimeste
23
Q

anticouagulants to avoid:

warfarin, phenoprocoumon

A
  • Spontaneous abortion, stillbirth, or preterm death
  • Cerebral hemorrhage leading to CNS abnormalities
  • Bone deformities
24
Q

anticoagulants to avoid:

apixaban, rivoroxaban, dibigatran

A

significant data gaps so they are to be avoided

25
Q

Analgesics of choice

A
  • Acetaminophen (especially in 3rd)
  • NSAIDS (only in 1st)
  • Opioid (cannot be used around the time of labor, because peripartal administration leads to respiratory depression in the newborn.)
26
Q

NSAIDs in 2nd and 3rd trimester

A
  • Premature closure of the ductus arteriosus
  • Persistent pulmonary hypertension
  • Inhibits uterine contractility
27
Q

analgesics to avoid:

metamizole

A
  • In the first and second trimesters:
    • increased occurrence of Wilms’ tumor in the embryo/fetus
  • In the third trimester:
    • causes premature closure of the ductus arteriosus.
28
Q

Thyroid drugs of choice

A
  1. Antithyroid drugs
    • First trimester: propylthiouracil
    • Second and third trimester: methimazole
  2. L-thyroxine
    • prevents maldevelopment of the central nervous system
29
Q

Thyroid drugd to avoid:

methimazome (1st), carbimazole, thiamazole

A
  • Aplasia cutis
    • ​absence of a portion of skin in a localized or widespread area at birth
  • Craniofacial malformations
30
Q

Antiepileptics to avoid:

phenytoin and carbamazepine

A
  • Fetal hydantoin syndrome
    • Characterized by cleft palate, phalanx/fingernail hypoplasia, excessive hair growth, and intrauterine growth restriction
    • Due to impaired absorption of folate
  • Neural tube defects (carbamazepine only)
31
Q

Antiepileptics to avoid:

valproate

A

neural tube defects

32
Q

steroids:

A

reduced birth weight

increased risk of preeclampsia

increased risk of oral and lip clefts

33
Q

oral antidiabetic agents

A

Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!

  • pre-eclampsia
  • neonatal jaundice
  • macrosomnia
  • neonatal hypoglycemia
34
Q

methotrexate

A

neural tube defects

35
Q

cholestyramine

A

fetal and maternal hemorrhage

36
Q

lithium

A

congenital heart defects

EBSTEIN’S anomaly: displaced tricuspid valve leaflets causing tricuspid valve regurgitation and right heartenlargement

37
Q

isotretinoin

A

multiple congential abnormalities

facial cleft

skeletal abnormalities

38
Q

misoprostol

A

abortions

frontotemporal congenital malformations

OBGYN Clerkship- Amboss Study Plan (9 decks)

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