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NAPLEX > Preggo/BF Drug Use > Flashcards

Preggo/BF Drug Use Flashcards

1
Q

Vitamin/Mineral Supplementation for Preggo

A
  • Folate: 600 mcg DFE/d
  • Calcium 100 mg/d
  • 600 IU/d of Vitamin D
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2
Q

Category A

A

Controlled studies in animals/women show no risk to fetus in firsttrimest.

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3
Q

Category B

A
  • Animal studies haven’t shown fetal risk

- No well-controlled studies in women either

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4
Q

Category C

A
  • Animal studies HAVE shown fetal risk
  • No well-controlled studies in women either
  • Use only if benefit outweighs the risk
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5
Q

Category D

A
  • Positive evidence of risk to a human fetus

- Benefit may outweigh risk in serious/life-threatening disease

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6
Q

Category X

A
  • Animal and human studies shows fetal abnormalities
  • Risks involved clearly outweigh the potential benefits
  • Use in pregnancy CI
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7
Q

Updated Pregnancy Sections

A
  • 8.1: risk of adverse developmental outcomes in pregnancy and whether they should participate in a registry for drug/disease state
  • 8.2: Whether drug/metabolites are present in human breast milk
  • 8.3: Effects on fertility and any pregnancy test/contraception requirements
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8
Q

Acne Teratogens

A
  • Isotretinoin

- Topical Retinoids

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9
Q

Antibiotic Teratogens

A
  • Quinolones

- Tetracyclines

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10
Q

Anticoagulant Teratogens

A

-WArfarin

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11
Q

Dyslipidemia/HF/HTN Teratogens

A
  • Statins

- RAASi (ACEi, ARBs, etc.)

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12
Q

Hormone Teratogens

A
  • Most!
  • Includes estradiol and progesterone products
  • Raloxifene
  • Duavee
  • Testosterone
  • Contraceptives
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13
Q

Migraine Teratogens

A
  • Ergotamine

- Dihydroergotamine

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14
Q

Other Notable Teratogens

A
  1. Hydroxyurea
  2. Lithium
  3. MTX
  4. Misoprostol
  5. NSAIDs
  6. Paroxetine
  7. Ribavirin
  8. Thalidomide
  9. Topiramate
  10. Weight Loss Drugs
  11. Valproic Acid/Divalproex
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15
Q

Morning Sickness or N/V Managements

A
  • Lifestyle First! (smaller meals, reduce stress, avoid triggering foods)
  • Pyridoxine (Vitamin B6) +/- doxylamine
  • Ginger is also “possibly effective” for morning sickness
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16
Q

GERD/Heartburn Management

A
  • Lifestyle first! (Smaller meals, avoid trigger foods, elevate head of bed, don’t eat w/in 3 hours of bedtime)
  • If these measures fail: calcium carbonate (Tums)
17
Q

Flatulence Management

A

Simethicone

18
Q

Constipation Management

A
  • Lifestyle first! (More exercise, fluids, better diet)

- Fail? Fiber (psyllium, calcium polycarbophil)

19
Q

Cough/Cold/Allergy Management

A
  • First line: Cromolyn
  • Second line: first-gen antihistamines - chlorpheniramine is first choice
  • Chronic allergies? Budesonide and beclomethasone are preferred agents in preggo
  • Avoid liquid cough/cold formulations with alcohol
20
Q

Pain Management

A
  • First-line: APAP

- Avoid NSAIDs and ASA, especially after 20 weeks

21
Q

Asthma Management

A
  • Budesonide is preferred of ICS, but all are safe
  • Rescue: Albuterol (inhaled)
  • Budesonide is also preferred for infants! (respules in nebulizer)
22
Q

HTN Management

A
  • Labetalol
  • Nifedipine
  • Methyldopa
  • CI: RAASi
23
Q

Diabetes Management

A
  • Insulin if not controlled with lifestyle

- Low-dose ASA recommended for preeclampsia prevention in patients with T1 or T2DM

24
Q

Infection Management

A
  • Penicillins, cephalosporins, erythromycin, and azithromycin are generally considered safe to use
  • Vaginal Fungal Inf: topical antifungals
  • UTI: Cephalexin or Ampicillin
  • Nitrofurantoin and Bactrim are LAST LINE in first trimester and shouldn’t be used in the last two weeks of pregnancy
  • Must treat bacteriuria in preggos, EVEN if asymptomatic
  • Toxoplasmosis: IgG test before pregnancy, avoid unpasteurized dairy and cat feces
25
Q

Anticoagulation in Preggo

A
  • VTE: LMWH over UFH for treatment
  • Pneumatic devices +/- LMWH for prophylaxis
  • Warfarin = teratogen
  • Oral Xa inhibitors and DTI haven’t been studied and therefore aren’t recommended
26
Q

Hypothyroidism Management

A

-Levothyroxine - increase dose by 30-50%

27
Q

Hyperthyroidism Management

A
  • PTU in first trimester
  • Methimazole for remainder of preggo
  • Both have a high risk of liver damage that can pass placenta and effect fetus
28
Q

Breastfed Baby Supplements

A
  • 10 mcg (400 IU)/d of vitamin D until drinking at least 1 liter of fortified formula/day
  • Need 1mg/kg of iron during months 4-6 of life or unit baby can adequately get iron from food (most have adequate iron stores before then)
29
Q

Pump and Dump Meds

A
  • Amphetamines
  • Amiodarone
  • Ergotamines
  • Lithium
  • Metronidazole
  • Phenobarbital
  • Statins
  • Pump and dump when [drug] is at its highest*
30
Q

Pain in BF

A
  • DON’T give codeine or tramadol

- Excessive sleepiness, resp. depression, and death can occur to infants of UM CYP2D6 mothers

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