Pharmacotherapy During Pregnancy

Question 1

ABX of choice

Answer 1

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

Question 2

ABX to avoid:

Teracyline

Answer 2

• bone damage
• malformations and yellow discoloration of primary teeth

Question 3

ABX to avoid:

aminoglycosides

Answer 3

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

Question 4

ABX to avoid:

TMP SMS

Answer 4

• Crdiovascular birth defects
• neonatal jaundice

Question 5

ABX to avoid:

chloramphenicol

Answer 5

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

Question 6

ABX to avoid:

clarithomycin

Answer 6

embryotoxic

Question 7

ABX to avoid:

Floroquinolones

Answer 7

bone and cartilage damage

Question 8

Antihypertensives of choice

Answer 8

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

Question 9

Antihypertensives to avoid:

Diuretics

Answer 9

reduction of placental perfusion, particularly in the 3rd trimenster

Question 10

Antihypertensives to avoid:

ACE inhibitors

Answer 10

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

Question 11

Antihypertentensives to avoid:

ARBS

Answer 11

Severe renal malformations

oligohydramnios

Question 12

antihypertensives to avoid:

atenolol

Answer 12

IUGR

decreased placental growth

Question 13

Antifungals of choice

Answer 13

• Topical: imidazoles
• Vaginal: nystatin
• Systemic: amphotericin B

Question 14

Antifungals to avoid:

ketoconazole, flucytosine, and griseofulvin

Answer 14

Teratogenic

embryotoxic

Question 15

Antifungals to avoid:

itraconazole, fluconazome (>300mg)

Answer 15

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

• teratogenic
• embryotoxic

Question 16

Antifungals to avoid:

iodides

Answer 16

congenital goiter

Question 17

Antivirals of Choice

Answer 17

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

Question 18

Antivirals to avoid:

efavirenz

Answer 18

1rst trimester

fetal neural tube defects

Question 19

Antivirals to avoid:

ribavirin, interferon a or (combintation)

Answer 19

preterm birth

significant teratogenic and/or embryocidal effects

Question 20

antivirals to avoid:

dianosine and stavudine combination

Answer 20

lactic acidosis and hepatic failure leading to death

Question 21

antivirals to avoid:

nevirapine

Answer 21

potentially fatal hepatotoxicity

Question 22

Anticoagulants of choice

Answer 22

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

Question 23

anticouagulants to avoid:

warfarin, phenoprocoumon

Answer 23

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

Question 24

anticoagulants to avoid:

apixaban, rivoroxaban, dibigatran

Answer 24

significant data gaps so they are to be avoided

Question 25

Analgesics of choice

Answer 25

* 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.)

Question 26

NSAIDs in 2nd and 3rd trimester

Answer 26

* Premature closure of the ductus arteriosus * Persistent pulmonary hypertension * Inhibits uterine contractility

Question 27

analgesics to avoid: metamizole

Answer 27

* 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.

Question 28

Thyroid drugs of choice

Answer 28

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

Question 29

Thyroid drugd to avoid: methimazome (1st), carbimazole, thiamazole

Answer 29

* **Aplasia cutis** * **​**absence of a portion of skin in a localized or widespread area at birth * Craniofacial malformations

Question 30

Antiepileptics to avoid: phenytoin and carbamazepine

Answer 30

* 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)

Question 31

Antiepileptics to avoid: valproate

Answer 31

neural tube defects

Question 32

steroids:

Answer 32

reduced birth weight increased risk of preeclampsia increased risk of oral and lip clefts

Question 33

oral antidiabetic agents

Answer 33

Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy! * pre-eclampsia * neonatal jaundice * macrosomnia * **neonatal hypoglycemia**

Question 34

methotrexate

Answer 34

neural tube defects

Question 35

cholestyramine

Answer 35

fetal and maternal hemorrhage

Question 36

lithium

Answer 36

congenital heart defects EBSTEIN'S anomaly: displaced tricuspid valve leaflets causing tricuspid valve regurgitation and right heartenlargement

Question 37

isotretinoin

Answer 37

multiple congential abnormalities facial cleft skeletal abnormalities

Question 38

misoprostol

Answer 38

abortions frontotemporal congenital malformations