Pregnancy care Flashcards

1
Q

drug properties in pregnancy and lactation

A
  • 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

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2
Q

Acceptable abx in pregnancy

A
  • beta-lactam abx: penacilin, cephalosporin
  • macrolides: azithromycin, erythromycin (avoid clarithromycin)
  • Nitrofurantoin - avoid at term due to potential risk of hemolysis
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3
Q

Asthma during pregnancy

A

standard asthma care with inhaled corticosteroids, SABA, LABA, short term systemic corticosteroids

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4
Q

allergic rhinitis care

A

intranasal corticosteroids
2nd gen antihistamine

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5
Q

Alalgesia during preg

A

acetominophen

avoid
* NSAIDS - 1st trimester pregnancy loss, after 20 wks, fetal renal dysfunction

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6
Q

Avoid used in pregnancy Abx

A

Fluroquinolones - floxacin suffix
Trimethoprim-Sulfamethoxazole (bactrim)
Clarithromycin

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7
Q

Know teratogens

A
  • 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
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8
Q

medications and breastmilk

A
  • 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
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9
Q

Hales’s lactation risk L1

A
  • L1 safest - controlled study failed to demonstrate risk - acetominophen, PCN, Depo-provera
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10
Q

Hales rule L2

A

Safer
* limited number of women studied witout risk
* macrolides (mycin)
* nitrofurantoin
* cephalosporins
* 2nd gen antihistamines
* prednisone
* SSRI’s

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11
Q

Hales rule L3

A

Moderatley safe - no controlled study or controlled study showed minimal, non-lifethreatening risk
* TMP-SMX
* FQ abx (floxacin)
* 1st gen antihistamines
* doxycycline

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12
Q

Hales L4

A

*hazardous
* positive evidence of risk but may be used if maternal-life threatening situation
* lithium
* ergot preparations
* daily HD systemic corticosteroids

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13
Q

Hales lactation risk L5

A
  • Contraindicated
  • significant and documented risk
  • radioactive isotopes
  • cocaine
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