Download Pregnancy and the Pharmacist

PREGNANCY
AND
THE PHARMACIST
SOME WORDS OF WISDOM
Dr. Yoel Abells
Some Do’s and Don’ts
• Do
– Be extra patient with the patient;
– Remember the power of language
• Don’t
– Forget that pregnancy is a multi-phased
event
• Do
– Remember folic acid
Some Do’s and Don’ts
Continued...
• Don’t
– Immediately choose meds;
– Consider non-medicinal options
• Do
– Consult (attending; motherisk)
• Don’t
– CPS everything
Nausea and Vomiting
• Dry foods in AM
• Small frequent meals
• Avoid strong/precipitating smells
• Avoid heavy/greasy/spicy foods
• Consider DiclectinTM (doxylamine and vitamin B6)
Gastric Reflux and Heartburn
• Avoid eating 2 hours before bedtime
• Avoid precipitating foods
(greasy/spicy/heavy/other)
• Elevate head of bed
• Consider medications (magnesium and aluminum
hydroxide-eg Maalox; alginic compounds- eg.
Gaviscon; calcium carbonate-eg. Tums; histamine
H2-receptor antagonists-eg. Zantac; GI
cytoprotective agents-eg. Sulcrate and bismuth
subsalicylate)
Aches and Pains
•Rest/heat/stretching/other
•Massage/other
•Consider medications (acetaminophen,
aspirin and NSAIDs-not third trimester,
TCA’s benzo’s, codeine and
dimenhydrinate for migraines)
Constipation
• Increased fluids
• Increased dietary fibre
• Commercial fibre supplement (metamucil)
• Consider medications (mineral oil, docusate
sodium/calcium-colace/surfak, glycerin, lactulose,
bisacodyl-dulcolax, etc.)
Skin Conditions
1) acne
• Cleansers
• Topical erythromycin/clindamycin
• Oral erythromycin
2) pruritis
• Moisturizers
• Consider medications (topical eg. calamine
lotion, steroid creams, local anaesthetics; oral
eg. hydroxyzine, diphenhydramine, steroids)
Other Odds and Ends
1) Allergies
• consider specific symptomatic treatment (see below)
• consider systemic treatment (diphenhydramine/Benadryl;
chlorpheniramine/Chlor-Trilpolon)
2) Congestion
• steam
• saline drops (Otrivin, Saline/Salinex)
• consider medications (oxymethazoline/Dristan;
xylomethazoline/Otrivin; cromolyn; etc.)
3) Cough
• fluids
• steam
• consider medications (dextromethorphan/Benylin-DM;
codeine)
More Odds and Ends
4) Fever
• rest, reassurance
• consider medications (acetaminophen)
5) Sore throat
• fluids, fluids, fluids
• candy/lozenges
6) Sun protection
• avoid over exposure
• sunscreen
More Odds and Ends
7) Insect bite prevention
• stay in at worst times
• avoid endemic areas
• avoid perfumes (etc.) and wear light coloured long clothes
• use sprays with less than 30% DEET and spray on clothes
and exposed skin
8) Avoid/limit
• alcohol
• caffeine (3 or less cups/day)
• hair colours/perms
• natural products
• sweeteners
• tobacco
Supplemental reading:
• Mazzotta P, Magee LA. A risk-benefit assessment of
pharmacological and nonpharmacological treatments for
nausea and vomiting of pregnancy. Drugs 2000;59: 781800.