drugs, meds, immunization Flashcards by L R

mild sedative used for trt of nausea in pregnancy w/c can cause phocomelia

thalidomide

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thalidomide is still used for trt of?

leprosy

multiple myeloma

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physiologic changes w/c affects drug mechanism

dec GI motility, inc gastric pH
inc plasma vol
dec serum albumin, inc alpha-1 acid glycogen
inc renal BF
inc hepatic microenzyme
hyperventilation, inc TV & pulmo BV
inc aqueous and fatty tissue spaces

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properties of drug that easily cross placenta

highly lipid soluble
non-ionized
LMW
minimally protein bound

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fetal pharmacokinetics affecting drugs

protein binding capacity of fetal plasma is lower than maternal
fetal plasma & amniotic fluid are slightly more acidic
metabolizing capacity of fetal liver enzyme is much less
fetal glomerular filtration is markedly reduce

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timing and effect of drugs during pregnancy

20 days

all or nothing; fetus is highly resistant to birth defects

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timing and effect of drugs during pregnancy

3-8 wks

possibly no effect
miscarriage
obvious birth defect
inc risk of childhood cancer
organogenesis

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timing and effect of drugs during pregnancy

2nd & 3rd trim

changes in growth & fx of normally formed organs & tissue
unlikely to cause obvious birth defect
unknown long-term effect

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FDA drug categories

A - adequate, well-controlled studies no risk of fetal abnormality
B - no risk in animal, no adequate studies in human; risk in animal, no risk in human
C - risk in animal, no adequate studies in human; no adequate studies in animal & human
D - benefit > risk
X - absolute contraindication

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Category C

Corticosteroids, Fluconazole, Methylene Blue, Minoxidil

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Category D

ACE inhibitors, Aminocaproic acid, ARBs, Aminoglycosides, Atenolol, Carbamazepine, Methimazole, Mifepristone, RU-486, Penicillamine, Potassium iodine, Diatrizoate, Tetracycline, Valproic acid, Antineoplastics (Alkylating agents), Aspirin, Benzodiazepines, Bromides, Colchicine, Phenytoin, Lithium, Mysoline, Phenobarbital or methylphenobarbital, Megesterol, Norethindrone, Tamoxifen

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Category X

Antineoplastics (antimetabolites): Methotrexate, Cytaribine, Chlorambucil, Cycolphosphamide Flurazepam, Triazolam, DES, Finasteride, Misoprostol, Raloxifene, Statins, Acetohydroxamin acid, Androrgens (ex. Danazol), Benzodiazepines, Temazepam, Ergotamine, Progestins, Retinoic acid, Isotretinoin (Accutane), Acitretin (Soriatane), Etretinate, Topical tazarotene, Thalidomide, Warfarin

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benzodiazepine (DX)

bradypnea or withdrawal symptoms if given late in pregnancy

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aminoglycoside (D)

ototoxicity

nephrotoxicity

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chloramphenicol (X)

gray baby syndrome

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fluoroquinolone

bone & joint abnormalities esp. in 1st trim

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nitrofurantoin (B)

hemolytic anemia at term
2-fold risk of cleft lip at 1st trim
contraindicated in G6PD def

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TMP-SMX (D)

TMP: interfere w/ folic acid metab
SMX: jaundice & hemolytic anemia

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warfarin (X)

schizencephaly, microcephaly, hydrocephalus, blindness, mental disability, fteal hemorrhage

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fluconazole (C)

in animals, fetotoxicity, teratogenicity

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spironolactone

anti-androgenic

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ACE inhibitors (D)

last trim, fetal kidney damage, oligohydramnios, facial, limb & lung defect, fetal hypotension

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what anti-hypertensive drugs can be given safely?

nifedipine

methyldopa

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beta-blocker (D)

dec HR & fetal growth restriction

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calcium channel blocker

1st trim, birth defect of fingers & toes

haloperidol

1st trim, limb defect | 3rd trim, extrapyramidal symptoms, restlessness, shaking, dob

phenytoin (D)

inc risk cleft palate & heart defect

valproate (D)

heart, face, skull, limb, and neural tube defect

methotrexate (X)

early, abortion | micrognathia, cleft palate, spinal abnormalities, ear defects, club foot

danazol (X)

early, masculinization

isotretinoin (X)

abortion, heart defect, small ears, hydrocephalus

radioactive iodine (D)

fetal hypothyroidism, mental retardation, inc risk of malignancy

safest & best drug for PPROM

ampicillin

drug for PPROM with complication

clindamycin

cephalosporin is generally safe. T or F?

true

co-amox is associated w/ birth defect if given in 1st trim. T or F?

false

tetracycline (D)

2nd or 3rd trim, dental staining

metronidazole (B)

carcinogenic in rats but no AE in human pregnancy

diphenhydramine & meclizine (B)

not recommended in the last 2 wks d/t risk of retrolental fibroplasia

metoclopramide (B)

inc rate of gastric emptying | high doses: extrapyramidal symptoms

ondansetron (B)

used in postchemo N/V

first line for N/V

emetrol

drugs for heartburn & GERD

antacids (B: Al & Mg; C: Ca) H2-R blocker (B) PPI (C): avoided in 1st trim

drugs for constipation

bisacodyl senna psyllium

drugs for diarrhea

kaolin & pectin | loperamide

paracetamol (B)

first choice | high dose: embryotoxicity

NSAID (C 30 wks; D >30 wks)

potential orofacial cleft (naproxen) & structural cardiac defect risk of premature closure of DA if given in 3rd trimester

opiods (C)

chronic use may lead to dependence & withdrawal symptoms | slightly greater risk of spina bifida, gastroschisis, cardiac abnormalities

magnesium sulfate (D)

prevent & treat seizure in preeclampsia fetal neuroprotection (<32 wks) short term prolongation of pregnancy (up to 48 hrs) AE: bone demineralization

nifedipine (C)

SM relaxation | anti-hypertensive & tocolytic

methyldopa (B)

first line anti-hypertensive alpha adrenergic agonist centrally not diminish uterin BF caution in depression

hydralazine (C)

SM relaxation (vasodilator) lowers BP rapidly AE: neonatal thrombocytopenia & lupus

isoxsuprine/terbutaline

beta 2 agonist (vasodilator) uterine muscle relaxation AE: maternal pulmo edema

recommendation for Hepa A & B vax

A: if needed B: if high risk

recommendation for TdaP

1 dose >20 wks preferrably 27-36 wks

recommendation for meningococcal vax

given if needed

recommendation for pneumococcal vax

given if needed

recommendation for HPV vax

not given during pregnancy

recommendation for MMR vax

contraindicated | avoid pregnancy <3 months post-MMR vax

recommendation for varicella vax

contraindicated

recommendation for zoster vax

contraindicated

recommendation for dengue vax

contraindicated

recommendation for rabies vax

given if needed

drugs, meds, immunization Flashcards

(63 cards)