Pharm Week 6: pregnancy, breastfeeding & ER drugs

What is the main thing to consider when giving meds other than pregnant women?

risk vs benefit ratio - teratogenic

What are the long term consequences of in utero exposure to agents?

dont really know because most studies done on animals

Best trimester to treat vs when we wanna treat:

all trimesters - treat in 3rd

First trimester

prophy, home care pt education, visual exam no x-rays

Second trimester

home care and pt education, another prophy if needed

trimester

avoid all drugs that may affect newborn

US FDA drug pregnancy categories

A - safest

X - contraindicated

B,C,D - fall inn between

What are drugs contraindicated during nursing/breastfeeding?

NSAIDS

tetracyclines

metronidazole

Bupivacaine and muipivacaine are which pregnancy class?

category C

Lidocaine, prilocaine and etidocaine fall into

category B

Can Epi be used in pregnant women?

small doses - avoid large doses since adverse affects in fetus and anoxia from vasoconstriction

Analgesics in pregnant women:

lowest possible dose, shortest duration possible, use adjunctive therapy first

Aspirin in pregnant women:

prolongs gestation

complicates delivery

increase risk of maternal or fetal hemorrhage

NSAID's in pregnant women

produce similar effects to aspirin

analgesics: Acetaminophen in pregnant women

safe

Opoids in pregnant women

fetal abnormalities, if mother addicted infant will experience withdrawal symptoms after brith

antiinfective agents: amoxicillin in pregnant women

safe to use, appears in breast milk

antiinfective agents: erythromycin in pregnant women

safe

antinfective agents: cephalosporins in pregnant women

not associated with teratogenicity

Antiinfective agents: tetracyclines in pregnant women

contraindicated

Why do we not want to use tetracycline in pregnancy women or children?

teeth staining

Antiinfective agents: clindamycin in pregnant women

no problems

Antiinfective agents: metronidazole in pregnant women

encountering dental situation in which the risk to the fetus would not be greater than the benefit to the mouther

Antiinfective agents: Nystatin in pregnant women

safe to use or for nursing pts to treat oral candida infections

Nitrous oxide in pregnant women:

higher incidence of spontaneous abortion and birth defects - not used in any trimester

Benzodiazepines in pregnant women

increase risk of congenital malformations - cleft palate/lip, neural tube defects - physical dependence in the infant

Benzodiazepines: category X drugs

temazepam

triazolam

Benzodiazepines: category D drugs

alprazolam

halazepam

lorazepam

what do we use for a asthma attack that just keeps getting worse and worse:

EPI!

What is fetal alcohol syndrome?

A group of birth defects caused by the effects of alcohol on an unborn child - long term

O2 tank is turned to

6

preparation for ER Tx:

circulation airway breathing

lost or altered consciousness

syncope, hypoglycemia, diabetic coma, convulsions/seizures

resp emergencies:

hyperventilation

asthma

anaphylactic shock

acute airway obstruction

CV emergencies

angina

MI

CA

other emergencies

Acute adrenal insufficiency

thyroid stoma

malignant hyperthermia

drug related emergencies

opioids overdose, reaction to LA, EPI

Epi

tx of anaphylaxis, severe allergic reaction or asthmatic attack that does not stop

diphenhydramine (Benadryl)

mild to mod allergic reaction

Hydrocortisone

tx of adrenal crisis

albuterol (Ventolin)

asthma and resp. distress

nitroglycerin (nitrostat)

chest pain (angina, MI)

oral carb/glucose

hypoglycemia

diazepam (valium)

management of prolonged seizures

ammonia inhalant

syncope or resp. depression

naloxone (narcan)

opioid od

oxygen

for most emergency situations EXCEPT COPD AND HYPERVENTILATION