Pregnancy and Supportive Care

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Pregnancy and Supportive Care
2011-04-08 00:46:48
Therapeutics Exam6

Therapeutics Exam6 Pregnancy and Supportive Care - Dr. Schultz
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  1. Supplements all pregnant pts should be on and why
    • Prenatal vitamins
    • folic acid - prevent neural tube defects, essential for RNA and DNA formation
    • iron - maternal blood volume expansion, placenta and cord needs, blood loss @ delivery
    • calcium - mineralization of fetal skeleton and teeth, may reduce preterm labor and HTN
    • omega 3 fatty acids - supports brain and eye development
  2. What criteria are needed to determine pregnancy risk category?
    • Category A: no demonstrated harm in human fetuses, ex: folic acid, levothyroxine
    • Category B,C: no evidence of fetal harm in human studies or no studies available (Category C might show fetal harm in animal studies)
    • Category D: Evidence of fetal harm, but benefits might outweigh risks in some cases
    • Category X: risks always outweigh benefits, ex: OCs, isotretinoin, warfarin, MTX
  3. Identify limitations of pregnancy risk categories
    • very hard for a med to be put into category A - hard to provide enough evidence - drugs may be categorized at less safe than they really are
    • Difficult for a drug to change from one category to another
    • U.S. classifications are different than those in other countries
  4. Treatment of n/v in pregnancy
    Non-pharm: small dry meals high in carbs and low in fat, avoid ppt factors, shorter workdays, freq naps

    • Pharmacologic:
    • 1st line:
    • metoclopramide (BBW for tardive dykinesia)
    • meclizine
    • dimenhydrinate
    • ondansetron

    • 2nd line:
    • promethazine
    • prochlorperazine

    • OTCs:
    • vitamins B6 and B12
    • ginger root
    • premesisrx (combo of B6, B12, folic acid, pyridoxine, calcium carbonate)
  5. treatment of constipation in pregnancy
    non-pharm: incr activity, fluids, fruits, veggies, whole grains

    • Pharmacologic:
    • bulk forming agts (metamucil, citrucel)
    • mild stimulants (bisacodyl, senna)
    • stool softeners (docusate sodium)
    • PEG
    • mild laxatives (MOM)
    • Avoid use of strong cathartics and enemas and castor and mineral oil
  6. Tx of GERD in pregnancy
    step up therapy preferred

    • OTCs: antacids
    • RX: sucralfate, H2RAs, PPIs are last line
  7. Tx of HTN in pregnancy
    • Nonpharmacologic is not effective
    • Pharmacologic:
    • Methyldopa is 1st line
    • Labetalol (ok to use short term in 3rd tri)
    • Nifedipine (ok during any tri)

    • Don't use:
    • diuretics
    • other beta-blockers
    • ACEs/ARBs
  8. Prevention of preeclampsia
    • 81 mg/d ASA after 12 weeks gestation if pt at risk (DM, chronic HTN, pre-eclampsia hx, kidney disease)
    • 1g/d calcium may decr. risk by 1/2
    • Tx: magnesium sulfate to prevent seizures - given during labor and 12-24 h post partum
  9. tx of VTE during pregnancy
    • LMWH is 1st line
    • Unfractionated Heparin is 2nd line
    • Do not use warfarin
  10. Tx of antenatal depression
    • SSRIs (not paroxetine)(fluoxetine most data)(sertraline, escitalopram, citalopram ok)
    • TCAs (desipramine, nortriptyline)
    • Venlafaxine
    • Bupropion
  11. Best resources for drug use recommendations in pregnancy
    • Best - most comprehensive = Drugs in Pregnancy and Lactation by Briggs
    • good recommendation for public =