Psych Meds in Pregnancy & Lactation Flashcards Preview

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Flashcards in Psych Meds in Pregnancy & Lactation Deck (55)
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1

Risks for Psychiatric Disorders

Mood disorders
Anxiety disorders
Psychotic disorders

2

Risks for a Fetus with Untreated Disorders

Preterm delivery
Lower birth weight
Spontaneous abortion
Pre-eclamsia
Instrumental deliveries
Operative deliveries

3

Neonatal Outcomes of Untreated Disorders

Poor neonatal adaptation
Increased risk of NICU admission
Growth retardation
Lower APGAR scores
Decreased head circumference

4

Child Development of Untreated Disorders

Negative effect on fetal-maternal bonding
Difficulty with affect regulation
Cognitive delays
Maladaptive social interactions
Increased levels of anxiety & fear
Increased levels of ADHD

5

Risk to Mother with an Untreated Disorder

Poor nutrition
Impaired self care
Failure to follow medical/prenatal guidelines
Worsening of co-morbid medical illness
Increased exposure to ETOH, tobacco, & drugs
Impact on family
Postpartum psychiatric complications

6

Treatment Options for Mental Disorders

Psychosocial
Psychotherapy
Massage
Light Therapy
Exercise
ECT

7

Key Concepts in Pregnancy for Pharmacotherapy

Placental barrier: lipid solubility, molecular weight, ionization
Safe period
Pharmacokinetics: physiologic changes, increased plasma volume, glomerular filtration, action of liver microsomal activity, protein binding, slowing of gastric motility
Drug safety data
US FDA pregnancy categories

8

Antidepressant Therapy

TCAs: amitriptyline, nortriptyline, desipramine
SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)
Bupropion (Wellbutrin)
Trazodone
Mirtazipine (Remeron)

9

Symptoms of SSRI or SNRI Withdrawal in the Neonatal

Tremor
Restlessness
Increased muscle tone
Increased crying

10

Issues in the Fetus when Mom is on Lithium

Epstein's anomaly (tricuspid valve)
Floppy baby syndrome
Neonatal hypothyroidism
Nephrogenic DI

11

Mood Stabilizers

Lithium
Lamotrigene (Lamictal)
Valproate (Depakote)
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Gabapentin (Neurontin)
Topiramate (Topamax)

12

Valproate (Depakote)

Human teratogen: neural tube defects, irritability, jitteriness, feeding problems, growth retardation, lower IQ scores

13

Carbamazepine (Tegretol)

Human teratogen: craniofacial defects, developmental delays, fingernail hypoplasia, neural tube defects
Decrease birth weight
Decreased head circumference

14

Antipsychotics

Phenothiazines & butyrophenones
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Clozapine (Clozaril)

15

Neonatal Withdrawal Syndrome with Benzodiazepines

Tremor
Irritability
Diarrhea
Vomiting
Hypertonicity

16

Benzodiazepines

Clonazepam (Klonopin)
Lorazepam (Ativan)
Alprazolam (Xanax)
Diazepam (Valium)

17

Sedative/Hypnotics

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)

18

Benefits of Lactation for the Infant

SIDS
GI problems
Anemia
Respiratory ailments
Otitis media
Obesity

19

Key Principles of Pharmacotherapy in Lactation

Low oral bioavailability unlikely to cause systemic effects
Drugs enter breast milk via diffusion
Lipid solubility
Protein binding
Molecular weight
pH
Establishment of milk production
Neonatal physiology
Safety in pregnancy doesn't equal to safety in lactation

20

Risk Categories in Lactation

L1: safest
L2: safer, remote risk
L3: moderately safe, risk possible
L4: possibly hazardous, positive evidence of risk
L5: contraindicated

21

Sertraline (Zoloft) Lactation Category (SSRI)

L2

22

Fluoxetine (Prozac) Lactation Category (SSRI)

L2

23

Amitriptyline (Elavil) Lactation Category (TCA)

L2

24

Imipramine (Tofranil) Lactation Category (TCA)

L2

25

Nortriptyline (Pamelor) Lactation Category (TCA)

L2

26

Venlafaxine (Effexor) Lactation Category (SNRI)

L3

27

Duloxetine (Cymbalta) Lactation Category (SNRI)

L3

28

Mirtazipine (Remeron) Lactation Category

L3

29

Bupropion (Wellbutrin) Lactation Category

L3

30

Trazodone Lactation Category

L2