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Pregnancy (Pharmacologic Changes (Increased maternal plasma volume,…

- - - - increase water and dietary fiber
      - exercise
    - - osmotic
        
        lactulose
        
        polyethylene glycol
        
        sorbitol
      - stimulant
        
        senna
        
        bisacodyl
      - bulk-forming (preferred, not absorbed)
        
        psyllium
        
        methylcellulose
        
        polycarbophil
    - - magnesium and sodium salts -- electrolyte imbalances
      - castor oil/mineral oil -- uterine contractions
  - - - nocturnal symptoms
        
        elevating head of the bed
        
        food avoidance before bed
      - daytime symptoms
        
        small infrequent meals
        
        alcohol and tobacco avoidance
    - - antacids (first line)
        
        avoid sodium bicarbonate and magnesium trisilicate
      - h2 blockers
        
        ranitidine
        
        cimetidine
      - PPIs
        
        omeprazole
  - - - Ginger
      - Dietary modifications
        
        Avoiding fatty or spicy foods
        
        Eating frequent, small, bland meals
      - Applying pressure to acupuncture point P6
    - - Pyridoxime (vit B6) with antihistamine (doxylamine)
        
        First line
      - Metoclopramide
        
        May cause sedation and EPS effects
      - Ondanestron
        
        Conflicting data about safety
        
        May increase risk of oral clefts
      - Corticosteroids
        
        Reserved only for use after first trimester
        
        Small increase risk of oral clefts in oral trimester
    - - unrelenting vomiting causing weight loss of more than 5% prepregnancy weight, dehydration, electrolyte imbalance, and ketonuria
      - Occurs in 0.5-2% of women
  - - - compression socks, exercise,
    - - enoxaparin (first line)
      - heparin (second line)
      - warfarin (not recommended)
        
        abnormalities in 6-12 weeks gestation, CNS in 2nd/3rd trimester
      - DOACs (not recommended)
        
        limited research
      - Fondaparinux (not recommended)
        
        limited research
    - - intermediate risk
        
        antepartum ppx with enoxaparin
        
        6 week postpartum ppx
        
        enoxaparin
        
        warfarin
      - high risk
        
        same as intermediate
      - low risk
        
        antepartum monitoring
  - - - hyperthyroidism
        
        if untreated
        
        fetal death, low birth weight, intrauterine growth restriction, preeclampsia
        
        treatment
        
        thioamides
        
        propylthiouracil
        
        methimazole
        
        radioactive iodine -- contraindicated
        
        thyroid disorder in fetus
        
        nervousness, anxiety, palpitations, emotional lability, easy fatigability, menstrual disturbances, and heat intolerance, weight loss
        
        Diagnosis
        
        Low TSH serum concentration, elevated T3 and T4 serum concentrations (in more severe disease)
        
        elevated RAIU (elevated radioactive iodine uptake) by thyroid gland when hormone is being overproduced
      - hypothyroidism
        
        if untreated
        
        increased risk of preeclampsia, premature birth, miscarriage, growth restriction, impaired neurological development
        
        treatment
        
        levothyroxine
        
        starting dose 0.1 mg/day (increase with pregnancy)
        
        f/u 4-6 weeks during pregnancy, TSH monitoring
        
        dry skin, cold sensitivity, weigh gain, constipation, and weakness
    - - gestational transient thyrotoxicosis
        
        causes: stimulation of thyroid gland by hCG
        
        treatment not needed, self-limiting; n/v symptoms treated
        
        symptoms
        
        Nervousness
        
        Anxiety
        
        Palpitations
        
        Fatigue
        
        Heat intolerance
      - postpartum thyroiditis
        
        causes: transient hyperthroidism
        
        treatment
        
        propranolol 10-20 mg for symptomatic relief
        
        levothyroxine replacement suggested for 6-12 months
        
        antithyroid drugs not effective
- - - - <500 Da crosses readily
      - 1000 Da does not cross
    - - Fetal albumin increases as maternal decreases which may cause higher conc of certain protein bound drugs in fetus