Pharmacology -- Happy prescribing! Flashcards
(31 cards)
What would you prescribe a pregnant person with the common cold or suffering w/ allergies?
Antihistamiens-chlorpheniramine, diphenhydramine, doxylamine, Zyrtec (Cetirizine), Allegra (Fexofenadine), Claritin (Loratadine)
Decongestants: Phenylephrine, pseudoephedrine
Cough: Robitussin (dextromethorphan), mucinex (Guaifenesin) codeine
Allergic rhinitis: nasal corticosteroids, intranasal cromolyn (Mast cell stabilizer)
Fever/pain: Tylenol
AVOID POLYPHARM
Common treatment for depression:_______
What to absolutely avoid:_________
1st line: SSRIs–Zoloft (sertraline), Prozac (Fluoxetine), Lexapro, escitalopram
***AVOID Paroxetine (Paxil) if pregnant–okay in BF
What drug is commonly prescribed in hypothyroidism? Does it usually need to lowered or raised? WHY?
SYNTHROID (Levothyroxine)
RAISED
Development (via mRNA) of fetus requires inc. in T3/T4 (hCG acts like weak TSH)
How do treat hyperthyroidism in pregnancy?
PTU (propylthiouracil) first (most preferred) and then switch to methimazole later.
Thyroidectomy may be considered, but do NOT use ablation (will ablate fetus’s thyroid too)
How do you treat HTN?
**Discont. thiazide diuretics if on them
may not need meds w/ pregnancy
1st line: Methyldopa (A2A)-250mg TID (up to 500mg qid)
& Labetalol (BB)
2nd Line/+: Hydralazine-Vasodilator, nifedipine (procardia)-CCB, other BB and A2A-Clonodine (max 1.2mg/d)
Tx. of DM in pregnancy
DM1: Insulin–Lispro (homolog)
DM2/GDM:
-INSULIN (preferred)-0.7-1U/kg/d, short and long acting combo
-GLYBURIDE-2.5-30mg
-METFORMIN-start w/500mg at night w/meals, check crtn & glucose–> inc. to BID if needed after 1wk
Tx. of Asymptomatic Bacturia, uncomplicated UTI,
Amox, Augmentin (amox+CA), Ampicillin, Cephalexin (Keflex), Clindamycin
For suppression therapy: Bactrim (sulfa) & macrobid (nitrofurantoin) –but avoid if G6PD, 1st Tri, and near term:
Tx. for pyelonephritis
1g IV abx- Ceftriaxone (q24hr) Cefepime (q12hr), Cefazolin, Gentamicin, Cefuroxime, Severe-Ertapenem
Tx for sinusitis
Augmentin Cefprozil Cefuroxime \+ Saline nasal spray
Tx. for strep throat
Penicillin
Macrolides (azithro/clarithro)
Tx. for strep pneumoniae or H. influenza
3rd gen Cephalosporins (Cefixime) or augmentin
+
Macrolide (azithro/clarithro)
AVOID QUINOLONES if possible
Tx. for influenza
1st: PREVENTION: vaccine
Tx: Antivirals: Tamiflu (Oseltamivir)-75mg PO BID x5d
Relenza (Zanamivir) 10mg 2-inhalations BID x5d
Tx. for asthma
Step up/down approach: ALL asthmatic women: B2Agonists- Albuterol, Low dose ICS (Budesonide) High dose ICS \+/- Bronchodilators (Theophylline) \+/-Leukotriene modifiers (-lukast) *PO CS (only if benefits>risks) *Avoid Omalizumab/Xolair)
Tx for GERD
1st line: Antacids (TUMs), lifestyle
2nd: H2-receptor blockers: (Famotidine/pepcid & ranitidine/zantac)
3rd: PPIs: (Ome/ianso-prazole) …least studied
Tx for mild, moderate, and severe N/V
MILD: 1. Replace PNvitamin w/folic acid alone; 2. B6/pyridoxine 25mg PO TID 3. Ginger 250mg PO qid; 4. P6 acupressure (sea-bands)
MOD:
1. Dicligis: B6 + doxylamine (unisom) 12.5mg PO qid 2. Antipsych-Compazine (prochlorperazine)-5-10mg PO q6-8hr, Thorazine (chlorpromazine)-10-25mg PO q4-6h, 3. 5-ht3 antag: Odansetron (Zofran) 8mg PO q12hr 4. gut motility stimulator: Reglan (metoclopramide -5-10mg PO q8hr; Antihistamine: Dramamine, Unisom, Phenergan (promethazine)-25mg PO q4-6hr; SEVERE-IV hydration, IV Benadryl-50mg + IV PB of the above (consider IV nutrition)
Tx of PTL:
Corticosteroids: (22-36 & 6/7wks) Betamethasone-12mg IM x2- 48hrs apart, 1st course given less than 28wks; rescue course is beneficial OR dexamethasone 6mgx4doses q12hr <48hr
CCB: Nifedipine
Mag Sulfate 6g bolus (24-31wks)
NSAID: Indomethacin 25-50mg q 6hr for <48hrs
PPROM/PROM
GBS + =penG,
Drugs that are contraindicated in ALL TRIMESTERS
Ergots Aminoglycosides (-mycin) *deaf Androgenic steroids *clitoromegaly ACE/ARBs *renal, HOTN, CNS Iodine/Iodide & ATD *Goiter, hypothyroid Benzos *cleft, w/drawal Cocaine (DUH) *abruption EtOH Isotretinoin Lindane Mifepristone Misoprostol Nicotine Statins Vit A >8000 Warfarin *SAB/CNS/hemorrhage
Drugs that are contraindicated in the 1st TRIMESTER
Anticonvulsants (carbamazepine) *NTD Cyclophosphanide *CNS/IUGR DES *SAB/stillbirth Lithium *toxicity/ebstein's anomaly Methotrexate (prob all Ts?) Phenytoin Thalidomide Trimethoprim Valproic acid
Drugs that are contraindicated in 2nd & 3rd TRIMESTERS
Amiodarone * hypothyroid
NSAIDs *closure of DA
Sulfanomides *hyperbilirubin
Tetra/doxycycline *teeth stain, maternal liver
Tx to inc. breastmilk=galactogues
L2-Metoclopramide
L3-Fenugreek, Blessed thistle, domperidone, sulpiride…not a whole lot of choices, inc H2O & stimulate breasts
Tx. of mastitis
10-14d Abx: Dicloxacillin (Dynapen) 250-500mg q6hr Keflex (caphalexin)-500mg q6h Erythromycin Milk c/s if unresponsive to Abx after 2d.--> IV Unipen (Nafcillin) or Oxacillin 2g q4h MRSA-Bactrim BID, Vaco, or Linda
GFR increases or decreases? By what %?
Increases 50% by term (majority during 1st try)
Explain changes in pregnancy r/t 1st pass through the liver
Activity is unchanged/blood flow to the liver remains the same TRICKED yah
