PMH-C Medications exam review questions
and answers
There are two patients - Treatment can benefit both mom and baby
No treatment poses risk to both mom and baby
"Exposure always occurs, be it to treatment or illness"
Prevalence - 13% of pg women were prescribed antidepressants
50% of pregnancies are unplanned - early exposure has often occurred
PMAD tx guidelines (APA & ACOG) - Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
,PMH-C Medications exam review questions
and answers
First option for medication - 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 - 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 - Other prescription/non-prescription
meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins
Maternal/paternal age
, PMH-C Medications exam review questions
and answers
Length of gestation
Stress
Socioeconomic status
Golden rules of pharmacological tx - 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 - 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
and answers
There are two patients - Treatment can benefit both mom and baby
No treatment poses risk to both mom and baby
"Exposure always occurs, be it to treatment or illness"
Prevalence - 13% of pg women were prescribed antidepressants
50% of pregnancies are unplanned - early exposure has often occurred
PMAD tx guidelines (APA & ACOG) - Mild - moderate:
- psychotherapy first line
- continue meds if needed
Severe/Recurrent
- continue meds
Suicidal/Psychotic
- immediate referral to hospital or psychiatric care provider
- medications
,PMH-C Medications exam review questions
and answers
First option for medication - 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 - 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 - Other prescription/non-prescription
meds
Nutrition
ETOH/cigarettes
Genetics
Obesity
Method of delivery
Environmental toxins
Maternal/paternal age
, PMH-C Medications exam review questions
and answers
Length of gestation
Stress
Socioeconomic status
Golden rules of pharmacological tx - 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 - 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
