Immunization and Consumption of Over-the-Counter Drugs during Pregnancy

Chapter 85 Immunization and Consumption of Over-the-Counter Drugs during Pregnancy




Clinical Case Problem 1 A Mother Moving to Nepal


A 26-year-old primigravida who has seen you once for prenatal care comes to your office asking for advice and immunizations. On the basis of your initial history and physical examination, she is at 18   weeks of gestation. Her husband has just accepted a position with a U.S. government agency in Nepal, and she will be moving there with him in 4   weeks. She is very anxious about possible infectious diseases she could contract, including tuberculosis. She recently moved to the area and had been unable to tell you her immunization status at the previous visit because she misplaced her records. She knows she received all the “childhood vaccines” and had a booster of some kind before entering college.



Select the best answer to the following questions




1. Which of the following immunization combinations would be acceptable for administration to this pregnant woman if she has not previously been immunized or received boosters and needs them because of exposure risk?


a. tetanus and diphtheria (Td); bacillus Calmette-Guérin (BCG); hepatitis A; measles, mumps, rubella (MMR); varicella

b. Td, influenza, hepatitis B, hepatitis A

c. Td, hepatitis B, MMR, varicella

d. Td, hepatitis A, meningococcal, varicella

e. MMR, hepatitis B

2. Your patient does not know about the risk of influenza in Nepal, but she will be in her second and third trimesters during the influenza season. Which of the following statements is true about influenza vaccination in pregnancy?


a. the immunization should not be given to high-risk patients (those with asthma, cardiovascular disease, or diabetes) within the first trimester

b. the vaccine should be administered to all pregnant women who will be in the second or third trimester of pregnancy during the influenza season

c. pregnant women have the same severity risk level of influenza as nonpregnant women

d. immunization of pregnant women for influenza is not safe

e. the live attenuated vaccine may be given to pregnant women

3. Your patient has studied communicable diseases and asks about the new Tdap vaccine to protect her from transmitting pertussis to her newborn infant. You suggest


a. she avoid contact with people who might have pertussis

b. she receive Tdap rather than the Td booster because it is approved for pregnancy

c. she receive the Tdap post partum unless the vaccine is not available where she will be living

d. she receive the Tdap vaccine after the infant is 6   months old because she can have viral shedding, which could infect the infant

e. she need not worry about pertussis because nearly all cases have been eliminated


Clinical Case Problem 2: A Pregnant Woman Concerned about Consuming Ibuprofen


A newly pregnant woman who comes to the office is concerned about the fact that she took ibuprofen for a headache during the past week. She is asking whether it is safe to take during pregnancy.



4. Which of the following statements about taking ibuprofen during pregnancy is true?


a. ibuprofen is considered safe during all stages of pregnancy

b. ibuprofen is considered relatively safe during the first and second trimesters but should be avoided in the third trimester because of effects on the fetal heart

c. ibuprofen should never be taken during pregnancy; the patient should be counseled to consult a geneticist

d. ibuprofen can be taken in the third trimester but should be avoided if possible in the first trimester


Clinical Case Problem 3: A Pregnant Patient with 2 Days of Influenza-like Symptoms, Nausea, and Vomiting


A 22-week-gestation primigravida patient of yours presents with a 2-day history of low-grade fever, myalgias, and vomiting once or twice. She received the influenza vaccine (killed) 1   month ago. Her physical examination is unremarkable except for slightly dry mucous membranes, and her laboratory examination is normal.



5. In addition to close follow-up and warnings about dehydration, which of the following over-the- counter (OTC) medications would you not recommend now or later during her pregnancy?


a. chlorpheniramine

b. pseudoephedrine

c. aspirin

d. acetaminophen (Tylenol)

e. diphenhydramine (Benadryl)

6. On the way out the door, she mentions she had a loose stool and wants to know which medications she could take if she has diarrhea. Which of the following would you consider least desirable because of her pregnancy?


a. kaolin and pectin (Kaopectate)

b. bismuth subsalicylate (Pepto-Bismol)

c. loperamide (Imodium)

d. atropine-diphenoxylate (Lomotil)

e. aluminum hydroxide–magnesium hydroxide (Maalox)

7. Which of the following statements is true concerning medications for vaginal yeast infections during pregnancy?


a. most of the OTC antifungal vaginal preparations have been studied, and although the largest studies are on clotrimazole, all are thought to be safe

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Immunization and Consumption of Over-the-Counter Drugs during Pregnancy

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