Pregnancy and Lactation Flashcards
What lab result confirms pregnancy?
human chorionic gonadotropin (hCG+)
Which trimester is the embryo most susceptible to birth defects?
1st trimester
Teratogenic drugs must cross the placenta to be considered teratogenic (t/f)
TRUE
Folate deficiency can causes..
neural tube defects
Recommended folate intake during pregnancy
600 mcg/day
400 mcg for all women of child-bearing age
Calcium and vit-d requirments for pregnant women
Ca: 1000 mg/day
Vit D: 600 IU/day
Old pregnancy category A meaning
Animal & human studies show no risk in 1st trimester
Old pregnancy category B meaning
Animal studies have demonstrated no risk, but no human studies available
OR animal studies show risk, but human studies didn;t show the same risk
Old pregnancy category C meaning
Animal studies have shown harm to fetus and there are no studies in humans
Or studies in humans and animals are not available
Old pregnancy category D meaning
Positive evidence of fetal risk is available
But benefits might outweigh risk in life-threatening conditions
Old pregnancy category X meaning
Studies show fetal abnormalities
contraindicated in pregnancy
New guidelines for pregnancy section in package inserts
- 1: Pregnancy risk summary
- 2: Lactation - include whether drug/metabolites go into human milk, possible adverse effects of baby and milk production
- 3: Affects of male and female fertility
Main tertiary source for pregnancy & lactation
Brigg’s Drugs in pregnancy and lactation
Key teratogenic drugs
Isotretinoin Quinolones, Tetracyclines Warfarin Statins All RAAS inhibitors (ARBs, Acei, etc.) Pretty much all hormones Hydroxyurea Methotrexate Lithium Topiramate, Valporic acid Paroxetine
Preferred treatment for morning sickness, N/V
Lifestyle first (smaller meals, more frequent meals, etc) Pyridoxine +/- doxylamine Pyridoxine/doxylamine (Diclegis; Rx)
Ginger - “possibly effective”
Preferred treatment for GERD/heartburn
Lifestyle first
Antacids with Calcium (Tums: calcium carbonate)
Preferred treatment for Flatulence
simethicone (Gas-X)
Preferred treatment for constipation
Lifestyle first: incr activity, water & fiver intake
Use fiber laxative with adequate fluid intake
Preferred treatment for cough,cold, allergies
1st line: 1st gen antihistamines (chlorpheniramine, benadryl)
Loratadine + cetirizine recommended sometimes in 2nd +3rd trimester
Nasal steroids: budesonide, beclomethasone (both B’s)
NO oral decongestants in 1st trimester
Generally avoid guaifenisen and dextromethorphan (little evidence)
Preferred treatment for pain
Non-drug options
1st line: APAP
Avoid NSAIDs and opioids generally
Preferred treatment for asthma
controller: budesonide
rescue: albuterol
Preferred treatment for hypertension
Labetalol
methyldopa
nifedipine
Preferred treatment for diabetes
Insulin is preferred
metformin and glyburide are also used
Preferred treatment for infections
PCNs, cephalosporins, azithromycin are generally considered safe
Vaginal fungal infections use topical agents; avoid fluconazole
UTI’s: treat even if asymptomatic bacteriuria
cephalexin
Ampicillin
Bactrim and nitrofurantoin: LAST LINE (esp. 1st trimester), only use if serious PCN allergy
