Pregnancy Flashcards
Physiological changes during pregnancy
Reduced GI motility, inc pH, dec serum albumin binding capacity, variability in hepatic metabolism, inc renal drug clearance, inc total body water (8L), placental drug transfer
Drug selection criteria during pregnancy
pregnancy category, timing of drug, lowest effective dose, does drug have inc protein binding
Category A classification
adequate and well controlled studies fail to show risk to fetus in 1st trimester or later
Category B classification
animal studies have failed to show risk, but no adequate studies in humans
Category C classification
Animal studies show adverse effects in fetus, no studies in humans, potential benefit may warrent use of drug
Category D classification
positive evidence in human fetus, but benefits may warrant use despite, no other drug option
Category X classification
studies in animal and humans have shown fetal abnormalities, the risks of using the drug outweighs the benefit, there are other alternatives
Antibiotics category B
penicillins, cephalosporins, macrolides, aztreonam, clindamycin, daptomycin, fosfomycin, carbapenems, metronidazole, nitrofurantoin, vancomycin (PO)
Antibiotics category C
fluoroquinolones (cartilage damage, last line only), linezolid, clarithromycin, sulfa/trimethoprim (Bactrim)- avoid during first trimester and after 32 weeks, vancomycin (IV)
Bactrim risks
risk of kernicterus, neural tube defects, may use for prophylaxis of PCP, or toxoplasmic gondii encephalitis
Vancomycin (IV)
no adverse effects reported, usually for prophylaxis of strep B
Antidepressants in pregnancy
TCA- Cat C, Nortriptyline preferred, taper 10-14 days before expect DOD, SSRIs- cat C (paroxetine cat D), no effects in late 3rd, taper 10-14 days, SNRIs- cat C, mirtazapine, trazodone- cat C, DRI- Cat B
Antibiotics Category D
Aminoglycosides (CN 8 toxicity), Tigecycline (tooth discoloration), tetracyclines (tooth discoloration)
Other Category D drugs
aspirin, lithium, paroxetine, ACE-I, ARBs, anticonvulsants
Category X drugs
Statins, warfarin, thalidomide, methotrexate, isotretinoin (Accutane), ergotamines
