routh Flashcards by Sara Vangjeli

first trimester

0-12 weeks
most susceptible to birth defects

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second trimester

13-28

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third trimester

29-40

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preconception care

weight/diet
prenatal suppl
vitamins/minerals

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weight and diet

preclampsia is a serious complication to the mother and baby

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caffeine

<200 mg of caffeine per day

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benefits for prenatal supplements

fetal development
prevent complications
ideally start 3 months prior to conception
folic acid should be initiated at least 1 month prior to trying to get pregnant

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calcium is important

builds strong bones

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Vitamin D

promotes healthy skin and eyesight helps with bone and teeth development

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folic acid

helps prevent neural tube defects of brain ad spinal cord; supports growth and developmet

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vaccine recomendations

inactivated influenza (october)
tdap (should be administered during EACH pregnanacy , those in close contact with the infant should be vaccinated if not aleady up to date)
RSV (can be adminitered during 32-36 weeks of pregnancy during september-january or baby <8 months old during RSV season
covid-19 stay up to date

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DO NOT GIVE THESE VACCINES TO PREGNANT PATIENTS

hpv, live influenza (nasal), yellow fever, MMR, varicella, typhoid fever

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tx in neonatal opioid withdrawl syndrome

buprenophine, morphine, methadone
IV fluids
Higher caloric formula

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absorption

slower GI motility
decreased rate of absorption

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distribution

increased vd of hydrophilic drugs
decreased protein binding

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metabolism

increased CYP3A4 activity
decreased CYP2C19 activity

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excretion

increase renal and hepatic blood flow
increase CrCl

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8.1 Pregnancy

focus is on evaluating the safety of drug use during pregnancy. the types of available data should be specified

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8.2 Lactation

Includes statement on whether or not to avoid breast feeding

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8.3 females and males of reproductive potential

includes any effects on fertility and requirements for pregnancy testing and contrception

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teratogen

drug or environmenal exposure with the potential to imact the fetus
hazardous medication and requires special handling

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teratogenicity

capability of producing congenital abnormalities or malformations

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teratogens in acne

isotret
topical retinoids

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teratogens in HRT

estradiol
progesterone
test.
raloxifene

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teratogen antibiotics

tetracyclines fluroquinolone

teratogen hypertension

ace inhibitors (pril) arbs (sartan) arni

teratogen dyslipidemia

statin

anticoagulation teratogen

warfarin

mingraine teratogen

dihydroergotamine

more teratogen

NSAID misoprostol lithium methotrexate hydroxyurea

short term complications during preg

N/V, heartburn, constipation, pain, fever, HA, UTIs, cough/cold

N/V

usually starts before week 9 and goes away by week 14

risk factors or n/v

history of motion sicknes gerd high fat diet younger patients

hyperemesis gravidarum (severe) n/v

severe for n/v affecting up to 3% pregnancies leads to weight loss, electrolyte imbalances, and dehydration

FIRST LINE TX OPTIONS FOR N/V

NON-PHARMACOLOGICAL

SECOND LINE TX for N/V

1. pyridoxine (vitamin b6) 2. doxylamine +b6 3. meclizine, dimenhyramine or diphenhydramine 4. ondansetron or metoclopramide

GERD

>50% of all pregnany women report severe heaartburn usually occurs during 3rd trimester causes: hormone levels changing, esophageal sphincter relaxing, and/or uterus enlarging

FIRST LINE TX FOR GERD

NON-PHARM

SECOND LINE TX FOR GERD

1. antacids 2. sucralfate 3. H2RAs or PPIs

cause of constipation

dereased peristalsis decreased gi movements

nonpharm tx for constipation

eat 25-30 g of fiber daily increase fluuid intake to 8-12 glasses perday get 20-30 mintes of moderate exercise 3x/week

pharm tx for constipation

fiber osmotic lax (peg, lactulose) stool softener (docusate) bulk lax (psyllium) avoid mineral oil/castor oil

pain, fever, and headache tx non pharm

cool compress manage stress increase relaxation techniques get at least 8 hours of sleep each night

pharm tx for pain, fever, and HA

1. tylenol avoid: nsaids and aspirin!!!!

cough cold and allergies 1st line

cromolyn

cough cold and allergies 2nd line

chlorpheniramine diphenhydramine

other tx for cough cold and allergies

loratidine cetrizine CAN ONLY BE USED DURING 2ND AND 3RD TRIMESTERS

what should be avoided in the 1st trimester?

ORAL DECONGESTANTS

uti in pregnancy tx

cephalexin bactrim +nitrofurantoin amox+augmentin fosfomycin + nitro

preeclampsia

new onet hypertension

preeclampsia+ecplampsia

hypertension AND seizures

preclamspia

sudden spike in bp proteinuria

preeclampsia managment

baby aspirin starting in the late 1st trimester, calcium supplementation, excercise

acute tx for preeclampsia

hydralazine labetalol nitroprusside nifedipine avoid: ace/arbs

general hypertension tx with preeeclampsia

labetalol, nifedipine, methyldopa

eclampsia management

continued monitoring of magnesium levels, mental/repiratory status, reflexes

Group B strep

an infection found in the vaginal/rectal areas that can be transferred to babies during delivery

tx for group b strep

1st line; penicillin G or ampicillin IV once labor has started PCN allergy mild: cefazolin PCN allergy severe: clindamycin and vancomycin

when to induce preg

>41-42 weeks preeclampsia infection fetal compromise diabetes, renal, HTN

risks of induction

low fetal HR failed induction infection uterine rupture bleeding after delivery

contraindications of induced labor

fetus sideways, previous high risk c-section. prior uterine incision, prior uterine rupture

oxytocin

hormone that causes contractions of the uterus contractions usually start ~30 minutes after administration uses: to induce labor and postpartum hemorrhage

oxytocin dosing

NS OR LR IV infusion low dose: 1-2 millinunits/min every 15-40 min high dose: 4-6 milinunits/min every 15-40 mins max dose: 40 milliunits/min oxytocin has a half life of ~3 minutes when infused

adverse reactions with oxytocin

arrhythmia bp changes tachycardia water intoxication n/v postpartum hemorrhage uterine rupture anaphylaxis pelvis hematoma