PMH C EXAMINATION PREP STUDY GUIDE
LATEST UPDATED PRACTICE SOLUTION
VERIFIED 100 PERCENT
◉ PMAD tx guidelines (APA & ACOG). Answer: Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
◉ First option for medication. Answer: Is often Sertraline/Zoloft
No single med is "safest" or "best" for use during
pregnancy/postpartum/lactation
◉ Why so much conflicting data on meds in perinatal. Answer: No
randomized, double-blind, placebo-controlled trials
,Many studies are retrospective database and case-control studies
- may involve voluntary reporting
- confounds (esp illness exposure)
◉ Confounding variables in assessing risk. Answer: Other
prescription/non-prescription meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins
Maternal/paternal age
Length of gestation
Stress
Socioeconomic status
◉ Golden rules of pharmacological tx. Answer: Keep it simple -
monotherapy where possible, don't change what's working
Ask about and document all known exposure to
medications/supplements/herbals/OTC
Encourage psychotherapy & social support
◉ Parental concerns around perinatal medication. Answer:
Miscarriage
, congenital malformation
preterm delivery / low birth weight
NAS - Neonatal Abstinence/Adaptation Syndrome
PPHN - Persistent Pulmonary Hypertension of the Newborn
Long term neurobehavioural effects
Autism
◉ Risk of miscarriage. Answer: not a true risk when adequate
controls are utilized - no increased risk with SSRIs
◉ Risk of congenital abnormalities. Answer: SSRIs -> no consistent
fetal malformations
General population risk is 3% - SSRIs don't increase this
SSRIs/SNRIs are not teratogenic
◉ Contraindicated medications. Answer: VALPROIC ACID (Epival,
Depakene, Depakote) in pregnancy
(Commonly used for Bipolar + epilepsy/migraine)
LITHIUM in breastfeeding
(Commonly used for Bipolar and MDD)
Paxil was thought to produce a risk of cardiac malformation but this
has been refuted
LATEST UPDATED PRACTICE SOLUTION
VERIFIED 100 PERCENT
◉ PMAD tx guidelines (APA & ACOG). Answer: Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
◉ First option for medication. Answer: Is often Sertraline/Zoloft
No single med is "safest" or "best" for use during
pregnancy/postpartum/lactation
◉ Why so much conflicting data on meds in perinatal. Answer: No
randomized, double-blind, placebo-controlled trials
,Many studies are retrospective database and case-control studies
- may involve voluntary reporting
- confounds (esp illness exposure)
◉ Confounding variables in assessing risk. Answer: Other
prescription/non-prescription meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins
Maternal/paternal age
Length of gestation
Stress
Socioeconomic status
◉ Golden rules of pharmacological tx. Answer: Keep it simple -
monotherapy where possible, don't change what's working
Ask about and document all known exposure to
medications/supplements/herbals/OTC
Encourage psychotherapy & social support
◉ Parental concerns around perinatal medication. Answer:
Miscarriage
, congenital malformation
preterm delivery / low birth weight
NAS - Neonatal Abstinence/Adaptation Syndrome
PPHN - Persistent Pulmonary Hypertension of the Newborn
Long term neurobehavioural effects
Autism
◉ Risk of miscarriage. Answer: not a true risk when adequate
controls are utilized - no increased risk with SSRIs
◉ Risk of congenital abnormalities. Answer: SSRIs -> no consistent
fetal malformations
General population risk is 3% - SSRIs don't increase this
SSRIs/SNRIs are not teratogenic
◉ Contraindicated medications. Answer: VALPROIC ACID (Epival,
Depakene, Depakote) in pregnancy
(Commonly used for Bipolar + epilepsy/migraine)
LITHIUM in breastfeeding
(Commonly used for Bipolar and MDD)
Paxil was thought to produce a risk of cardiac malformation but this
has been refuted
