S2E4: Pregnancy/lactation Flashcards
1 mo before conception
400-800 mcg folic acid
3-12 w after conception (whats happening?)
organogenesis
Category A
Human studies show no risk
Category B
Ok in animals, not studied in humans.
Category C
Animals show bad effects. Use if benefit > risk
Category D
Evidence of human risk. Could still use is benefit > risk
Category X
Animal or human studies show fetal risk > benefit
Peri-conception rx
folic acid 400 mcg
flu vaccine 2nd or 3rd trimester
Morning sickness tx
doxylamine, vit B6 (pyridoxine), meclizine, dimenhydrinate, diphenhydramine, ondasetron, metoclopramide, phenothiazines
Heart burn tx during pregnancy
1: antacids (mag, Al, Ca carbonate), sucralfate
2: H2 blocker, PPI
Constipation tx during pregnancy
- metamucil, citrucel, surfactants
- stimulants
* avoid mineral oil
HA tx during pregnancy
rest, ice, APAP
*avoid NSAIDs, migraine rx (triptans, ergotamine)
Coag d/o tx during pregnancy
heparin (unfrac or frac OK)
enoxaparin (LMWH)
*NO WARFARIN after 6 wk
GDM tx
- insulin (NPH/intermediate + regular insulin)
2. metformin (glyburide)
HTN (pregnancy induced) tx
- Methyldopa + Ca
- Labetolol, nifedipine
* NO ACE-I or ARB
UTI tx during pregnancy
Ampicillin, cephalexin, nitrofurantoin
*No tetracyclines or FQL
Syphilis tx during pregnancy
PCN
Gonorrhea tx during pregnancy
ceftriaxone
Chlamydia tx during pregnancy
erythromycin
asthma tx during pregnancy
albuterol and inhaled corticosteroids (flovent)
Allergic rhinitis tx during pregnancy
inhaled corticosteroids and 1st gen antihistamines (diphenhydramine)
2nd gen antihystamine (Cetirazine (zyrtec) and Loratadine (claritin)) only if clearly needed.
Depression tx during pregnancy
- SSRIs (fluoxetine, sertraline, citalopram) with TCAs (amitryptyline, nortriptyline)
- buproprion
* No paroxetine (SSRI) during pregnancy, but preferred during lactation
Depression tx during lactation
- sertraline, paroxetine, or TCAs
* avoid fluoxetine (transition to paroxetine or sertraline after delivery)
Allergic rhinitis tx during lactation
short term: antihistamines
long term: nasal steroid or cromlyn
asthma tx during lactation
inhaled steroids (flovent)
HTN tx during lactation
labetalol, atenolol, metoprolol, nifedipine, enalapril, captopril
- labetalol, nifedipine also ok in pregnancy
- enalapril, captopril only ACE-Is that are ok (but remember, not in pregnancy!!)
- no ARBs