Pregnancy and Lactation

How many weeks constitute a term pregnancy?

Fill the table below with the appropriate Physiologic/Pharmacokinetic changes

Which of the following are true in regards to medication use in pregnancy? (select all that apply)

What vaccinations should be administered during pregnancy?

Why are multivitamins used during pregnancy?

Why is calcium used during pregnancy?

[blank_start]Folic acid[blank_end] is used during pregnancy to prevent neural tube defects

Drugs with a molecular weight of less than [blank_start]600[blank_end] daltons readily cross the placenta barrier.

Lipophilic drugs will cross the placental barrier more than hydrophilic drugs

Which albumin levels are higher, fetal or maternal?

Fetal blood pH < maternal, therefore weak bases more easily cross, ionize, and less likely to diffuse back across the placental barrier

Only [blank_start]unbound[blank_end] drugs can cross placental membranes

Blood flow to [blank_start]uterus[blank_end] impacts drug transfer to fetus

What is the drug of choice for the treatment of hyperemesis gravidarum?

The treatment of choice for nausea and vomiting during pregnancy is [blank_start]nonpharmacological treatment[blank_end]

What is the first line or drug of choice for nausea and vomiting during pregnancy?

For nausea and vomiting during pregnancy, [blank_start]phosphoric acid[blank_end] should not be used if the patient is a diabetic

Nausea and Vomiting 2nd line therapy is [blank_start]metoclopramide[blank_end] 3rd line therapy is [blank_start]dopamine antagonist[blank_end]

First line line treatment for constipation during pregnancy is incerase [blank_start]fiber[blank_end] and [blank_start]fluid[blank_end] intake

What drugs should not be used to treat constipation during pregnancy?

GERD/Heartburn 1st line: [blank_start]Lifestyle Modifications[blank_end] 2nd line: [blank_start]antacids or sucralfate[blank_end]

Which of the following treatment can be used to treat Hemorrhoids during a pregnancy?

Bulk forming agents should be utilized to treat diarrhea during pregnancy, what drugs should be avoided?

Saline nasal spray/drops are safe to use during pregnancy in the treatment of cough, colds, and allergies

What is the drug of choice to treat cold , cough, and allergies during pregnancy?

What drugs are recommended during the 2nd and 3rd trimesters in the treatment of cough, cold, and allergies during pregnancy?

What nasal steroids are recommended for chronic allergies during pregnancy?

[blank_start]Acetaminophen[blank_end] is the drug of choice for acute pain managment during pregnancy

What is the drug of choice in the treatment of HTN and severe eclampsia?

IV [blank_start]Magnesium[blank_end] is used for seizure protection and treatment

Pharmacological treatment for gestational HTN should be started if the systolic BP is greater than [blank_start]150-160[blank_end] OR the diastolic is greater than [blank_start]100-110[blank_end]

Essential/Gestational HTN 1st line (DOC): [blank_start]Methyldopa[blank_end] 2nd line: [blank_start]Labetolol[blank_end]

Coagulation Disorders You need to continue treatment for women with history of Deep Vein Thrombosis/Pulmonary Embolism, Mitral Valve Replacement, clotting factor deficiencies, antiphospholipid antibodies

Coagulation Disorders 1st line: [blank_start]LMWH[blank_end] 2nd line: [blank_start]UFH[blank_end] Treatment is to be contiuned through pregnancy and [blank_start]6[blank_end] weeks after delivery (including breastfeeding)

Which of the following drugs are contraindicated in the treatment of UTIs during pregnancy?

What are the top drug choices in the treatment of UTIs during pregnancy?

What drugs are utilized in the treatment of pyelonephritis?

STI's Drug of choice syphillis: [blank_start]penicillin G[blank_end] Drug of choice for gonorrhea: [blank_start]cetriaxone[blank_end] Durg of choice for chlamydia: [blank_start]amoxicillin[blank_end] ; 2nd line: [blank_start]ertthromycin[blank_end]

Acyclovir/valacyclovir is used in the treatment of genital herpes during pregnancy

[blank_start]Metronidazole[blank_end] is the treatment of choice for bacterial vaginosis, and the alternative treatment is clindaymcin

Asthma [blank_start]Albuterol[blank_end] is the short acting beta agonist of choice and [blank_start]budesonide[blank_end] is the inhaled corticosteriod of choice during preganancy

During pregnancy, changing agents to minimize risk is NOT recommended for the treatment of epilepsy

What drugs are the safest to use to treat epilepsy during pregnancy?

HIV during pregnancy New diagnosed: [blank_start]HAART[blank_end] [blank_start]Zidovudine[blank_end] is the mainstay of antiretroviral therapy Avoid [blank_start]efavirenz[blank_end]

Treatment of schizophrenia, bipolar disorder, depression usually needs to be continued during pregnancy and breastfeeding; high relapse rates if discontinued

What are the most preferred agents in the treatment of mental health issues in pregnant women?

Nortriptyline and desipramine are TCAs of choice in the treatment of mental health issues during pregnancy

Treatment of choice for HYPOthryoridism: [blank_start]levothyroxine[blank_end] Treatment of choice for HYPERthryroidism: [blank_start]propylthiouracil[blank_end] or [blank_start]methimazole[blank_end]

[blank_start]Tocolysis[blank_end] is the prcoess of stopping contractions

What drugs are utilized in pre-term labor and tocolysis?

What drugs are needed for cervical ripening? Cervical ripening: in order to dilate, collagen must loosen and separate; moisture necessary; occurs naturally in women who spontaneously enter labor

Labor induction 1st line: [blank_start]oxytocin[blank_end] 2nd line: [blank_start]methylergonovine[blank_end]

If mother colonized with Group B Streptococcus: [blank_start]Penicillin G[blank_end]

Analgesia can prolong the 1st and 2nd stages of labor

[blank_start]Epidural[blank_end] analgesia has better profile than parenteral opioids (poor maternal pain relief and less vigorous neonates)

Drug FactorsGeneral Guidelines Most drugs appear in breast milk to some degree. Most common mechanism of transfer is passive diffusion. Levels of most drugs in breast milk do not usually exceed 1% to 2% of ingested maternal dosage If the milk/plasma ratio of drug and active metabolites is less than [blank_start]1:1[blank_end], it is usually safe to breastfeed RID: If infant dose is less than [blank_start]10[blank_end]% of maternal dose (weight adjusted), it is usually safe to breastfeed

Depression Sertraline and paroxetine are most frequently prescribed with few reported adverse effects,

breast milk is more acidic; weak bases are more likely to stay trapped in breast milk “ion trapping: