Psych Meds in Pregnancy and Lactation Flashcards
What are the 3 postpartum psychiatric disturbances?
Postpartum blues: resolves within 2-4wks, may be crying but still happy
Postpartum depression: not happy they had their baby and feel as though the baby wouldd be better off if they were gone.
Postpartum psychosis: believe their baby is possessed.
What psychiatric disorder gets better with pregnancy?
Panic disorder gets better with pregnancy.
To treat or not to treat psychiatric disorders while pregnant? WHat are some consequences of non treating in the infant, child and mother?
Women with psych disorders that are not treated are at higher risk of preterm delivery, lower birth weight, spontaneous abortion, pre-eclampsia, instrumental deliveries, operative deliveries. Neonates have poorer outcomes in the following areas:
- poor adaption; excessive crying, irritability, erratic sleep
- growth retardation
- increased risk of NICU admission
- lower Apgar scores
- decreased head circumference.
Child Consequences:
- negative effect on fetal maternal bonding
- difficulty with affect regulation
- cognitive delays
- maladaptive social interaction s
- increased levels of anxiety and fear
- increased levels of ADHD
Mother:
- poor nutrition
- failure to follow medical advice
- worsening of co-morbid medical illnesses
- increased exposure to alcohol, tobacco, drugs
- postpartum psych complications
Pharmacotherapy in Pregnancy: describe in relation to the placenta
- lipid solubility
- molecular weight
- ionization
Lipids: more lipophillic drugs tend to cross the placental barrier more efficiently.
The lower the molecular weight = crosses placental barrier more easily.
Non-ionized will cross the placental barrier
The first 14 days of pregnancy are referred to as? What is this significance of this?
The first 14 days are known as “all or none,” if given psych meds there will either be no affect at all to the fetus or it may result in miscarriage.
How are the pharmokinetics altered in a pregnant women in each of the following areas:
- plasma volume
- glomerular filtration rate
- gastric motility
- liver microsomal activity
- protein binding
Plasma volume increased (dilutional effect)
Increased glomerular filtration
Slowing of gastric motility
increased action of liver microsomal activity (increased degredation of drug)
Increased protein binding (more is bound to protein so less is available)
What were the USDA pregnancy categories? WHat is the new system?
A: generally considered safe
B: caution advised
C: weight risk/benefits
majority are listed here
D: weigh risk/benefits
X: risk outweigh benefits
New System:
Pregnancy (labor and delivery)
Lactation
Females and males of reproductive potential
Antidepressants in Pregnancy:
- which is first choice?
- explain neonatal withdrawal syndrome, sx, and tx
1st choice = zoloft –extremely safe in pregnancy and during breastfeeding.
Neonatal withdrawal syndrome:
-exposure to/withdrawal from SSRI or SNRI
Sx: tremor, restlessness, increased muscle tone, increased crying
Tx: resolves1-4days after birth
Mood Stabalizers
-which drug is mainstay for acute and maintenance therapy in pregnancy?
Lithium is mainstay for acute and maintenance therapy
Pharmacotherapy during lactation: describe each of the following;
- lipid solubility
- molecular weight
- protein binding
- pH
lipid: higher in breast milk
molecular weight: higher molecular weight = lower conc in milk
Protein: the higher protein bound the drug is = less in milk
pH: the higher the pH = increased milk concentration
T/F: maternal drug levels are proportional to breast milk level?
T/F: breastfeeding just before next dose will result in lower breast milk levels?
T/F: shorter half-life drugs are preferred over once daily dosed drugs?
True, TRUE, TRUE!!!
What are the lactation risk categories? what is the safest?
L1-L5.
L1 is the safest and L5 is CI.
What is RID? What % do we want this at? why?
relative infant dose; we want 10% or less, this means baby is getting 10% or less of the drug the mother is taking.
What is lactation risk category for Zoloft? how about most of the other SSRIs?
What is lactation risk category for lithium? Depakote?
L2, most of the other SSRI’s are L2 as well.
Lithium = L3, RID 12-30% Depakote = L2
Of the following mood stabalizers which of the following are safe in pregnancy? lactation?
- depakote
- tegratol
- lithium
Depakote; not safe in prego, safe in breastfeeding
Tegratol; not safe in prego, safe in brestfeeding
lithium; safe in prego, not safe in breastfeeding
