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 Ends1) 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 Ends4) 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: 781-800.