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Supplements all pregnant pts should be on and why
- Prenatal vitamins
- folic acid - prevent neural tube defects, essential for RNA and DNA formation
- iron - maternal blood volume expansion, placenta and cord needs, blood loss @ delivery
- calcium - mineralization of fetal skeleton and teeth, may reduce preterm labor and HTN
- omega 3 fatty acids - supports brain and eye development
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What criteria are needed to determine pregnancy risk category?
- Category A: no demonstrated harm in human fetuses, ex: folic acid, levothyroxine
- Category B,C: no evidence of fetal harm in human studies or no studies available (Category C might show fetal harm in animal studies)
- Category D: Evidence of fetal harm, but benefits might outweigh risks in some cases
- Category X: risks always outweigh benefits, ex: OCs, isotretinoin, warfarin, MTX
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Identify limitations of pregnancy risk categories
- very hard for a med to be put into category A - hard to provide enough evidence - drugs may be categorized at less safe than they really are
- Difficult for a drug to change from one category to another
- U.S. classifications are different than those in other countries
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Treatment of n/v in pregnancy
Non-pharm: small dry meals high in carbs and low in fat, avoid ppt factors, shorter workdays, freq naps
- Pharmacologic:
- 1st line:
- metoclopramide (BBW for tardive dykinesia)
- meclizine
- dimenhydrinate
- ondansetron
- 2nd line:
- promethazine
- prochlorperazine
- OTCs:
- vitamins B6 and B12
- ginger root
- premesisrx (combo of B6, B12, folic acid, pyridoxine, calcium carbonate)
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treatment of constipation in pregnancy
non-pharm: incr activity, fluids, fruits, veggies, whole grains
- Pharmacologic:
- bulk forming agts (metamucil, citrucel)
- mild stimulants (bisacodyl, senna)
- stool softeners (docusate sodium)
- PEG
- mild laxatives (MOM)
- Avoid use of strong cathartics and enemas and castor and mineral oil
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Tx of GERD in pregnancy
step up therapy preferred
- OTCs: antacids
- RX: sucralfate, H2RAs, PPIs are last line
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Tx of HTN in pregnancy
- Nonpharmacologic is not effective
- Pharmacologic:
- Methyldopa is 1st line
- Labetalol (ok to use short term in 3rd tri)
- Nifedipine (ok during any tri)
- Don't use:
- diuretics
- other beta-blockers
- ACEs/ARBs
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Prevention of preeclampsia
- 81 mg/d ASA after 12 weeks gestation if pt at risk (DM, chronic HTN, pre-eclampsia hx, kidney disease)
- 1g/d calcium may decr. risk by 1/2
- Tx: magnesium sulfate to prevent seizures - given during labor and 12-24 h post partum
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tx of VTE during pregnancy
- LMWH is 1st line
- Unfractionated Heparin is 2nd line
- Do not use warfarin
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Tx of antenatal depression
- SSRIs (not paroxetine)(fluoxetine most data)(sertraline, escitalopram, citalopram ok)
- TCAs (desipramine, nortriptyline)
- Venlafaxine
- Bupropion
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Best resources for drug use recommendations in pregnancy
- Best - most comprehensive = Drugs in Pregnancy and Lactation by Briggs
- good recommendation for public = www.americanpregnancy.org
- www.cdc.gov
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