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30 Cards in this Set
- Front
- Back
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Asthma Medication Safety while breastfeeding
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- albuterol and budesonide are safe due to low bioavailability
- Theophylline may cause infant hyperstimulation and disrupt sleep- to decrease exposure encourage mother to feed before taking the med, then abstain from nursing for 2-4 hours |
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Asthma medication safety in pregnancy
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- pharm treatment for asthma is safer than untreated asthma
- NIH endorses stepwise approach in pregnancy - albuterol is safe and widely studied in pregnancy |
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General Considerations for Asthma management
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**Know the difference and appropriate use of rescue drugs vs. maintenance drugs
- primary rescue drug- albuterol (SABA) - Maintenance drugs: B2 agonists (LABA- salmeterol to acheive sustained bronchodilation), Glucocorticoids (mainstay of maintenance) Others (mast fell stabilizers- Cromolyn, leukitriene antagonists0 Montelukast, anticholinergics- ipratropamine, Methylxanthines- Theophylline |
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General Considerations for allergies and the common cold in pregnancy
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- women are more prone to colds, infection, and allergies during pregnancy
- colds are usually short-lived, best to avoid meds in 1st trimester whenever possible - avoid drugs that are combos, long-acting, extended release, or contain alcohol |
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Decongestant use in lactation
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-safety of oxymetazoline and Sudafed is unknown in lactation
- AAP considers sudafed safe in lactation, but it may decrease milk supply - consider nasal (oxymetazoline) before systemic to decrease teh amount passed to the baby |
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Decongestants in Pregnancy
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- short pds of time only
- starte with nasal (oxymetazoline- cat C) over oral -pseudoephedrine (Sudafed-C) may increase risk of gastroschesis if used during 1st trimester - AVOID phenylephrine- may cause fetal hypoxia |
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antitussives in lactation
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-guaifenesin is probably safe in lactation- although it has not been studied
- opiods- infants are v. sensitive to opioids- may cause resp depression- best to avoid- if you must, prescribe smallest dose for shortest time - dextromethorphan is probably safe, but as it is not very effective, probably best to avoid |
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antitussives in pregnancy
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codeine- cat C in 1st trimester- fetal malformations. *all opioids cross placental barrier
-guaifenesin and dextromethorphan are cat C- 1st trimester use of guaifenisin is assocated with birth defects |
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antihistamines in pregnancy
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- 1st gen antihistamines have been more widely studies in pregnancy- start with Chlorpheniramine (CHlor-Trimeton)- Cat B
- Claritin (Loratidine)- Cat B- safe for 2nd trimester - Doxylamine- Cat B |
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antihistamines in lactation
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-pref. to start with non-sedating (Loratidine)
- take a single does @ bedtime after last nursing session - can decrease milk supply, especially if combined w Sudafed - Doxylamine is a Pregnancy Cat B, but is possibly unsafe in lactation |
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Decongestants- Mechanism of Action (Oxymetazoline, Sudafed, et)
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activate alpha1 adrenergic receptors, leading to vasoconstriction of the nasal blood vessels and relief of congestion
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anticholinergics- mechanism of action (Ipratopium- atrovent)
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block parasympathetic response, thereby indirectly causing bronchdilation
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Beta2- agonists Mechanism of Action (Albuterol)
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decrease bornchoconstriction and bronchospasm
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antihistamines Mechanism of Action (diphenhydramine)
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blocks the action of histamine which causes many allergic symptoms
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Nasal Corticosteroids- Mechanism of Action (Beclomethasone)
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interrupt inflammation by supressing the synthesis of hystamine
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Antitussives Mechanism of Action (Dextromethorphan)
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acts in teh CNS to suppress cough- elevates the cough threshold
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Antitussives- uses
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acute cough
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antitussives- adverse effects
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mild innebriation and mind-body dissociation when abused. can increase analgesic response to morphine
- codeine is the most effective antitussive- potential for abuse |
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Methylxanthines Mechanism of action- (Theophylline)
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produces bronchodilation by relaxing bronchi
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Methylxanthines- uses
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asthma (beta2 agonists and inhaled corticosteroids are preferred, though)
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Methylxanthines- adverse effects
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narrow therapeutic range
dysrhythmias, v-fib convulsions, cardiorespiratory collapse, death. many drug-drug interations |
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beta2 adrenergic agonists- mechanism of action (SABA- Albuterol)
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activation of beta2 adrenergic receptors in the lung. promotes bronchodilation. rapid onset of action for rescue breathing. suppresses histamine release in the lung. increases ciliary motility
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Beta2adrenergic agonists- uses
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rapid relief of asthma sx
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beta2 adrenergic agonists- adverse effects
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tachycardia, angina, fever
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leukotriene modifiers- Montelukast (SIngulair)- Mechanism of Action
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blocks leukotriene receptors. reduces inflammation, bornchoconstriction, edema. decreases secretion of mucous. reduces eosinophils and other inflammatory cells. reduces doses of inhaled corticosteroids.
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Laukotriene Modifiers- uses
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control of asthma (not used as 1st line therapy). prevention of exercise induced bronchospasm (EIB). allergic rhinitis. not for rescue
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Leukotriene Modifiers- adverse effects
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gi upset. delayed effect. possible rare neuropsychiatric effects (mood change, suicidal thoughts)
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beta2 adrenergic agonists- long acting (LABA)- Salmeterol (Serevent) mechanism of action
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activates beta2 adrenergic receptors in the lungs. promotes bornchodilation. suppresses histamine release in the lungs. increases ciliary motility
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LABA uses
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asthma. **should not be used alone, but should be used in conjunction with an ICS- when asthma is more severe
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LABA adverse effects
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effect is delayed by 20-30 min. not to be used for rescue breathing. tachycardia, angina, tremor, and leg cramps.
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