Therapeutics - Drugs in Pregnancy 1
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What is the abnormality, estimated risk and critical period for teratogenicity of Thalidomide?
- Critical Period: 1st tri
- % risk: 30
What is the abnormality, estimated risk and critical period for teratogenicity of Warfarin?
- Fetal warfarin syndrome
- Critical Period: 6-9 wk
- % risk: 5-10
What are the signs of fetal alcohol syndrome?
- Small head circumference
- Epicanthic folds
- Short nose
- Small midface
- Low nasal bridge
- Thin reddish upper lip
- Short Palpebral fissures
What are the suspected teratogens?
What drugs cause adverse effects in pregnancy but are not teratogens?
- Antithyroid drugs
- Oral hypoglycemic agents
- Narcotic analgesics
What drugs are considered safe in pregnancy?
- Docusate sodium
- Multiple vitaminsNarcotic analgesics
- Thyroid hormones
- Tricyclic antidepressants
How can you treat Morning sickness non-pharmacologically?
- Small, frequent meals high in carbohydrates
- Limit spicy foods
- Avoid nausea producing situations, smells etc.
- Cracker at bedside
What are the Pharmacologic Morning sickness treatments?
- Pyridoxine (Vit B6)
- Cyanocobalamin (Vit B12)
- ??? Corticosteroids (If very severe, Dexamethasone, Prednisolone)
- Diclegis (FDA approved)
What is the treatment for constipation in pregnancy?
- Physical exercise
- High fiber foods
- Bulk-forming laxatives
- Stool softeners
- Milk of magnesia
What constipation treatments should not be used in pregnancy?
- NO enemas or strong stimulant laxatives without MD approval
- Lactulose, sorbitol, bisacodyl, Senna, CI: Castor and mineral oil
How is GERD in pregnancy treated?
- Small, frequent meals, no late night meals
- ↓ Caffeine, nicotine, chocolate etc.
- ↑ HOB or sleep on 2 pillows
- Antacids for mild to moderate
- Ranitidine (Zantac®)
- Metoclopramide (Reglan®) for severe
What cannot be used for GERD in pregnancy?
NO sodium bicarbonate without MD approval
How is epilepsy treated in pregnancy?
- Stop medications if seizure free for several years
- Single drug therapy when possible
- Folic acid supplementation 0.4 – 5 mg daily
- Vitamin K 10 mg PO daily in the last month
- Screen for neural tube defects with:
- Carbamazepine (Tegretol®)
- Divalproex sodium (Depacon®)
- Valproic acid (Depakote®)
What are the risk factors for GDM?
- >30 years of age
- Previous history
- + family history
- African, Hispanic, Native, Asian American
What glucose levels indicate GDM?
- FBS > 90 – 99
- 1 hr post prandial > 140
- 2 hr post prandial of >120 – 127
What is the goal blood sugar for GDM?
Maintain FBS 80 - 110 and 2 hr post prandial of <155
What drugs are given in GDM?
- - Multiple daily insulin injections if necessary
- - Split dosing with NPH and regular
- Glyburide (May consider after 11 weeks gestation)
- Metformin (Was used more commonly, but studies say that may cause pre-term baby)
How is bacterial vaginosis treated in pregnancy?
- - 500 mg po BID X 7 days
- - 250 mg po TID X 7 days
- Clindamycin 300 mg po BID X 7 days
- (don’t use vaginal preparations)
How should HIV be treated in pregnancy?
- ZVD after 14 wks gestation
- Antepartum therapy and neonatal prophylaxis
- ZVD drip (Retrovir®)
- Nevirapine (Viramune®)
How should HTN be treated in pregnancy?
- Avoid ACEs, diuretics and ARBs
- BBs are OK
What drugs should you give for depression in pregnancy?
- TCAs and SSRIs
- Avoid Paxil
What should you give patients with mood disorders during pregnancy?
- ??? Lithium
- Caution with valproic acid and carbamazepine
How should HA be treated in pregnancy?
- APAP, codeine, narcotics
- NSAIDS (CI late in pregnancy)
- ?Beta Blockers?
What should not be used to treat HA in pregnancy?
CI – ergotamine and dihydroergotamine
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