PSI Pharm Flashcards by Kalee Woody

Do SSRIs cause autism?

SSRI use in pregnancy itself does not increase the risk of autism

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Do antipsychotics cause autism?

Risk of ASD related to maternal characteristics and not antipsychotic exposure

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When is the risk of autism increased?

Greater in women with psychiatric disorders who DON’T use SSRIs than in women who do

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What should you tell a mother concerned about baby SSRI withdrawal?

Poor Neonatal Adaptation: Noted in 25-30% of babies, lasts 1-2 days, no long term sequelae from it

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What is the risk of relapse of anorexia in pregnancy?

50%

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What baby issues are associated with anorexia in pregnancy?

Prematurity
Low birthweight
Small for gestational age

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What is the correlation between SSRI use and Neonatal Persistent Pulmonary Hypertension?

Correlation but not clinically significant

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What is the risk of NPPH compared to the relapse of mental health conditions when stopping SSRIs in the 3rd trimester?

RISK OF NPPH IS LESS THAN RELAPSE OF MENTAL HEALTH CONDITIONS OF STOPPING SSRI IN 3RD TRIMESTER

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What does untreated Perinatal Panic Disorder increase the risk of?

Preterm delivery
Perinatal depression

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Should Paroxetine be avoided during pregnancy?

Not contraindicated in pregnancy, but not first choice if psychotherapy and other agents are effective

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What is unique about Paroxetine regarding pregnancy?

Only antidepressant with FDA warning of use in pregnancy
-Increased risk of CV malformation and neonatal withdrawal

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What are the risks for perinatal depression?

Strong family history
Current mental health issues
1st pregnancy

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What are the protective factors for perinatal depression?

Treatment with remission of symptoms
Good partner support
Active involvement in healthcare

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Is psychotherapy indicated for perinatal depression?

PSYCHOTHERAPY IS STRONGLY RECOMMENDED BY USPSTF

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What else can help postpartum depression?

Estrogen (if out of DVT/PE window and seems hormonally driven)
Coordinate with OBGYN

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What medication can be used for hyperemesis gravidarum with comorbid anxiety and depression?

Mirtazapine (no increased risk of birth defects, may increase preterm labor but confounds not ruled out)

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What is the effect of Prazosin during pregnancy?

Can decrease placental perfusion and interfere with labor initiation
-weigh risks vs benefits: may be worth it if nightmares affecting sleep

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What should be done if a mother experienced sexual trauma and is breastfeeding?

Educate on normal sensations of breastfeeding
Can express milk and then use bottle at first until ready
Start with least anxiety provoking situations (day feeding if night causes anxiety)

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Does talking about suicide increase the risk of it happening?

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What is the prevalence of suicide in the postpartum period?

1.6-4.5% prevalence
-80% of cases were preventable

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leading cause of maternal perinatal mortality?

suicide and overdose

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What should be checked if a mother feels she can’t adequately take care of herself or her baby?

Suicidal thoughts

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Mother complains of insomnia. What do you do first?

figure out WHY not sleeping
sleep hygiene education

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Chronic insomnia during pregnancy may increase risk of?

Gestational DM
HTN
Preterm birth

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What is the best studied Z drug for insomnia?

Zolpidem best studied

What is the concern with Melatonin during pregnancy?

NOT first line due to concern could later fetal melatonin receptors

Can trazodone be used in pregnancy?

okay, but not first line

benzodiazepine use in pregnancy and breastfeeding?

-not contraindicated -baby can withdrawal if mom used regularly

Does hydroxyzine cause birth defects?

No birth defects

what do you want to be careful of with Hydroxyzine use in pregnancy?

Seizures in baby due to abrupt discontinuation when used long term at high doses

What should you screen for if SSRIs make a patient irritable or angry?

Bipolar disorder, do Mood Disorder Questionnaire

What is the most studied SSRI in the perinatal period?

Sertraline; if successful treatment with sertraline in the past, always use this one

What should be done for a patient who had to discontinue venlafaxine due to HTN and is irritable and not sleeping?

-Goals: minimize risk of preeclampsia, improve sleep and mood irritability -could reintroduce venlafaxine at low dose to help with withdrawal

What medications are at risk of increasing HTN?

* Venlafaxine (RR=1.5) * Duloxetine (RR1.04-1.14)

When should Depakote be used in pregnancy?

ONLY WHEN OTHER MOOD STABILIZERS ARE INEFFECTIVE AND BENEFITS OUTWEIGH RISKS (carries greatest risk for teratogenicity compared to other mood stabilizers)

What is the risk of congenital abnormalities with first trimester exposure to lithium?

4.6% risk of congenital abnormalities; 1.2% absolute risk of CV abnormalities

What should be monitored for with lithium during pregnancy?

* Nephrogenic diabetes insipidus * Transient hypothyroidism * Transient neonatal toxicity (floppy baby syndrome)

What happens to lithium levels during pregnancy?

They decrease, dose will likely be increased compared to prepregnancy dose

What should be done with lithium dose after delivery?

Immediately return to pre-pregnancy dose

How do you reduce toxic lithium peaks to the fetus?

Divide doses toward end of pregnancy

Women with bipolar disorder are substantially more likely to develop postpartum ___

Psychosis

Does lamotrigine increase risk for neural tube defects, behavioral issues, or cleft palate in infants?

What happens to lamotrigine levels during pregnancy?

Decrease, dose during pregnancy will likely need increased

What should be done with lamotrigine dose after birth?

Slowly taper back to pre-pregnancy dose to avoid lamotrigine toxicity

Are there congenital malformations with Olanzapine use in pregnancy?

What are the risks to the mother with olanzapine use in pregnancy?

* Excessive weight gain * Gestational diabetes

How much of olanzapine gets into breast milk?

0.3-1.1% -case reports of irritability, tremor insomnia, somnolence

What are the risks of cigarette smoking during pregnancy?

* Low birth weight * Preterm birth * Perinatal loss (miscarriage, stillbirth) * SIDS * Possible increase in cardiovascular birth defects

Does reducing the number of cigarettes during pregnancy help?

Not if they are inhaling them more deeply

What are the risks associated with Wellbutrin during pregnancy?

* Increased risk of CV abnormalities with first trimester exposure * Miscarriage * Lowered seizure threshold * ADHD in offspring (may be confounded by indication) * Fetal cardiac arrythmia and neonatal hyperinsulinism

What are the options for smoking cessation during pregnancy?

* Chantix: no birth defects but watch for suicidality in history of depression * NRT: gum> patch as patch exposes baby to more nicotine * Don’t underestimate counseling/behavior modification!

What are the complications of alcohol use in pregnancy?

* Fetal alcohol syndrome (cognitive malformations and impairment) * Increased risk of miscarriage, stillbirth, newborn infections

What are the non-pharmacologic interventions for alcohol cessation in pregnancy?

* Motivational interviewing * Acceptance/mindfulness based interventions * Mutual support groups (AA, SMART)

What is the risk of naltrexone in pregnancy?

Not studied in pregnancy specifically; no difference in congenital abnormalities, stillbirth compared to women using buprenorphine or methadone

Is acamprosate safe in pregnancy?

yes, no increased risk of congenital abnormalities or low birth weight

Should opioid use disorder (OUD) in pregnancy be treated with MAT?

Yes; Relapsing pattern of addiction associated with preterm birth, low birth weight, reduced head size, SIDS

What should be told to mothers about MAT and infant withdrawal?

Withdrawal can be managed in hospital

What is the effect of methadone use in pregnancy?

Improves outcomes compared to relapsing remitting pattern of addiction

What is the effect of buprenorphine use in pregnancy?

Crosses placenta less than methadone; less intense infant withdrawal compared to methadone

What should be considered with ADHD treatment during pregnancy?

Weigh risk of stress and accident risk of untreated ADHD on infant vs being treated

What are the risks associated with ADHD stimulants in pregnancy?

* Possible increased risks of preeclampsia * Preterm birth * Low birth weight * Fetal hypoxia * Seizures * NICU admissions * CV malformations (seen with methylphenidate but not amphetamines) ***absolute risks appear to be small, confounds were not ruled out, there are no systemic long term studies on neurobehavioral effects on offspring

What should mothers be warned about with stimulants in pregnancy?

Decreased appetite/weight gain

What is the percentage of methylphenidate in breast milk?

<1%

What is the percentage of amphetamines in breast milk?

<2%

Is there any adverse effect with breastfeeding while on ADHD medications?

No adverse effects with breastfeeding, though limited data