Week 2 Fmp Gandhi Medications In Pregnancy

Front 1

Drug Risk Categories
- What are they?
- Are they useful?

Back 1

A, B, C, D, X
- Not useful since studies not done in pregnant women for every drug

Front 2

Dr. Gandhi's Approach to Classifying Drugs
(3)

Back 2

1. Safe
2. Weigh Risks and Benefits
3. Avoid

Front 3

Case 1: Ramipril (ACEi)

Back 3

ACEi and ARBs are teratogens in 2nd and 3rd Trimester
- Stop drug once pregnancy recognized (unplanned pregnancy on this drug not an issue, although should stop drug if planning pregnancy)
May need to stay on ACEi in first trimester if UNDERLYING RENAL DISEASE

Front 4

Safe / Unsafe Antihypertensives

Back 4

1. Methyldopa = safe
2. Hydralazine = rarely used
3. Beta blockers (esp labetalol) are good; Caveat: atenolol is to be avoided b/c risk of IUGR

Front 5

Safe / Unsafe Antihypertensives II
1.Calcium Channel Blockers
2. Hydrochlorothiazide

Back 5

1. No data in first trimester but safe afterwards
2. Avoid thiazide b/c of risk of decreasing plasma volume

Front 6

Case 2: Epilepsy
Dilantin (phenytoin) and Carbamazepine. Few seizures in eight years.

Back 6

Reduce meds.
Consider switching meds.
Increase folic acid to 5mg / day
Do 18 week scan

Front 7

Case 3: Antidepressants
SSRIs

Back 7

Not teratogenic
Risk of neonatal maladaption syndrome, aka withdrawal after birth
However, risk to mother of withdrawal; maternal suicide is common

Front 8

1. TCAs
2. SNRIs
3. Lithium
4. Antipsychotics

Back 8

1. TCAs safe
2. SNRIs safe
3. Lithium: small (<1% risk) of Epstein's Abnormality
4. Antipsychotics: limited data but probably safe

Front 9

Case 4: Asthma in Mother (3 fetus 32 weeks GA)
1. Bronchodilators
2. Inhaled Steroids
3. Systemic Steroids (oral or IV)

Back 9

1. Bronchodilators (B2 agonists) are safe
2. Inhaled steroids are minimally absorbed therefore safe for fetus.
3. Systemic steroids double risk of cleft palate BUT
- risk very small to begin with
- at 32 weeks face formed anyway

Front 10

Case 5: Woman presents to ER 18 weeks pregnant with swollen, painful leg
Warfarin?
Heparine?

Back 10

Warfarin: Risk of Fetal Warfarin Syndrome (nasal hypoplasia, stippled epiphyses, neurologic concerns) at 6-9 weeks GA
Heparin: Tx of choice here. Even LMW heparin DOES NOT cross placenta.

Front 11

Pain Management
Acetaminophen?
NSAIDS?
Opiates?

Back 11

Acetaminophen = SAFE
NSAIDS: weight risks and benefits; can cause closure of ductus at 35-36 weeks
Opiates: no malformations but can cause neonatal withdrawal
Don't use past 32 weeks

Front 12

What do you do for migraine?

Back 12

Sumatripan and ergot derivative should be avoided in pregnancy

Front 13

Medication and Lactation
Are drugs safe?
Which drugs to avoid?

Back 13

Drugs generally safe if relative infant dose is 10% (infant dose / maternal dose)
Lipophilic drugs like atenolol