Meds and Pregnancy

Question 1

If patient takes a med that’s bad for the baby what happens in week 2-4, week 4-13, week 13?

Answer 1

2-4: all or nothing
4-13: embryonic period-> anomalies
>13: fetal period-> ??

Question 2

What to take when pregnant with a URI?

Answer 2

acetaminophen is great!

NyQuil, cough drops, nasal spray all good

Question 3

Caution pregnant people taking phenylephrine in pts with ____

Answer 3

cHTN or gHTN/preX (its a vasoconstrictor)

Question 4

What to take when pregnant with heartburn?

Answer 4

antacid, famotidine, omeprazole

can even take them together

Question 5

What to take when pregnant with allergies?

Answer 5

diphenhydramine, loratadine, cetirizine

Question 6

What to take when pregnant with constipation?

Answer 6

stool softener, miralax, glycerin, bisacodyl are all great

Question 7

What is OTC that is NOT safe in pregnant individuals

Answer 7

NSAIDs (renal development concern, closure of DA)

aspirin is ok

Question 8

Pregnancy with cHTN, what meds to be on ____. What is bad?

Answer 8

β blocker, Ca channel, diuretics, methyldopa

ACE-Is and ARBs-> renal anomalies

Question 9

Pregnancy with asthma, what meds to be on ____. What is bad?

Answer 9

SABA, anticholinergics (ipratropium), inhaled corticosteroids, LABA
No: oral corticosteroids (prednisone), particularly in first trimester

Question 10

Pregnancy with depression/anxiety, what meds to be on ____. What is bad?

Answer 10

SSRIs, SNRIs, 2nd gen antipsychotics (withdrawal in baby = 48 hours of fussy baby)
Not good but not B A D: benzos, Li, ?Lamotrigine?

Question 11

What is the risk to the baby for a pregnant person on Lithium?

Answer 11

Ebstein anomaly (tricuspid valve not formed well)
(mom can be on it, need to discuss the risk benefits)

Question 12

Pregnancy with diabetes, what meds to be on ____. What is bad?

Answer 12

metformin, sulfonylureas (bad for actual glycemic control), insulins
No idea: α-glucosidase inhibitors, DDP-4s, GLP-1, meglitinides, SGLT2s

Question 13

Pregnancy with hypothyroidism, what meds to be on ____. What is bad?

Answer 13

Levothyroxine (in pregnancy they will need more (30% increase))

Question 14

Pregnancy with anticoagulation, what meds to be on ____. What is bad?

Answer 14

heparin/LMWH
bad: Coumadin
No idea: DOAC

Question 15

Pregnancy with UTI, what meds to be on ____. What is bad?

Answer 15

PCN/cephalosporins, nitrofurantoin, clindamycin, bactrim (îs ok but not for UTI)
Bad: fluoroquinolone, tetracyclines

Question 16

What is pediatric complication with Bactrim

Answer 16

liver stuff

Question 17

What are good options for pregnant patients with N/V

Answer 17

1st line: B6 and Doxylamine

promethazine, prochlorperazine, ginger, scopolamine, zofran (post 10 weeks)

Question 18

When baby is likely to deliver soon but between 22-34 weeks they should be given ___. Why does this work?

Answer 18

corticosteroids (dexamethasone or betamethasone)

Changes the way the lungs are developing from type 1 to type 2 pneumocytes

Question 19

Labor inducing drugs

Answer 19

misoprostol

Pitocin

Question 20

Tocolysis (stopping contractions) can be done with ___ acutely and ___ preterm

Answer 20

Acute: terbutaline (fast acting to help baby recover)

Preterm (<34wks): NSAIDs (short 48 interval between 16-32 weeks), Nifedipine (Ca2+), Mg sulfate

Question 21

What antibiotics to use for:
group B strep prophylaxis
intra-amniotic infection
endometritis

Answer 21

group B strep prophylaxis: penicillin or ampicillin
intra-amniotic infection: ampicillin/gentamycin
endometritis: gentamycin/clindamycin

Question 22

What medications to use for severe preeclampsia

Answer 22

Prevent seizures: Mg sulfate

Acutely lower BP: hydralazine, labetalol, nifedipine