Leah Robinowitz, DO

Outline

Cases

Preconception counseling

Caring for the pregnant patient

Medication Safety

Over the counter medications

RX medications

Case discussion

Summary

Case 1

You get a frantic call at 4:53pm on a Friday from an

established patient who just found out she is pregnant.

She is excited, but very worried that some of the

medicines she is on could hurt her baby.

She is currently on omeprazole, valium, metoprolol,

and takes flexeril as needed

Case 2

Your last patient before lunch is a new patient with a

history of depression and anxiety previously well

controlled with a medication she can’t remember.

However, when she became pregnant she was afraid of

the potential side effects on her baby, so she stopped

taking her meds. She is now at 14 wga c/o worsening

symptoms without suicidal ideations, and wants to

resume medication.

Preconception Counseling

What is her BMI?

Start prenatal vitamins

Do a medication reconciliation

Counsel smoking and alcohol cessation

Overview Caring For The

Pregnant Patient

Don’t be afraid!!! Your pregnant patient is still your

patient

The fetus does not tolerate well the death of the mother

Screen for depression and domestic violence

Strongly recommend immunizations

Consider keeping a fetal heart monitor

Medication Safety

Categories

Over The Counter

Medications

Cold symptoms

Sleep aids

Nausea

Constipation

Pain

Prescription Medications

Cold symptoms

Sleep aids

Nausea

Constipation

Pain

Prescription Medications II

Psych

GI

Analgesia

GU

Respiratory

Cardiovascular

Case 1 Discussion

After calming the patient down, you instruct her to

stop taking her metoprolol and put her on labetalol.

You inform her the valium is unsafe for pregnancy, so

you plan to wean her off of it, and start buspar

Omeprazole is probably safe, but a switch to

lansoprazole is recommended

Flexeril is safe to use

Case 2 Discussion

After having a thorough discussion with the patient to

ensure her safety, you two decide on a medication that

is safe for her to take

Summary

Be familiar with what to recommend for patients

planning conception

Please screen your pregnant patients for depression and

domestic violence

Have a short list of safe and unsafe medications

Don’t be afraid of your pregnant patients!

References

Narges Farahi, MD, and Adam Zolotor, MD, DrPH

Recommendation for Preconception Counseling and Care.

Am Fam Physician. 2013 Oct 15;88(8):499-506.

Jessica Servey, MD, and Jennifer Chang, MD. Over-the-Counter

Medications in Pregnancy. Am Fam Physician. 2014 Oct 15;90

(8):548-555.

Cunningham, F. G., & Williams, J. W. 1. (2010). Williams Obstetrics

(23rd ed.). New York, New York.: McGraw Hill.

www.cdc.gov

www.uptodate.com