Term
| What are the three pregnancy stages and the biggest risk in each? |
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Definition
- Germinal (Days 2-14), Embryonic(14-60), Fetal (60-term)
Germinal: Fertilization to embryo, decreased sensitivity to teratogenicity, but biggest chance of fetal death
Embryonic: Going from Embryo to fetus, highest risk of severe teratogenic effects such as structural abnormalities
Fetal: Weeks 9-term. Decreased teratogenicity effects, but highest rate of functional or developmental delays |
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Term
| What are some physiologic changes that take place during pregnancy? |
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Definition
- Increase in plasma volume by 30-50%
- May be changes in first pass effect, doubling of hepatic enzymes
- Increase in cardiac output and GFR
- Reduced GI motility and increased gastric pH |
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Term
| What are the categories of FDA risk classification? |
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Definition
A- no harm to fetus
B - Animal studies show no harm, no human studies though
C - Animal studies show adverse events, but no human studies
D- Evidence of fetal risk in humans
X - Don't use this goddamn drug |
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Term
| What are the categories of risk for breast feeding/lactation? |
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Definition
Compatible
Hold breast feeding - Use a breast pump and time when they are pumping and when they are taking medications
No/limited data - probably compatible
No/limited data - potential toxicity
Contraindicated |
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Term
| What analgesics can and can't be used in pregnancy? |
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Definition
APAP - Category B, lactation compatible, the GO-TO!
NSAIDS - Never use in 3rd trimester (D). Ibuprofen and Ketoprophen are B in 1st and 2nd trimester, but Naproxen would be a C.
Risks of NSAIDS are cardiac defects, pulmonary HTN, intracranial bleeding, Gastroschisis |
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Term
| What cold medications can and can't be used? |
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Definition
- Pseudoephedrine, Dextromethorphan, and Guaifenisin are all category C
- Should not be used until BEYOND 1st trimester
- Sudafed can cause clubbed feet
- Dextro is the only one with lactation data, which says it's compatible
- Guaifenesin has shown to cause aguano hernia, similar to gastrochesis |
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Term
| What antihistamines can and can't be used? |
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Definition
- 1st gen prefered, except Brompheniramine which is Cat. C.
- Probably lactation compatible
- 2nd gen can be used, but Fexofenadine is a C.
- Cetirizine would be best 2nd gen, most likely lactation compatible |
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Term
| What antacids can and can't be used? |
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Definition
- Recommend Antacids such as Tums first, H2 blockers second, PPI as a last defense (except omeprazole, cardiac defects and gastric tumors in animal studies)
- Famotidine can be excreted a tiny amount in breast milk |
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Term
| What constipation/diarrhea meds can and can't be used? |
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Definition
- Never aspirin in pregnancy
- Pepto Bismol is a C (salicylate comp.), causes closure of ductus arteriosis and intracranial hemorrhage
- Loperamide is good, cat. B
- Docusate is lactation compatible, but a cat. C
- Bulk forming laxatives are a category B, use these. |
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Term
| What medications for N/V can and can't be used? |
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Definition
- N/V affects 50-70% of pregnant women
- Doxylamine is best, while Diphenhydramine, Dimnehydrinate, and Meclizine are all best
- Metoclopramide is a cat. B, but is most likely toxic
- Vitamin B6 is Category A and lactation compatible
* for N/V use D and V |
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Term
| What anticoagulants can and can't be used in pregnant patients? |
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Definition
- Never use Warfarin, category D. Leads to skeletal defects, microcephaly, developmental delay.
- Heparin is the go-to anticoagulant for pregnancy. Category C, no sig. fetal defects
- LMWH are a category B |
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Term
| Are there any anticonvulsants that CAN be used during pregnancy? What are the main side effects of each? |
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Definition
- No anticonvulsants that were mentioned that can be used, all category D
- Phenytoin --> Hydantoin syndrom, sydactyly
- Phenobarbital --> Induction of liver enzymes, fetal hemorrhage, neurobehavioral abnormalities
- Valproic acid --> Kidney abnormalities, Encephalocele (herniation of brain tissue), spina bifida
- Benzos --> could be category X. Gastrochesis, clef lip, malformation of skull, CNS abnormalities |
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Term
| What antineoplastics can be used during pregnancy? |
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Definition
- None, category X
- CI lactation
- Work related considerations
- Avoid CONTACT even if trying to conceive |
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Term
| What retinoids can be used during pregnancy? |
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Definition
- Isotretinoin (Accutane) is X
- Tretinoin is D (systemic)/C (topical)
- Accutane causes spina bifida, hydrocephalis, cardiac abnormalities
- Retin-A causes growth retardation if given topically, and CNS and cardiac abnormalities if taken systemically |
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Term
| What kind of iPledge requirements does someone going on Accutane have to do? |
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Definition
Need 2 negative pregnancy tests prior to use, a negative pregnancy test each month of use, and a negative pregnancy test one month after use.
Contraception is a requirement. Have to verify they are using it 1 month before, during, and 1 month after using 2 types, primary can be hormonal or surgical, second type must be barrier, excluding female condom, and spermicide must be used. |
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Term
| What are the risks of hormonal therapy in Pregnant women? |
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Definition
- Do not use, all are X
- Estrogen leads to congenital heart defects and limb malformations
- Progestin leads to virilization (male forming effects in females)
- Androges can cause virilization as well
- Have not seen sig. risks with being on an OC before you know you're pregnant. |
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Term
| What misc/herbal products can and can't be used in prego patients? |
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Definition
Alcohol - Fetal alcohol syndrome, hyperactivity, poor coordination, abnormal facial features
Caffeine - OK to use in moderation, more than 2 cups in a day increases risk of miscarriage.
Echinacea - Category C
Ginger - Category C
Alka Seltzer - has salicylate, avoid
Tobacco/Marijuana - Avoid, low birth weight, spontaenous abortion, premature delivery
Gingseng and Valerian Root - Only cat. B herbals, rest are C. |
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