Ch 22: Drug Use in Pregnancy and Lactation Flashcards

1
Q

folic acid

A

400 mcg/d normally. 600 mcg/d during preg

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2
Q

calcium/vit d requirement

A

preg 1000 mg/d ca and 600 iu/d vit d.

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3
Q

previous category: A

A

no risk in 1st trimester

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4
Q

previous category: B

A

animal studies have either no demonstrated a fetal risk + no controlled studies in preg OR animal studies have ADR that was not confirmed in preg women

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5
Q

previous category: C

A

animal studies have shown harm, no controlled studies in humans. OR studies in humans/animals not avail. give only if benefit outweighs risk.

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6
Q

previous category: D

A

pos evid of fetal risk, but benefits may outweigh risk for life-threatening or serious disease

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7
Q

previous category: X

A

use in preg is contraindicated always

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8
Q

key teratogens: acne, abx, anticoag

A

isotretinoin, topical retinoids (including tazarotene). quinolones, tetracyclines. warfarin

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9
Q

key teratogens: dyslipidemia, HF, HTN

A

statins, RAAS inhibitors (ACEIs, ARBs, aliskiren, entresto)

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10
Q

key teratogens: hormones, migraine

A

most - estradiol, proesterone (including megace), raloxifene, duavee, testosterone, contraceptives, etc. (dihydro)ergotamine

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11
Q

key teratogens: others

A

hydroxyurea, lithium, MTX, misoprostol, paroxetine, ribavirin, thalidomide, topiramate, valproic acid/divalproex, wt loss drugs

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12
Q

tx in preg: morning sickness, NV

A

lifestyle first. then pyridoxine (vit b6) +/- doxylamine

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13
Q

tx in preg: GERD/heartburn

A

lifestyle first. then ca carbonate.

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14
Q

tx in preg: flatulence

A

simethicone (gas-x)

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15
Q

tx in preg: constipation

A

lifestyle first. fiber (psyllium, ca polycarbophil, methylcellulose)

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16
Q

tx in preg: cough, cold, allergies

A

first gen anti-histamines (chlorpheniramine is choice or benadryl) are first line. loratidine and cetirizine can be rec in 2nd-3rd trimester. budesonide (rhinocort) or beclomethason (beconase) for chronic allergies. avoid liquid forms with alcohol. PO decongestants not rec.

17
Q

tx in preg: pain

A

apap first line. avoid NSAIDS and opioids

18
Q

tx in preg: asthma

A

mx steroid: inhaled budesonide. rescue tx: albuterol.

19
Q

tx in preg: HTN

A

labetalol, methyldopa, nifedipine. RAAS inhibitors are contraindicated.

20
Q

tx in preg: DB

A

lifestyle first. insulin preferred. metformin and glyburide are used.

21
Q

tx in preg: VTE/mech valve

A

LMWH preferred. pneumatic compression devices sometimes used. warfarin is teratogenic

22
Q

tx in preg: hypothyroidism

A

levothyroxine needs 30-50% inc

23
Q

tx in preg: hyperthyroidism

A

PTU in 1st trimester. methimazole in 2nd and 3rd trimester.

24
Q

pain in lactation

A

do not use codeine, tramadol, or opioids d/t risk with 2d6 ultra metabolizers

25
Q

HIV in lactation

A

not rec to breastfeed

26
Q

specific meds in lactation

A

avoid: amphetamines, ergotamines, lamotrigine, lithium, statins. metronidazole: milk should be pumped and discarded for 12-24 h after single dose, try to avoid. phenobarbital can result in acute withdrawal effects

27
Q

supplements in lactation

A

400 iu of vit d daily until baby consuming at least 1 L of vit D fortified formula/day.