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BCPS > Pregnancy & Lactation > Flashcards

Pregnancy & Lactation Flashcards

1
Q

Placental transport factors

A

Molecular weight
-<400-600 Da crosses placenta. Most drugs are 250-400 Da

Protein binding
-Less protein binding in fetus = more free drug

Blood flow
-Equivalent between mom & baby, so fetal drug conc 50-100% maternal

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2
Q

FDA labeling for pregnancy risk

A
  1. Pregnancy
    Fetal risk summary
    Clinical considerations
    Data section
    Information for exposure registries
  2. Lactation
  3. Females and males of reproductive potential
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3
Q

Selected known teratogens

A

ACE/ARB
Anticonvulsants
Isotretinoin
Lead
Lithium
Methimizole
Methotrexate
Paroxetine
Statins
Tetracycline
Thalidomide
Warfarin

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4
Q

Resources for Pregnancy Medication Use

A

-Drugs in Pregnancy & Lactation (on Facts, Lexi)

-TERIS (Teratogen Information System) & Shepard’s Database (Micromedex)

-Diseases, Complications, Drug Therapy in Obstetrics (textbook - chronic disease management in pregnancy)

-OTIS (organization of Teratology Information Specialists): MotherToBaby (has information sheets)

-Micromedex: REPROTEXT and REPROTOX (pregnancy, teratogenicity, lactaction, medication use)

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5
Q

Decrease Milk Supply

A

Androgens
Bromocriptine (DA agonist)
Ergot alkaloids
Estrogen
Levodopa (increase DA)
MAOIs
Pyridoxine
Sympathomimetics

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6
Q

Increase Milk Supply (galactagogues)

A

Amoxapine
Antipsychotics (DA antagonist)
Cimetidine
Methyldopa
Metoclopramide
Reserpine

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7
Q

How to minimize effect of drugs during breastfeeding

A

-Choose drugs w/ short half lives
-Administer immediately after a feed or before long sleep period
-Consider if drug given to neonates
-Consider age/health of neonate
-Short-term drug: pump & dump

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8
Q

Contraindicated in breastfeeding

A

Amphetamines
Antineoplastics
Benzos
Bromocriptine
Cocaine, drugs of abuse
Ergotamine
Kava
Lithium
Nicotine
Pain (oxycodone, pentazocine, meperidine)
Yohimbe
Herbs lacking safety data

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9
Q

Relatively safe agents in breast feeding

A

Analgesics - ibuprofen, APAP
ABX (PCN, cephalosporins, erythromycins)
Caffeine, in moderation
Insulin

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10
Q

Resources for lactation

A
  1. LactMed - provides safety & alternatives
  2. Drugs in Pregnancy & Lactation - textbook, Facts
  3. Hale T. Medications & Mother’s Milk - ranked L1 to L5, with L1 safest
  4. Micromedex REPROTEXT and REPROTOX
  5. OTIS: MotherToBaby
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11
Q

Management of Morning Sickness

A

First line:
-Diclegis (DR) or Bonjesta (ER)
-Alt: Pyridoxine

-Dimenhydrinate
-Diphenhydramine
-Zofran (if not controlled w/ first line. possible cardiac birth defects. Avoid during first 10 weeks)
-Metoclopramide (if N/V not controlled w/ first line)
-Phenothiazines (if N/V not controlled w/ first line) (promethazine, prochlorperazine)

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12
Q

Heartburn management in pregnancy

A

Antacids (magnesium hydroxide, aluminum hydroxide, calcium carbonate)

Sucralfate (not absorbed)

Second line: famotidine, PPI

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13
Q

Constipation management in pregnancy

A

Increase fiber & fluid intake, exercise

Stool softeners, bulk laxatives

Stimulants are not first line.

Avoid mineral oil

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14
Q

Hemorrhoid management in pregnancy

A

Treat constipation
Sitz bath
Avoid topical anesthetics & steroids

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15
Q

Headache mangement in pregnancy

A

APAP, rest
Avoid Aspirin, NSAIDS, ergotamine, triptans

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16
Q

Prophylactic VTE management in pregnancy

A

Lovenox 40mg SC daily
Dalteparin 5000 units SC daily
Tinzaparin 4500 units SC daily
Heparin
1st tri: 5000-7500 units SC q12h
2nd tri: 7500-10000 units SC q12h
3rd tri: 10000 units SC q12H

17
Q

Anticoagulants to avoid in pregnancy

A

warfarin
DOACs

18
Q

Therapeutic VTE management pregnancy

A

Lovenox 1mg/kg q12H
Dalteparin 200 units/kg SC daily
Tinzaparin 175 units/kg SC daily
Heparin 10000 units SC q12H

19
Q

VTE management prior to delivery

A

-At 36 weeks, may transition from lovenox to heparin for ease of anesthesia induction. Lower risk of epidural or spinal hematoma. Greater ease of heparin reversal w/ protamine

-D/C LMWH or UFH ppx 12 hours before delivery
-D/C LMWH or UFH therapeutic 24 hours before delivery

20
Q

VTE management after delivery

A

Anticoagulation for 6 weeks postpartum

21
Q

Two-step approach to diagnose gestational diabetes

A

50 g OGTT; if >= 130 or 140, then 100g test

100g: (two ranges, went with lower one)
fasting >95
1 hr >180
2 hr > 155
3 hr >140

22
Q

One step approach to diagnose gestational diabetes

A

75g OGTT
fasting >92
1 hr >= 180
2 hr >= 153

23
Q

Preferred treatment for GD

A

Insulin, start at 0.7-1.0 unit/kg/day

Does not cross placenta

24
Q

Alternative treatment for GD

A

Metformin, possible premature birth

Glyburide, but increased risk of hypoglycemia and macrosomia in infant, so not preferred

25
Q

Gestational hypertension

A

BP >= 140/90, occurring at least 4 hours apart on 2 different occasions with previously normal BP and no proteinuria or pathologic edema

26
Q

Preeclampsia

A

HTN + proteinuria (>=300, protein/creatinine ratio >=3.0, dipstick reading 2+)
OR
SBP >=160, DBP >=110
Thrombocytopenia
New liver/renal impairment
Pulmonary edema
Unresponsive headache
Visual changes

27
Q

Eclampsia

A

Preeclampsia + tonic-clonic seizures

28
Q

Prevention of preeclampsia

A

Aspirin 81-162mg/day from 11-36 weeks

If high risk (hx preeclampsia, multifetal gestation, chronic HTN, T1-2DM, renal disease, autoimmune diesease), start at 12 weeks and continue daily until delivery

29
Q

Preeclamspia treatment

A

Term: deliver
Preterm: bedrest

Severe: magnesium sulfate IV to prevent seizure

BP management: labetalol, nifedipine ER

Emergent therapy: IV labetalol, IV hydralazine, nifedipine (but caution w/ magnesium, can cause hypotension, reduced HR & Contractililty)

30
Q

PPX of preterm labor

A

If history of preterm labor
PPX at 16-26 weeks

17-hydroxyprogesterone caproate 250mg IM weekly

31
Q

Terbutaline

A

Tocolytic (inhibit contractions)
B-agonist

Given SC (NOT PO)
May cause hypotension, tachycardia - do not give longer than 48 hours

32
Q

Magnesium sulfate as tocolytic

A

Given to inhibit uterine activity by antagonism of calcium

Monitor closely for toxicity - therapeutic range is 5-8, and toxicity may occur close to that. Respiratory or cardiac depression.

DOC for pt w/ diabetes

33
Q

Magnesium sulfate reversal agent

A

calcium gluconate IV

34
Q

NSAID for tocolytic

A

Indomethacin - limit to 72 hours

35
Q

CCB for tocolytic

A

Nifedipine - limit to 48 hours

36
Q

Medication abortion

A

Use up to 10 weeks gestation

Mifepristone 200mg x1
Misoprostol 800mcg x1. Place 2 tabs in each cheek for 30 minutes, then swish with water and swallow. 24-48 hours after mifepristone

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