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Obs and Gynae Y4 > 11. Prescribing in Pregnancy > Flashcards

11. Prescribing in Pregnancy Flashcards

1
Q

Pharmacokinetics in pregnancy

A
  • Slow gastric emptying (reduced drug absorption)
  • Increased maternal plasma volume (low serum levels of drugs, reduced effect)
  • Increased maternal hepatic metabolism (reduced plasma drug levels)
  • Increased renal perfusion and drug elimination (drugs cleared by the kidneys quicker so its’ plasma levels drop)
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2
Q

Pre-implantation period development:

A

2 weeks post conception – ‘All or none effect’

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3
Q

Embryonic period development:

A

3rd -7th week (Day 18-55) post conception – problems in organogenesis causing permanent anatomical defects

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4
Q

Foetal period development

A

8th week post conception to birth – growth and functional maldevelopment

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5
Q

Shortly before term development:

A

Adverse effects on labour or neonate

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6
Q

Drugs causing anatomical defects:

A

Alcohol, lithium, phenytoin, tetracycline, thalidomide, warfarin, isotretinoin, danazol

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7
Q

Phenytoin effect on foetus:

A
  • Cleft palate
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8
Q

Tetracycline

A
  • Teeth staining
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9
Q

Thalidomide

A
  • Embryopathy
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10
Q

Folate antagonist drugs

A

Anticonvulsants, methotrexate, sulfasalazine,

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11
Q

Neural crest cell disruption drugs

A

Retinoids

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12
Q

Oxidative stress-causing drugs

A

Thalidomide, anticonvulsants, anti-arrhythmic

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13
Q

Vascular disruption-causing drugs

A

Misoprostol, aspirin, ergotamine

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14
Q

Receptor or Enzyme-mediated teratogenesis

A

NSAID, statins, ACE inhibitors, Angiotensin II receptor blockers

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15
Q

Drug abuse: tobacco

A
  • IUGR

- Placenta praevia, placental abruption, ectopic pregnancy, PPROM

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16
Q

Drug abuse alcohol

A
  • FAS (mental and growth retardation)

- Spontaneous miscarriage in 1st trimester

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17
Q

Drug abuse: cocaine

A
  • Vasoconstrictor

- Placental abruption, growth and mental retardation, spontaneous miscarriage

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18
Q

Drug abuse: heroin or opiates

A
  • Vasoconstrictor
  • Spontaneous miscarriage, growth retardation, placental abruption
  • Neonatal withdrawal symptoms
  • Respiratory depression
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19
Q

Ecstasy and LSD:

A
  • No withdrawal but delayed neonatal development
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20
Q

Anti-emetics in pregnancy:

A

Safe: Prochlorperazine, Ondansetron, Metoclopramide, Domperidone, Cyclizine
SE: drowsiness, muscle spasm

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21
Q

Hyperemesis gravidarum treatment:

A

Anti-emetics + Thiamine 1.5mg OD + Prednisolone 16mg OD + Parental fluids

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22
Q

Antacids in pregnancy :

A

Simple (Ca, Mg, Aluminium)
H2 blockers: Cimetidine, Ranitidine
PPI: Omeprazole

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23
Q

Analgesics in pregnancy:

A

Aspirin: safe, but not in late pregnancy – delays labour and increases haemorrhage risk
NSAIDs: avoid post 30/40 as causes PDA closure, necrotising enterocolitis and pulmonary hypertension in bebo. Postpartum Ibuprofen preferred than Diclofenac
Opioids: safe for short term/ or neonatal withdrawal – Codeine, Dihydrocodeine, Morphine, Pethidine, Fentanyl, Methadone

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24
Q

Laxatives in pregnancy:

A
  • Lactulose, Glycerine suppositories: not absorbed, safe
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25
Q

Laxatives to avoid in pregnancy:

A

Senna, bisacodyl (cause contractions), purgatives with Mg, Na – cause electrolyte imbalance

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26
Q

Antifungals in pregnancy:

A

Topical (safe as pessaries or creams): Clotrimazole, Econazole

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27
Q

Antifungals to avoid in pregnancy:

A

Systemic (hepatotoxic, teratogenic): Fluconazole, Griseofulvin, Terbinafine

28
Q

Antibiotics in pregnancy:

A

Safe: Penicillins, Cephalosporins, Erythromycin, Metronidazole, Ethambutol, Isoniazid

29
Q

Antibiotics to avoid in pregnancy:

A

Ototoxic: Streptomycin
NTD, facial cleft: Rifampicin, Trimethoprim
Arthropathy: Ciprofloxacin, Quinolones
Cataract, dysplasia of bones, teeth staining: Tetracycline

30
Q

Anticoagulants in pregnancy:

A

Heparin (unfractioned does not cross placenta) and LMWH safe

31
Q

Anticoagulants to avoid in pregnancy:

A

DOAC – contraindicated, risk of bleeding

32
Q

Warfarin in pregnancy:

A
  • Teratogenic; not given in 1st trimester (blindness, mental retardation, midface hypoplasia)
  • 2nd and 3rd trimester: risk of placental/foetal haemorrhage
33
Q

Anti-epileptic drugs in pregnancy:

A

Teratogenic/NTD, but Lamotrigine, Carbamazepine – safest.

34
Q

Hypertension in pregnancy:

A
  • B blockers (safe in 3rd trimester)
  • Methyldopa
  • Nifedipine
  • IV labetalol (avoid in asthma) or hydralazine
  • Magnesium sulphate
35
Q

Hypertension in pregnancy – contraindicated treatments:

A
  • ACE inhibitors and Angiotensin II receptor blockers (cross placenta: foetal hypotension, IUGR, renal dysgenesis, lung underdevelopment)
  • Diuretics
36
Q

Diabetes in pregnancy:

A

Metformin and insulin – safe

37
Q

Diabetes in pregnancy treatment to avoid:

A
  • Sulphonylureas – foetal hyperinsulinemia and hypoglycaemia
  • Steroids avoided
38
Q

Anaemia in pregnancy:

A
  • Iron deficiency (6-180mg elemental iron)
  • Megaloblastic anaemia (400-500mcg folate)
  • Sickle cell (folate supplements and transfusion at 6 week intervals)
39
Q

Thyroid disease in pregnancy:

A

Hypothyroid: levothyroxine safe
Hyperthyroid: radioactive therapy is contraindicated; Carbimazole and propylthiouracil -> cross placenta so use lowest dose

40
Q

Asthma in pregnancy:

A

Oral/IV corticosteroid + nebulised b2-agonist for exacerbations (Prednisolone preferred to corticosteroids for oral treatment)

41
Q

Which vaccinations to avoid in pregnancy?

A

Live vaccines, rubella vaccine, MMR, Polio

42
Q

Vaccines contraindicated in pregnancy:

A 
o	BCG vaccine
o	Measles vaccine
o	Rubella vaccine
o	Varicella vaccine
o	Vaccinia (pox) vaccine
o	HPV vaccine
43
Q

Recommended vaccinations in pregnancy:

A 
o	Inactivated influenza vaccine
o	Pertussis vaccine
o	Inactivated polio vaccine 
o	Diphtheria toxoid 
o	Tetanus toxoid
44
Q

Drugs to reduce vertical transmission in HIV:

A
  • Zidovudine

- Combination ART (Tenofovir DF/ Abacavir + Emtricitabine / Lamivudine)

45
Q

Pregnancy and HIV treatment:

A

Mother: combined ART (Tenofovir DF/ Abacavir + Emtricitabine / Lamivudine)
Baby: Low risk: Zidovudine PO until 6 weeks old OR High risk: Combination PEP

46
Q

Antipsychotics in pregnancy side effects:

47
Q

Least toxic antipsychotics in pregnancy:

A

Haloperidol, Olanzapine, Quetiapine, Risperidone

48
Q

TCAs in pregnancy side effects:

A

Imipramine: tachycardia, muscle spasms, respiratory distress

49
Q

SSRI/SNRI in pregnancy side effects:

A

Anencephaly, cardiovascular malformations, neonatal hypoglycaemia, persistent pulmonary hypertension

50
Q
A

Fluoxetine

51
Q

Lithium in pregnancy:

A

Teratogenic, cardiac abnormalities, goitre, hypotonia, DI

52
Q

Benzodiazepines in pregnancy:

A

Risk of cleft palate, neonatal withdrawal and hypotonia, and cardiac malformations

53
Q

Mifepristone

A

Anti-progestogenic steroid, sensitises myometrium to PGs, induces contractions and dilates the cervix – used in TOP

54
Q

Induction of labour drugs:

A
  • Vaginal prostaglandin (PGE2 or Dinoprostone): to induce labour in women with ‘favourable cervix’
  • Oxytocin (syntocinon) – slow IV infusion by syringe pump
55
Q

Anaesthetic agents

A
  • GA (Depress neonatal respiration if used in 3rd trimester)
  • Local anaesthetic (with large dose, respiratory depression, hypotonia, bradycardia)
  • Prilocaine and Procaine – neonatal methemoglobinemia
56
Q

Tocolytics:

A

Uterine relaxants/Labour suppressants: Delay of uncomplicated premature labour between 24 and 33+6 gestational weeks with intact membranes

57
Q

Contraindications for tocolytics:

A
  • Cardiac disease,
  • Foetal death
  • Antepartum haemorrhage
  • Cord compression
  • Placenta praevia
58
Q

Types of tocolytics:

A
  • Oxitocin receptor antagonist

- Nifedipine

59
Q

Ureterotonics:

A

Induce contraction or greater tonicity of the uterus. Used both to induce labour and to reduce postpartum haemorrhage

60
Q

Indications for ureterotonics:

A
  • Induction of labour
  • Management of 3rd stage of labour (prevention of PPH, uterine contractions post C-section)
  • Bleeding in spontaneous miscarriage
61
Q

Mechanism of action of uterotonics:

A

Contractions of fundus by acting on local oxytocin receptors

62
Q

Adverse effects of uterotonics:

A

Uterine spasm, nausea, vomiting, hypotension, tachycardia

63
Q

Contraindications:

A
  • Mechanical obstruction in pregnancy
  • Predisposition for uterine rupture
  • Foetal distress
64
Q

Drugs to supress lactation:

A
  • Cabergoline (same action, first line)

- Bromocriptine: dopamine receptor agonist (inhibits prolactin release)

65
Q

Contraindications for lactation suppression drugs:

A

Hypersensitivity, hypertension, coronary artery disease, or mental disorders

66
Q

Side effects of lactation suppression drugs:

A

Nausea, vomiting, constipation, headache, dizziness, postural hypotension, drowsiness, vasospasm

Obs and Gynae Y4 (22 decks)

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