Pregnancy care

Question 1

drug properties in pregnancy and lactation

Answer 1

• 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

Question 2

Acceptable abx in pregnancy

Answer 2

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

Question 3

Asthma during pregnancy

Answer 3

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

Question 4

allergic rhinitis care

Answer 4

intranasal corticosteroids
2nd gen antihistamine

Question 5

Alalgesia during preg

Answer 5

acetominophen

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

Question 6

Avoid used in pregnancy Abx

Answer 6

Fluroquinolones - floxacin suffix
Trimethoprim-Sulfamethoxazole (bactrim)
Clarithromycin

Question 7

Know teratogens

Answer 7

• 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

Question 8

medications and breastmilk

Answer 8

• 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

Question 9

Hales’s lactation risk L1

Answer 9

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

Question 10

Hales rule L2

Answer 10

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

Question 11

Hales rule L3

Answer 11

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

Question 12

Hales L4

Answer 12

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

Question 13

Hales lactation risk L5

Answer 13

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