Pregnancy care Flashcards
drug properties in pregnancy and lactation
- the higher the molecular weight the more difficult to pass into milk or placenta
- Greater than 1000Da: virtually no passage - insulin, UF heparin, LMWH
- 500-1000 Da: Difficult
- 250 - 500 DA easily passes - alcohol, nicotine cocaine, most PO meds
lipophilic meds pass easier than hydrophylic - drugs that are sedating or exciting
Acceptable abx in pregnancy
- beta-lactam abx: penacilin, cephalosporin
- macrolides: azithromycin, erythromycin (avoid clarithromycin)
- Nitrofurantoin - avoid at term due to potential risk of hemolysis
Asthma during pregnancy
standard asthma care with inhaled corticosteroids, SABA, LABA, short term systemic corticosteroids
allergic rhinitis care
intranasal corticosteroids
2nd gen antihistamine
Alalgesia during preg
acetominophen
avoid
* NSAIDS - 1st trimester pregnancy loss, after 20 wks, fetal renal dysfunction
Avoid used in pregnancy Abx
Fluroquinolones - floxacin suffix
Trimethoprim-Sulfamethoxazole (bactrim)
Clarithromycin
Know teratogens
- ACEI (pril)
- ARB (sartan) - risk of fetal hypotension, IUFD, renal atrophy
- Tetracyclines - doxycyline, minocyclone
- Statins
- Isotrentinoin - acutane
- Thalidomide
- carbamazepine (tegretol)
- Valproic acid - depakote
- Lithium - cardiac anomolies
medications and breastmilk
- meciations pass in and out of breast milk due to diffusion - movement from higher concentration to lower concentration
- pump and dump is not effective - this creates an rea of lower concentration and drug will difuse in
- pump and dump only to wait out the 1/2 life of drugs
- Hales rule: infant recieves <1 % of maternal drug dose
Hales’s lactation risk L1
- L1 safest - controlled study failed to demonstrate risk - acetominophen, PCN, Depo-provera
Hales rule L2
Safer
* limited number of women studied witout risk
* macrolides (mycin)
* nitrofurantoin
* cephalosporins
* 2nd gen antihistamines
* prednisone
* SSRI’s
Hales rule L3
Moderatley safe - no controlled study or controlled study showed minimal, non-lifethreatening risk
* TMP-SMX
* FQ abx (floxacin)
* 1st gen antihistamines
* doxycycline
Hales L4
*hazardous
* positive evidence of risk but may be used if maternal-life threatening situation
* lithium
* ergot preparations
* daily HD systemic corticosteroids
Hales lactation risk L5
- Contraindicated
- significant and documented risk
- radioactive isotopes
- cocaine