Preggo/BF Drug Use Flashcards
Vitamin/Mineral Supplementation for Preggo
- Folate: 600 mcg DFE/d
- Calcium 100 mg/d
- 600 IU/d of Vitamin D
Category A
Controlled studies in animals/women show no risk to fetus in firsttrimest.
Category B
- Animal studies haven’t shown fetal risk
- No well-controlled studies in women either
Category C
- Animal studies HAVE shown fetal risk
- No well-controlled studies in women either
- Use only if benefit outweighs the risk
Category D
- Positive evidence of risk to a human fetus
- Benefit may outweigh risk in serious/life-threatening disease
Category X
- Animal and human studies shows fetal abnormalities
- Risks involved clearly outweigh the potential benefits
- Use in pregnancy CI
Updated Pregnancy Sections
- 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
Acne Teratogens
- Isotretinoin
- Topical Retinoids
Antibiotic Teratogens
- Quinolones
- Tetracyclines
Anticoagulant Teratogens
-WArfarin
Dyslipidemia/HF/HTN Teratogens
- Statins
- RAASi (ACEi, ARBs, etc.)
Hormone Teratogens
- Most!
- Includes estradiol and progesterone products
- Raloxifene
- Duavee
- Testosterone
- Contraceptives
Migraine Teratogens
- Ergotamine
- Dihydroergotamine
Other Notable Teratogens
- Hydroxyurea
- Lithium
- MTX
- Misoprostol
- NSAIDs
- Paroxetine
- Ribavirin
- Thalidomide
- Topiramate
- Weight Loss Drugs
- Valproic Acid/Divalproex
Morning Sickness or N/V Managements
- Lifestyle First! (smaller meals, reduce stress, avoid triggering foods)
- Pyridoxine (Vitamin B6) +/- doxylamine
- Ginger is also “possibly effective” for morning sickness
GERD/Heartburn Management
- 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)
Flatulence Management
Simethicone
Constipation Management
- Lifestyle first! (More exercise, fluids, better diet)
- Fail? Fiber (psyllium, calcium polycarbophil)
Cough/Cold/Allergy Management
- 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
Pain Management
- First-line: APAP
- Avoid NSAIDs and ASA, especially after 20 weeks
Asthma Management
- Budesonide is preferred of ICS, but all are safe
- Rescue: Albuterol (inhaled)
- Budesonide is also preferred for infants! (respules in nebulizer)
HTN Management
- Labetalol
- Nifedipine
- Methyldopa
- CI: RAASi
Diabetes Management
- Insulin if not controlled with lifestyle
- Low-dose ASA recommended for preeclampsia prevention in patients with T1 or T2DM
Infection Management
- 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
