Pharmacotherapy During Pregnancy Flashcards
ABX of choice
- Penicillin group : ampicillin, amoxicillin, flucloxacillin, penicillin V, propicillin
- Cephalosporins (not in 1st trimester)
- Macrolides: erythromycin, azithromycin
- Metronidazole (not in 1st trimester or breastfeeding)
- Nitrofurantoin
ABX to avoid:
Teracyline
- bone damage
- malformations and yellow discoloration of primary teeth
ABX to avoid:
aminoglycosides
- under strict indication during breastfeeding
- Ototoxicity (CN VIII toxicity) and hearing loss
ABX to avoid:
TMP SMS
- Crdiovascular birth defects
- neonatal jaundice
ABX to avoid:
chloramphenicol
Gray baby syndrome: syndrome associated with chloramphenicolaccumulation in the body, caused by a lack of glucuronidation reactions.
- ashen gray color of the skin
- cardiovascular collapse
- abdominal distention
ABX to avoid:
clarithomycin
embryotoxic
ABX to avoid:
Floroquinolones
bone and cartilage damage
Antihypertensives of choice
- Methyldopa in arterial hypertension and hypertensive crisis
- Beta blockers: metoprolol and labetalol (not in 3rd trimester- IUGR)
- Dihydralazine in uncontrolled hypertension
- Nifedipine
Antihypertensives to avoid:
Diuretics
reduction of placental perfusion, particularly in the 3rd trimenster
Antihypertensives to avoid:
ACE inhibitors
- First trimester:
- cardiovascular and CNS malformations
- Second and Third
- Fetal Kideny Damage or death
Antihypertentensives to avoid:
ARBS
Severe renal malformations
oligohydramnios
antihypertensives to avoid:
atenolol
IUGR
decreased placental growth
Antifungals of choice
- Topical: imidazoles
- Vaginal: nystatin
- Systemic: amphotericin B
Antifungals to avoid:
ketoconazole, flucytosine, and griseofulvin
Teratogenic
embryotoxic
Antifungals to avoid:
itraconazole, fluconazome (>300mg)
use of low-dose fluconazolein very select situations after the first trimester is deemed to be safe.
- teratogenic
- embryotoxic
Antifungals to avoid:
iodides
congenital goiter
Antivirals of Choice
- Acyclovir and valacyclovir for herpes
- Oral oseltamivir and zanamivir for influenza
- Zidovudine + lamivudine + nevirapine + atazanavir for HIV infection
Antivirals to avoid:
efavirenz
1rst trimester
fetal neural tube defects
Antivirals to avoid:
ribavirin, interferon a or (combintation)
preterm birth
significant teratogenic and/or embryocidal effects
antivirals to avoid:
dianosine and stavudine combination
lactic acidosis and hepatic failure leading to death
antivirals to avoid:
nevirapine
potentially fatal hepatotoxicity
Anticoagulants of choice
- Heparin: anticoagulant of choice (doesn’t cross placental blood barrier)
- Aspirin (ASA)
- Low doses may be prescribed for high-risk preeclampsia.
- High doses should be especially avoided in the 3rd trimeste
anticouagulants to avoid:
warfarin, phenoprocoumon
- Spontaneous abortion, stillbirth, or preterm death
- Cerebral hemorrhage leading to CNS abnormalities
- Bone deformities
anticoagulants to avoid:
apixaban, rivoroxaban, dibigatran
significant data gaps so they are to be avoided
Analgesics of choice
- 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.)
NSAIDs in 2nd and 3rd trimester
- Premature closure of the ductus arteriosus
- Persistent pulmonary hypertension
- Inhibits uterine contractility
analgesics to avoid:
metamizole
- 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.
Thyroid drugs of choice
- Antithyroid drugs
- First trimester: propylthiouracil
- Second and third trimester: methimazole
- L-thyroxine
- prevents maldevelopment of the central nervous system
Thyroid drugd to avoid:
methimazome (1st), carbimazole, thiamazole
-
Aplasia cutis
- absence of a portion of skin in a localized or widespread area at birth
- Craniofacial malformations
Antiepileptics to avoid:
phenytoin and carbamazepine
- 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)
Antiepileptics to avoid:
valproate
neural tube defects
steroids:
reduced birth weight
increased risk of preeclampsia
increased risk of oral and lip clefts
oral antidiabetic agents
Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!
- pre-eclampsia
- neonatal jaundice
- macrosomnia
- neonatal hypoglycemia
methotrexate
neural tube defects
cholestyramine
fetal and maternal hemorrhage
lithium
congenital heart defects
EBSTEIN’S anomaly: displaced tricuspid valve leaflets causing tricuspid valve regurgitation and right heartenlargement
isotretinoin
multiple congential abnormalities
facial cleft
skeletal abnormalities
misoprostol
abortions
frontotemporal congenital malformations
