1. PREGNANCY AND THE PHARMACIST SOME WORDS OF WISDOM Dr. Yoel Abells

2. 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

3. Some Do’s and Don’ts Continued... Don’t –Immediately choose meds; –Consider non-medicinal options Do –Consult (attending; motherisk) Don’t –CPS everything

4. Nausea and Vomiting Dry foods in AM Small frequent meals Avoid strong/precipitating smells Avoid heavy/greasy/spicy foods Consider Diclectin TM (doxylamine and vitamin B6)

5. 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 H 2 -receptor antagonists-eg. Zantac; GI cytoprotective agents-eg. Sulcrate and bismuth subsalicylate)

6. 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)

7. Constipation Increased fluids Increased dietary fibre Commercial fibre supplement (metamucil) Consider medications (mineral oil, docusate sodium/calcium-colace/surfak, glycerin, lactulose, bisacodyl-dulcolax, etc.)

8. 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)

9. Other Odds and Ends 1) 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)

10. More Odds and Ends 4)Fever rest, reassurance consider medications (acetaminophen) 5)Sore throat fluids, fluids, fluids candy/lozenges 6)Sun protection avoid over exposure sunscreen

11. 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

12. 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.