Drug Use In Pregnancy And Lactation

Question 1

Average pregnancy cycle

Answer 1

37-40 weeks

Question 2

Time for most organ development

Answer 2

0-12 weeks

Question 3

Most likely time for teratogenicity to occur

Answer 3

0-12 weeks

Question 4

What drives drug dose or regimen adjustment during pregnancy

Answer 4

Pharmacokinetics changes that occur during pregnancy

Question 5

Gravida (G)

Answer 5

Number of pregnancies

Question 6

Para (P)

Answer 6

Number of births

Question 7

Folic acid dose in pregnancy

Answer 7

600 DFE/day

Question 8

Calcium dose in pregnancy

Answer 8

1000 mg/day

(Babies will consume mothers bone for calcium during development)

Question 9

Vit D dose in pregnancy

Answer 9

600 IU/day

Question 10

Recommended vaccination during pregnancy

Answer 10

Inactive influenza

Single dose Tdap/pregnancy

Avoid live vaccination

Question 11

Drug information resources for pregnant

Answer 11

Briggs drugs in pregnancy and lactation

Question 12

Key teratogenic drugs in pregnancy: Acne

Answer 12

Isotretinoin

Topical retinoids

Question 13

Key teratogenic drugs in pregnancy: antibiotics

Answer 13

Fluoroqunolone

Tetracycline

Aminoglycosides

Question 14

Key teratogenic drugs in pregnancy: anticoagulants

Answer 14

Warfarin

Question 15

Key teratogenic drugs in pregnancy: Dyslipidemia/HF/Cardio

Answer 15

Statins

ACEi/ARB/Aliskeren/Entresto

Amiodarone/Dronedarone

Atenolol

Question 16

Key teratogenic drugs in pregnancy: Hormones

Answer 16

All hormone containing agent

Duavee

Question 17

Key teratogenic drugs in pregnancy: Migraine

Answer 17

Digydroergotamine

Ergotamine

Question 18

Key teratogenic drugs in pregnancy: AED

Answer 18

Topiramate

VPA/Divalproex

Carbamazepine

Phenobarbital

Phenytoin

Question 19

Key teratogenic drugs in pregnancy: others

Answer 19

Hydroxyurea

Lithium

Methotrexate

NSAIDs

Misoprostol

Paroexetine

Weight loss drugs

Ribavirin

Question 20

Key teratogenic drugs in pregnancy: others part 2

Answer 20

BZD

Dutasteride

Finasteride

Fluconazole

Voriconazole

MMI/PTU

Radioactive iodine

Question 21

Elevated BP + organ failure

Answer 21

Preeclampsia

Question 22

Elevated BP + organ failure + seizure + death

Answer 22

Eclampsia

Question 23

Low dose aspirin at the end of the first trimester

Answer 23

To prevent preeclampsia

Question 24

Risk factors for preeclampsia

Answer 24

HTN

T1/2D

Renal disease

Hx of preeclampsia

Question 25

Nausea/Morning Sickness/Vomiting tx

Answer 25

Lifestyle Pyridoxine (B6) +\- doxylamine Ginger

Question 26

Hyperemesis gravidium tx

Answer 26

OB to treat

Question 27

Bonjesta Diclegis

Answer 27

B6 + doxylamine

Question 28

GERD-Heartburn treatment

Answer 28

Lifestyle Avoid meals 3h prior to sleep Antacid (Calcium carbonate) Last: H2RA/PPI

Question 29

Flatulence treatment

Answer 29

Simethicone

Question 30

Gas-X Mylicon

Answer 30

Simethicone

Question 31

Constipation treatment

Answer 31

Lifestyle Fiber (psyllium, calcium polycarbophil, methyl cellulose) Docusate PEG

Question 32

Cough, Cold, Allergies

Answer 32

Cromolyn First generation antihistamine (chlorphemriamine, diphenyhyramine) Second gen: second and third trimester Avoid decongestant in first trimester Avoid alcohol based liquid formulation Intranasal steroid preferred for severe allergies (budesonide or beclomethasone)

Question 33

Rhinocort allergy

Answer 33

Budesonide

Question 34

Beconase AQ

Answer 34

Beclomethasone

Question 35

Pain treatment

Answer 35

Non-drug options Acetaminophen first line agent Avoid NSAID/Opioid

Question 36

Asthma treatment

Answer 36

Budesonide (control) Albuterol (rescue)

Question 37

Respules

Answer 37

Budesonide nebulizer for infants

Question 38

Iron deficiency treatment

Answer 38

Iron Monitor for constpation

Question 39

Hypertension

Answer 39

Methyldopa Nifedipine Labetalol

Question 40

Diabetes

Answer 40

Insulin Metformin Glyburide

Question 41

General safe antibacterial

Answer 41

Beta lactams Macrolide

Question 42

Vaginal fungal infection

Answer 42

Topical antifungal for 7 days Avoid fluconazole

Question 43

UTI

Answer 43

Keflex/Ampicillin 500mg QID x7 days Bactrim/Macrobid last line during first trimester. Avoid in last 2 weeks of pregnancy

Question 44

Treat asymptomatic bacteuria in pregnancy

Answer 44

Yes

Question 45

How to test for toxoplasmosis

Answer 45

IgG test

Question 46

Anticoagulants for pregnant

Answer 46

Tx: LMWH Ppx: IPC +/- LMWH

Question 47

Pregnant woman with mechanical valve on warfarin prior to pregnancy

Answer 47

Switch to LMWH until 14th week and switch back to warfarin and switch back to LMWH close to delivery

Question 48

When to draw anti-Xa level in pregnancy

Answer 48

4hrs post dose of LMWH

Question 49

Hypothyroidism Treatment

Answer 49

Levothyroxine May require higher dose than normal (30-50% increase) Pregnancy is a hypermetabolic state

Question 50

Hyperthyroidism

Answer 50

Achieve euthyroidism prior PTU preferred if trying to conceive or first trimester Switch to MMI for remainder of pregnancy Both can be teratogenic and both carry risk of hepatotoxicity Avoid radioactive iodine (teratogenic)

Question 51

American Academy of Pediatrics recommendations for breastfeeding

Answer 51

First 6 months should be exclusively breast feeding

Question 52

AAP Vitamin D recommendations

Answer 52

10 mcg (400 IU) daily until can consume at least 1L of Vit.D fortified formula/day

Question 53

AAP Iton recommendations

Answer 53

1 mg/kg/day during months 4-6

Question 54

Lactating mother calories intake

Answer 54

Increase diet calories by 450-500 kcal/day Continues prenatal vitamins and omega-3 supplements

Question 55

Characteristics of drugs that can cross breast milk

Answer 55

Non-ionized Smaller molecular weight Low volume of distribution High lipid solubility

Question 56

Lactation drug references

Answer 56

Briggs LactMed

Question 57

Pain meds to avoid with lactation

Answer 57

Codeine Tramadol

Question 58

HIV and breastfeeding

Answer 58

Breastfeeding is not recommended

Question 59

HIV positive but on ARV therapy and breastfeeding

Answer 59

Breastfeeding not recommended

Question 60

Drugs that should be completely avoided with lactation

Answer 60

Chemo Illicit drug Radioactive drugs

Question 61

Drugs that require pumping and disposing of breast milk when levels are higher

Answer 61

Amphetamines Amiodarone Ergotamine Lithium Flagyl Phenobarbital Statins