drug use in preg/lactation (NAPLEX)

In the ___ trimester most organ development occurs making the embryo more susceptible to birth defects

1st

Vitamin B9

Folic acid

ACOG

American College of Obestricians and Gynecologists

Folic acid reason & dose

Prevent neural tube defects

Adults: 400mcg

Pregnancy: 600mcg

Calcium & Vitamin D dose

Calcium 1000mg/day

Vitamin D 600IU/day

Risk category X (old classification)

Use in pregnancy is contraindicated

MEDS THAT ARE TERATOGENIC (18)

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Isotretinoin/topical retinoids

FQ

Tetracyclines

Warfarin

Statins

ACE/ARB/ARNI

Hormones (estradiol, progesterol, raloxifene, testosterone)

Dihydroergomine, ergotamine

Hydroxyurea

Lithium

MTX

Misoprostolol

NSAID

Paroxetine

Ribavirin

Thalidomide

Weight loss drugs

VPA

Vaccinations recommended during pregnancy (3)

Inactivated flu vaccine (not live)

Tdap single dose

RSV if the pt will be due between weeks 32-36 during Sep to Jan

ALL LIVE VACCINES ARE CONTRAINDICATED

What is preeclampsia?

Elevated BP with evidence of end organ damage

PPX of preeclampsia

Low dose aspirin at end of first trimester for pts at risk (DM, renal dx, hx of preeclampsia, chronic HTN)

Morning sickness, n/v TX

Lifestyle first

Pyridoxine (vit B6) +/- doxylamine

ginger

GERD/heart burn TX

Lifestyle first

Tums (calcium carbonate)

Flatulence TX

Simethicone

Constipation TX

Lifestyle modifications

Fiber (psyllium, calcium polycarbophil)

Cough/cold/allergies TX

First line: Cromolyn

Second line: FGA, Chlorpheniramine

If nasal steroids are needed, budesonide is preferred

avoid cough syrups containing alcohol

Pain TX

APAP

avoid NSAIDs and aspirin

Asthma TX

Maintenance: Budesonide

Budesonide Respules are used in a nebulizer

Rescue: ICS-formoterol, or albuterol

HTN TX

Labetalol

Nifedipine ER

Methyldopa

ACE/ARB/ARNI contraindicated

What ABX are generally safe to use (4)

Penicillins

Cephalosporins

Erythromycin

Azithromycin

Vaginal fungal infection TX

Topical antifungals x 7 days

UTI TX

Cephalexin

Amoxicillin

Alternatives: nitrofurantoin, Bactrim; last line during first trimester and should not be used in the last 2 weeks of pregnancy

Women can be tested with Ig___ test before pregnancy to test for TOXO

IgG

What should pregos avoid to prevent TOXO? (3)

Dirty food and water

Unpasteurized dairy products

Cat feces

Levothyroxine dose adjustment

increase by 30-50%

Hyperthyroidism TX

PTU first trimester, then MMI rest of pregnancy

Lactation vitamins to recommend (2)

Vitamin D 400 IU

Iron 1mg/kg daily after 4 months old

What opioids should be avoided for postpartum pain? (2)

Codeine, tramadol

Caution codeine with what CYP enzyme?

CYP2D6 ultra rapid metabolizers

Can women who are HIV positive breastfeed?

No

MEDS to avoid during LACTATION (7)

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Amphetamines

Amiodarone

Erogtamines

Lithium

Metronidazole

Phenobarbital

Statins

VTE treatment

LMWH preferred over UFH for outpatient therapy

Vitamin K antagonists are also used but require careful monitoring

Can oral factor Xa inhibitors and DTIs be used in pregnancy?

No