A woman has just learned she is pregnant and is in her 10th ...

[arivle123]

A woman has just learned she is pregnant and is in her 10th gestational week. The woman reports that she takes valproic sodium (Depakote) for a seizure disorder and has been seizure-free for several years. The NP should:
 
  a. prescribe folic acid supplements.
  b. change her antiepileptic drug to lamotrigine (Lamictal).
  c. order prophylactic vitamin K to be given in the second trimester.
  d. recommend that she discontinue taking the valproic sodium by 12 weeks.

Question 2

A woman tells a primary care NP that she is considering getting pregnant.
 
  During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily. The NP should counsel this patient to: a. take her asthma medications only when she is having an acute exacerbation.
  b. avoid using antihistamine medications during her first trimester of pregnancy.
  c. discontinue her seizure medications at least 6 months before becoming pregnant.
  d. use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control.

[Sarahjh]

Answer to Question 1

A
Maternal folic acid deficiency is induced by anticonvulsants, especially valproic acid, so folic acid supplements must be given. Although antiepileptic drugs can have consequences for the developing fetus, once a woman is pregnant, the benefit-risk ratio favors continued use of the woman's current antiepileptic medication, so she should not discontinue the medication or change to lamotrigine. Vitamin K is recommended beginning at 36 weeks of gestation and for the newborn at birth to counter the possibility of hemorrhagic disease of the newborn.

Answer to Question 2

B
Optimal treatment of asthma during pregnancy includes treatment of comorbid allergic rhinitis, which can trigger symptoms. Antihistamines are recommended after the first trimester, if possible. Asthma medications should be continued during pregnancy because poorly controlled asthma can be detrimental to the fetus; she should continue using her daily inhaled corticosteroid. Although discontinuing seizure medications is optimal, this must be done in conjunction with this woman's neurologist because management of epilepsy during pregnancy is beyond the scope of the primary care provider. Oral corticosteroids have greater systemic side effects and greater effects on the fetus and should be used only as necessary.

[arivle123]

Excellent

[Laurenleakan]

Gracias!