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What medication is the Spina Bidifa birth defect most common with ?
VPA
Is epilepsy a contraindication to pregnancy?
No
What 2 drugs pose the highest risk for pregnancy in epilepsy
VPA
Topirimate
______ AED doses tend to increase risk of brith defects in Pregnancy
Higher
AEDs taken during the _______ trimester increase the risk of defects in the offspring of WWE
First
_______ probably does not substantially increase the risk of defects in the pddpring of WWE
Crabamazepine
What AEDs post the highest risk of poor neurodevelopmental outcomes in baby
VPA
Phenobarbital
What 2 drugs increase in clearance during pregnancy and how do we adjust dose?
Lamotrigine & Lithium
may need to increase dose, decrease right when baby comes
Is breasfeeding while on AEDs OK?
•Breastfeeding is good and OK except sedating drugs
Highly protein bound drugs are _______ likely to go into breast milk
Less
Are antipsychotics associated with increased risk for malformationsi n pregnancy
No
Second gen antipsychotics are associated with what risks in pregnancy
weight gain and gestational diabetes in pregnant individual, increased infant size, poor neonatal adaptation syndrome, neurodevelopment delays that resolve by 12 month
First gen antipsychotics are associated with what risks in pregnancy
low birth weight, preterm delivery, transient EPS and withdrawal with 3rd trimester use
Recommendations for antipsychotic use in pregnancy
generally antipsychotic patient has been taking will be continued if efficacious
Close metabolic monitoring during pregnancy
Lithium poses a risk of _______ in the 1st trimester in pregnancy
Cardiac malformations in baby
Reccommendations for Lithium in Pregnancy
Provide education on teratogenic risks of lithium and discuss birth control options with individuals who could become pregnant
Avoid use in individuals considering pregnancy
If used during pregnancy, avoid use during first trimester if possible
Increase frequency of lithium monitoring and dose adjust as needed (usually require higher doses during pregnancy)
reduce dose to pre-pregnancy levels postpartum
What bipolar meds pose the higest risk of teratogenicity
VPA
Lithium
What bipolar meds pose the lower risk of teratogenicity
Lamotrigine
Second gen antipsychotics
Antidepressants (adjunct)
Benzo use in pregnancy
Not reccommended- if neccessary, at least taper before delviery
Postpartum depression
Postpartum depression generally refers to depression during the 12 months following birth
Onset of depression symptoms can occur prior to, during or after pregnancy:
Treatmeant of mild to moderate postpartum depression
Start with psychotherapy
Antidepressants if psychotherapy not effective or available)
Which antidepressants for postpartum
SSRI
SNRI
Bupropion
Mirtazepine
Treatmeant of severe postpartum depression
1) Start with antidepressant
2) Consider Zuranolone or Brexanolone if not antidepressant not effective
Risks of SSRIs/SNRIS in pregnanacy
Newborns who have been exposed to SSRIs/SNRIs in utero occasionally experience neonatal adaptation syndrome (NAS), which generally exhibits as some combination of respiratory distress 7, 23-26, feeding difficulty 23, 27, jitteriness 23, irritability, temperature instability 23, 24, sleep problems 28, tremors 29, ...
General Reccs of antidepressant use in pregnancy
joint decision between individual and their provider
present with risks of both antidepressant use during pregnancy and untreated depression for informed decision
If antidepressant is to be continued, recommend agent individual is currently taking (if effective and well tolerated)
If newly starting antidepressant during or after pregnancy, usually select SSRI based on previously discussed factors, also considering compatibility with breast feeding
Utilize lowest effective dose, increase frequency of monitoring, adjust doses as necessary
FDA approved meds for Post partum depression
Zuranolone
Brexanolone
Zuranolone dosing
50mg/day PO in the evening with fatty meal (absorption) for 14 days
Zuranolone time to benefit
3 days
Zuranolone ADEs & warnings
ADEs: somnolence, headaches
Warnings: driving impairment due to CNS depressant effects, advised not to drive for at least 12 hours after taking the pill
T/F Brexanolone Requires onsite clinician monitoring for excessive sedation or loss of consciousness
True
Brexanolone Dosing
Administered continuously over 60 hours as single IV infusion (inpatient setting)
Brexanolone time to benefit
(24 – 60 hours)
Brexanolone ADEs
dry mouth, flushing/hot flashes, loss of consciousness, sedation/somnolence