LECTURES 55, 56 - medication use in pregnancy & lactation / oxytocin Flashcards
Describe an appropriate prenatal diet (increases/additives)
300-400 extra calories per day
Folate & folic acid
Calcium intake
Vitamin D
Proteins
Describe an appropriate prenatal diet (decreases/things to avoid)
Artificial sweeteners
Unpasteurized foods
Unwashed fruits / vegetables
Herbal teas
Undercooked meat, poultry, eggs
Caffeine (< 200 mg / day)
Alcohol & Substance Use (AVOID)
– tobacco, marijuana, opioids, etc.
Describe why / how prenatal supplements should be used
Benefits:
– Fetal development
– Prevent complications
Ideally started 3 months prior to conception
(folic acid should be initiated at least 1 month prior to trying to get pregnant)
No set recommendation for how long to continue after birth
Describe the recommended dosage & benefits of calcium during pregnancy
1,000mg / day
Strong bones & teeth
Describe the recommended dosage & benefits of Vitamin D during pregnancy
600 IU / day
Forms healthy skin & eyesight, helps with bone & teeth development
Describe the recommended dosage & benefits of Folic Acid during pregnancy
600 mcg / day
Helps prevent neural tube defects of brain & spinal cord, supports growth & development
When should oxytocin be introduced when used in obstetrics?
- ≥ 41-42 weeks
- Preeclampsia
- Infection
- Fetal Compromise
- Diabetes, renal, HTN
List the risks of oxytocin use in obstetrics
Low fetal HR
Failed induction
Infection
Uterine rupture
Bleeding after delivery
List the CONTRINDICATIONS for oxytocin use in obstetrics
Fetus sideways
Previous high-risk C-section
Prior uterine incision
Prior uterine rupture
Describe oxytocin and its use in obstetrics
Hormone that causes contractions of the uterus
Contractions usually start ~ 30 minutes after administration
Uses:
Inducing labor
Postpartum hemorrhage
How is oxytocin dosed in obstetrics?
Dosing:
Low dose
1-2 milliunits/min every 15-40 min
High dose
4-6 milliunits/min every 15-40 min
Max dose → 40 milliunits/min
List possible adverse reactions to oxytocin
CV:
Arrhythmia, BP changes, Tachycardia
Endocrine / Metabolic:
Water intoxication
GI:
N/V
Genitourinary:
Postpartum hemorrhage
Uterine rupture
List the maternal benefits of breastfeeding
- Faster healing from childbirth
- Weight loss
- Reduced risk: T2DM, Breast/Ovarian cancer, Osteoporosis, RA, CVD
- Economic
List the infant benefits of breastfeeding
Reduced risk:
- Infection
- Asthma
- Childhood Cancer
- Obesity
- Eczema
- Diarrhea/Vomiting
- Diabetes
- Hospitalization
List potential options for increasing milk production
Herbals:
Blessed thistle, herbal tea(s)
Food:
Oatmeal, date/figs, dark leafy vegetables
Medication:
Metoclopramide, domperidone
Pumping
List the exceptions to the “smaller drugs enter milk easier” rule of thumb
insulin & heparin
List the factors that influence risk for adverse effects (from drugs taken by the mother) on the breastfeeding baby
Timing of the dose
Volume of breast milk
Age of infant
Toxicity
Oral bioavailability
Relative infant dose (RID)
Describe “Relative infant dose (RID)”
- Can be used to calculate potential exposure (always use the highest number if there is a range)
- Dose received via breast milk (mg/kg/day) relative to the mother’s dose (mg/kg/day) expressed as a percentage
Describe how to interpret RID
< 2% → minimal transfer to milk
2-5% → small amount of transfer to milk
5-10% → moderate amount of transfer to milk
> 10% → large amount of transfer to milk - risk of effects in infants
Describe how the short-term pregnancy complication of N/V can be treated non-pharmacologically
- Avoid triggers (food, smell, motion, etc)
- Drink consistently throughout the day
- Eat smaller, frequent, dry meals
- Eat dry toast / crackers before getting out of bed
- Avoid spicy foods
- Try to avoid the stomach being completely empty
Describe how the short-term pregnancy complication of N/V can be treated pharmacologically
First Line - Pyridoxine (vitamin B6)
2nd line - Doxylamine + B6
3rd line:
Meclizine
Dimenhydrinate
Diphenhydramine
Last line:
Ondansetron
Metoclopramide
Describe how the short-term pregnancy complication of Heartburn can be treated non-pharmacologically
- Smaller & more frequent meals
- Eat slowly
- Avoid food/drink >/= 3 hours before bed
- Elevate the head of the bed or add pillows
- Avoid smoking & alcohol
Describe how the short-term pregnancy complication of Heartburn can be treated pharmacologically
- Antacids (Mg hydroxide, Ca carbonate)
- Sucralfate - not absorbed in GI tract
- H2Ras or PPIs
Describe how the short-term pregnancy complication of constipation can be treated non-pharmacologically
- Eat 25-30g of fiber daily
- Increase fluid intake to 8-12 glasses per day
- Get 20-30 minutes of moderate exercise 3x/week
