Psych meds in pregnancy Flashcards
1
Q
The components of an ideal pregnancy?
A
- planned
- prenatal vitamins started 6 wks prior to conception
- 15% of ideal body wt at time of conception
- routine prenatal care
- no meds
- no obstretical complications
- breastfeed w/o difficulty
- euthymia (positive attitude) throughout pregnancy and postpartum
2
Q
Reality of pregnancy?
A
- around 50% unplanned
- usually don’t realize pregnant until 4th-7th week
- 84.5% result in viable infant, 2-4% reqr surgical intervention
- 80% prescribed meds (includes prenatal vitamins)
- of these 33% are psychotropic meds
3
Q
Risk for psych disorders in women?
A
- mood disorders: risk of depression and dysthymia 2x that of men during childbearing years
- Anxiety: risk of anxiety and panic disorder higher as well
- bipolar and psychotic disorders seem to be about sam ein both sexes except during pregnancy and postpartum when risk increases
4
Q
Is pregnancy mood protective?
A
- no, 70% report depressive sxs and 10-15% meet criteria
- panic disorder may actually get better during pregnancy
- OCD is exacerbated, 25% have first onset during pregnancy
- postpartum blues: mood lability, depression, resolves in 2 weeks, mother still happy she has had her child
- postpartum depression: more prevalent in adolescent mothers, men also get postpartum depression
- postpartum psychosis: 1-2/1000 live births with onset within first 6 weeks postpartum - overt psychotic sxs - believe their child is possessed
5
Q
Untreated illnesses that aren’t benign can lead to?
A
- preterm delivery
- lower birth wt
- spontaneous abortion
- pre-eclampsia
- instrumental deliveries: c-sections
- operative deliveries
6
Q
Poor neonatal outcomes from disorders being left untx?
A
- poor neonatal adaptation: excessive crying, irritability, erratic sleep
- increased risk of admission to NICU
- growth retardation
- lower APGAR scores
- decreased head circumference
7
Q
Untx disorders affect on child development?
A
- negative effect on fetal-maternal bonding
- difficulty with affect regulation
- cognitive delays
- maladaptive social interactions
- increased levels of anxiety and fear
- increased levels of ADHD
- high levels of cortisol from mom - leads to disturbance in hypothalamic pituitary adrenal axis fxn - long term effects in child
8
Q
Risk to mother if disorders are left untx?
A
- poor nutrition, impaired self care
- failure to follow medical/prenatal guidelines
- worsening of co-morbid medical illness
- increased exposure to ETOH, tobacco and drugs
- impact on family
- postpartum psych complications
9
Q
Tx options in pregnancy?
A
- non-pharm: psychosocial options psychotherapy massage light therapy (like in SAD) exercise - electroconvulsive therapy: anesthetic agent only risk to mother, very effective - given muscle relaxant - induce a seizure
10
Q
Key pharmcotherapy concepts in pregnancy - placental barrier?
A
placental barrier:
- lipid solubility: more lipophilic drugs tend to cross barrier more efficiently than nonlipophilic
- MW: wts of 500 D or less facilitate crossing the barrier (insulin and heparin can’t cross)
- ionization: drugs taht are nonionized at physiologic pH cross placenta more efficiently
11
Q
key pharm concepts in pregnancy - safe period?
A
- first trimester: highest risks of birth defect
- first 14 days - all or none - no effect or miscarriage
- 14-60: cell diff, organogenesis
- up to 32 days - neural tube defect
- 21-56 days: heart forms
- 42-63: cleft palate occurs
- try to keep off meds during first trimeseter - keep on antidepressants if already on
12
Q
key pharm concepts in preg- pharmacokinetics?
A
physiologic changes:
increased plasma volume = dilutional effect
increased glomerular filt= excretion increased
slowing of gastric motility
increased action of liver: drugs breakdown faster
increased protein binding - less med available for use
13
Q
US FDA pregnancy categories?
A
- A: generally considered safe
- B: caution advised
- C: weigh risks/benefits
- D: weigh risks/benefits
- X: risks outweigh benefits
14
Q
New FDA drug labeling?
A
3 sections:
- pregnancy: list out risks, labor and delivery
- lacation
- females and males of reproductive potential
15
Q
First line tx of depression in pregnancy?
A
- zoloft
16
Q
Antidepressants and assoc birth defects?
A
- paxil - RV outflow tract defects - failure of normal circulatory transition - R to left
- prozac - VSDs (not first line in lactation - accum in neonate)
- celexa - neural tube defects
- failure of normal circulatory transition - R to L extrapulm shunting of blood, hypoxemia
- study shown that theses defects are same in these drugs as background (Not being on drugs) - same risk as not being on paxil
