I am replying to a peer’s post on pregnancy and laceration

Re: Week 12: Discussion 1: Pregnancy and Lactation Research

by Alysa Ramalho – Thursday, 23 March 2023, 11:40 PM

In week 5, I prescribed Lexapro 10mg PO daily for the treatment of depression. In week 7, I prescribed Lithium treatment at 300mg PO TID for the treatment of bipolar disorder. If the patient in week 5 had been pregnant, I would be more likely to prescribe her Zoloft instead of Lexapro. Zoloft is pregnancy category C, meaning that risk cannot be ruled out and there have been no satisfactory studies in pregnant women. A benefit of prescribing Zoloft to a pregnant women who needs treatment for depression is that Zoloft has a very low transmission into breast milk and is considered safe for use with lactating women (Howland, 2007). It is important to discuss the risks and benefits of treatment with pregnant women. Although most studies show that SSRIs are not associated with birth defects, they may contribute to potential complications of maternal weight changes and premature birth (Howland, 2007). However, there is also a risk to non-treatment. According to Wichman & Stern (2015), “women who are depressed during pregnancy are more likely to use alcohol, illicit substances, and tobacco throughout pregnancy and to have worse nutrition and are less likely to be adherent with optimal prenatal care and to recognize or report the signs of labor”. Further, “neonates whose mothers are depressed are more likely to have lower birth weights and preterm deliveries, as well as lower Apgar scores and a smaller head circumference” (Wichman & Stern, 2015). If the patient in week 7 was pregnant, I would be more likely to prescribe her quetiapine. Although quetiapine is generally considered safe to use in pregnancy, it is still pregnancy category C, and should be used with caution and may increase the risk for gestational diabetes (Rowland & Marwaha, 2018). A very small amount of quetiapine passes into breast milk and it is considered to be a safe treatment in lactating women.Howland, R. H. (2007). Managing common side effects of ssris. Journal of Psychosocial Nursing and Mental Health Services, 45(2), 15–18. https://doi.org/10.3928/02793695 20070201-04Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic advances in psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/2045125318769235Stahl, S. M. (2017). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.Wichman, C. L., & Stern, T. A. (2015). Diagnosing and Treating Depression During Pregnancy. The primary care companion for CNS disorders, 17(2), 10.4088/PCC.15f01776. https://doi.org/10.4088/PCC.15f01776

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4. Week 12: Pharmacotherapeutic Considerations in the Childbearing Years
5. Week 12 Discussion 1: Pregnancy and Lactation Research

Week 12 Discussion 1: Pregnancy and Lactation Research

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

Note: Consider your prior case studies for Depression in Module 5 and Bipolar Disorder in Module 7. Revisit and thoroughly review them.

• How would your treatment plan (i.e., medications, therapy, and so on) change for the pregnant female in Module 5 with Depression and Module 7 with Bipolar Disorder?
• How would this change if the female were lactating (i.e., breastfeeding)?
• What patient teaching would you include?
• What additional safety components would you consider for this patient, if any? Why?
• Please include proper citations and use APA format.

Response Post

Review your peers’ responses and respond to at least two classmates’ posts.

Note: Two key details from the writings of each peer you reviewed.

Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80 percent. Students are directed to review the Discussion Grading Rubric for criteria that exceed expectations.

Posting to the Discussion Forum

1. Select the appropriate Thread.
2. Select Reply.
3. Create your post.
4. Select Post to Forum.

NU-643-05-23PCSP Adv.Psychopharmacology

1. Dashboard
2. My courses
3. NU-643-05-23PCSP
4. Week 12: Pharmacotherapeutic Considerations in the Childbearing Years
5. Week 12 Discussion 1: Pregnancy and Lactation Research

Week 12 Discussion 1: Pregnancy and Lactation Research

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

Note: Consider your prior case studies for Depression in Module 5 and Bipolar Disorder in Module 7. Revisit and thoroughly review them.

• How would your treatment plan (i.e., medications, therapy, and so on) change for the pregnant female in Module 5 with Depression and Module 7 with Bipolar Disorder?
• How would this change if the female were lactating (i.e., breastfeeding)?
• What patient teaching would you include?
• What additional safety components would you consider for this patient, if any? Why?
• Please include proper citations and use APA format.

Response Post

Review your peers’ responses and respond to at least two classmates’ posts.

Note: Two key details from the writings of each peer you reviewed.

Please refer to the Grading Rubric for details on how this activity will be graded. The described expectations meet the passing level of 80 percent. Students are directed to review the Discussion Grading Rubric for criteria that exceed expectations.

Re: Week 12: Discussion 1: Pregnancy and Lactation Research

by Salwa Said – Thursday, 23 March 2023, 3:48 PM

Untreated psychiatric illness during and after pregnancy has been linked to adverse outcomes for both the mother and the baby, such as preterm birth, low birth weight, slowed fetal growth, and cognitive and emotional problems after birth. Even so, many women are either not treated at all or undertreated as providers may be hesitant to prescribe medications to pregnant or breastfeeding women (Becker et al., 2016).When deciding whether or not to take a medication, it is crucial to consider the risks and benefits for both the mother and the baby. For example, when prescribing for a breastfeeding woman, the lowest-risk drugs should be chosen, and the dose should be given before the baby’s longest sleep time. In addition, prescribers should use up-to-date, accurate, easy-to-use, government-sponsored, authoritative resources that list information about the safety of many medications and are available for free online (Spencer et al., 2022).Non-pharmacological treatment includes continuing Cognitive Behavior therapy (CBT). Cognitive behavioral therapy (CBT) is a gold-standard learning-based psychological treatment for anxiety and depressive disorders that involves practicing adaptive coping strategies to effectively modify maladaptive responses to emotional events (Stange et al., 2020).Week 5 case study was on Mrs. Lane, a 42-year-old Korean American woman who stated, “I am so sad that I cannot stop crying.”. She presented with worsening depression symptoms. She was on Escitalopram. According to (Stahl) Escitalopram is not recommended during pregnancy, especially in the first trimester. However, treatment may be necessary during pregnancy and has not been shown to be harmful to the fetus. However, there might be more bleeding during delivery and transient irritability or sedation in the newborn. Therefore, it is essential to weigh the risk of treatment to the child and mother against the risk of no treatment. Early exposure to SSRIs during pregnancy may be associated with an increased risk of septal heart defects; however the risk is still small. SSRI use beyond the 20th week of pregnancy may be associated with an increased risk of pulmonary hypertension in newborns, although this is not proven. As for breastfeeding, a trace amount may be present in nursing children whose mothers are on the medication. If a child becomes irritable or sedated, breastfeeding or drug may need to be discontinued (Stahl et al., 2021).Mrs. Sylvia Contesta was diagnosed with Bipolar I disorder with psychotic features and was given Depakote ER as part of her treatment. Taking this drug during the first three months of pregnancy may raise the risk of neural tube defects like spina bifida or other congenital disabilities. There is also an increased risk of lower cognitive test scores in children whose mothers took Valproate during pregnancy. Therefore, this medication should be discontinued before an anticipated pregnancy. However, due to the risk of recurrent bipolar illness during pregnancy, which can be very disruptive for the mother, atypical antipsychotics may be better than lithium or anticonvulsants like Valproate if treatment is needed. Regarding breastfeeding, it is safe to breastfeed while taking Valproate. However, if the medication is continued while breastfeeding, it is crucial to monitor for possible adverse such as sedation or irritability (Stahl et al., 2021).ReferencesBecker, M., Weinberger, T., Chandy, A., & Schmukler, S. (2016). Depression during pregnancy and postpartum. Current Psychiatry Reports, 18(3).Spencer, J. P., Thomas, S., & Trondsen Pawlowski, R. H. (2022).Medication Safety in Breastfeeding. American Family Physician, 106(6).Stahl, S. M., Grady, M. M., & Muntner, N. (2021). Stahl’s essential psychopharmacology: Prescriber’s Guide. Cambridge University Press.Stange, J. P., MacNamara, A., Kennedy, A. E., Hajcak, G., Phan, K. L., & Klumpp, H. (2020). Brain-behavioral adaptability predicts response to cognitive behavioral therapy for emotional disorders: A person-centered event-related potential study. Neuropsychologia, 145, 106408

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