Prego drugs

Prior to 2015 the FDA graded prego drugs on a system from A-D and X. What does each category stand for?

A : adequate, no increased risk to fetus in any trimester B : no adequate human studies but animal studies demonstrate no harm to the fetus C : no studies animal or human D : adequate well-controlled studies conducted in prego women demonstrate some risk to fetus x in some cases the benefits outweigh the risks X : medication is contraindicated in prego or trying to be prego women

In 2015 the FDA revamped the guidelines to include what three main risk categories?

Risk to Pregnancy drugs Risk during Lactation drugs Risk to Reproduction drugs

What kind of care/medication is safe during the 1st trimester for a pregnant woman?

1st trimester-1-12 weeks - none unless necessary - elective care contraindicated - Emergency care, active infection, abscess, or severe pain treatment may be redendered - Radiographs should always be used judiciously during any trimester - When in doubt consult with the patient's physician

Which weeks of fertilization/pregnancy define each trimester?

1st trimester-1-12 weeks 2nd trimester 13-28 weeks 3rd trimester 29-40 weeks

What kind of care/medication is safe during the 2nd trimester for a pregnant woman?

2nd trimester 13-28 weeks - Routine care can be performed - SRP, Basic restorative, etc - Emergency care, active infection, abscess, or severe pain treatment may be redendered - Radiographs should always be used judiciously during any trimester - When in doubt consult with the patient's physician

What kind of considerations need to be taken during the 3rd trimester for a pregnant woman?

3rd trimester 29-40 weeks - Comfort for the woman and baby is the main issue - Position patient on her left side to avoid hypotensive syndrome - Take BP frequently - Emergency care, active infection, abscess, or severe pain treatment may be redendered - Radiographs should always be used judiciously during any trimester - When in doubt consult with the patient's physician

Other than lidocaine what category are most dental local anesthetics?

Category C

What category prego drug is epinephrine?

Category C - fetal malformation has been seen with IV epinephrine use but NO KNOWN RISKS with LA epi - May actually decrease toxicity of local anesthetic by keeping it localized - May decrease milk production in lactating mother

What category of drug is the following? The use of this medication is contraindicated in women who are or may become pregnant.

Category X

Put the following in the right category. Penicillins Macrolides Fluoroquinolones- (Ciprofloxacin) Tetracyclines

Amoxicillin-Cat B PenVK- Cat B Clindamycin- Cat B; use if benefits outweigh risks Macrolides - Azithromycin- Cat B; use if benefits outweigh risks - Avoid clarithromycin - Metronidazole- Cat B but avoid during the 1st trimester Fluoroquinolones- (Ciprofloxacin) - Category C, Best to avoid during pregnancy Tetracyclines- Category X, Contraindicated teeth and bones

What category of drug is the following? Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well-controlled studies in pregnant women.

B

You decide that you will treat the patient with an antibiotic for one week then bring her back for the extraction- Which antibiotic will be your first choice? A- Cipro B- Amoxicillin C- Doxycycline D- Metronidazole

B- Amoxicillin

You want to give her something for pain as well, what is the best option? A- Give her Norco (Hydrocodone/APAP) 10/325 and have her take it 1-2 Q4-6 hrs prn. B- Tell her to take Tylenol 500mg every 4-6 hours and ibuprofen 600mg Q6hrs for 2 days. Also, give her an Rx for 5 tablets of Tylenol 3 and if the pain is really bad the first couple of days she can take one of these in place of the regular Tylenol. C- Tell her she is pregnant and she will just have to deal with the pain. That is what she gets for getting pregnant. There are already too many people in the world anyways. D- Give her an Rx for Percocet (oxycodone/APAP) 10/325 and have her take it 1-2 Q4-6 hrs prn.

B- Tell her to take Tylenol 500mg every 4-6 hours and ibuprofen 600mg Q6hrs for 2 days. Also, give her an Rx for 5 tablets of Tylenol 3 and if the pain is really bad the first couple of days she can take one of these in place of the regular Tylenol.

A 27 year old female presents to your office on Friday afternoon with severe pain and swelling and requires extraction of #16. While reviewing the medical history you notice that she is 22 weeks pregnant. What is the appropriate action with this patient? A- Do nothing she is pregnant B- Refer to OS because you don't deal with pregnant women C- Take a radiograph to confirm your diagnosis D- Wait until Monday to get a consult from her OB/GYN.

C- Take a radiograph to confirm your diagnosis

Lidocaine is what category prego drug?

Category B - no known risks

Which of the following antibiotics is the safest to prescribe in the 1st trimester? Ciprofloxacin Clindamycin Clarithromycin Metronidazole

Clindamycin is the safest but likely not prescribed unless there is a true penicillin allergy otherwise use Amoxicillin instead.

What is the safest Analgesic? A- Ibuprofen tablets B- Hydrocodone/APAP tablets 5/300 C- Tylenol 3 tablets D- Tylenol (acetaminophen)

D- Tylenol (acetaminophen)

What is dangerous about hydrocodone in prego women?

Hydrocodone is a Cat C/D drug that causes respiratory depression in the neonate.

Is aspirin safe for babies? Neonates? Breast feeding women.

No! - AVOID Aspirin in all situations in which a baby/fetus can be dosed! - Causes possible changes in hemostatis

Are Codeine or Hydrocodone safe for nursing mothers?

Nope! Codeine - Cat C/D - Benefits must outweigh risks - Possible teratogenic to respiratory tract Hydrocodone - Cat C/D - Benefits out weight risks - Respiratory depression in neonate

2015 FDA guidelines for prego are now broken down into what categories?

Prego Lactation Man + Women of Reproductive age

Which of the following pain meds is the safest to prescribe for pregnant women? Tylenol (Acetaminophen) NSAIDS Ibuprofen and Naproxen Aspirin Codeine Hydrocodone

Tylenol (Acetaminophen) - Category B so safe for baby and mother - First line for babies with pain Ibuprofen and Naproxen - EXCEPT in the third trimester where it can cause premature closure of ductus arteriosus - Use only for 24-72 hours

Can you prescribe the antibiotic, Metronidazole, to a prego lady?

Yes... BUT avoid during the 1st trimester

Can you use topical anesthetic on prego ladies?

Yup! Category C drug