11. Prescribing in Pregnancy Flashcards
Pharmacokinetics in pregnancy
- 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)
Pre-implantation period development:
2 weeks post conception – ‘All or none effect’
Embryonic period development:
3rd -7th week (Day 18-55) post conception – problems in organogenesis causing permanent anatomical defects
Foetal period development
8th week post conception to birth – growth and functional maldevelopment
Shortly before term development:
Adverse effects on labour or neonate
Drugs causing anatomical defects:
Alcohol, lithium, phenytoin, tetracycline, thalidomide, warfarin, isotretinoin, danazol
Phenytoin effect on foetus:
- Cleft palate
Tetracycline
- Teeth staining
Thalidomide
- Embryopathy
Folate antagonist drugs
Anticonvulsants, methotrexate, sulfasalazine,
Neural crest cell disruption drugs
Retinoids
Oxidative stress-causing drugs
Thalidomide, anticonvulsants, anti-arrhythmic
Vascular disruption-causing drugs
Misoprostol, aspirin, ergotamine
Receptor or Enzyme-mediated teratogenesis
NSAID, statins, ACE inhibitors, Angiotensin II receptor blockers
Drug abuse: tobacco
- IUGR
- Placenta praevia, placental abruption, ectopic pregnancy, PPROM
Drug abuse alcohol
- FAS (mental and growth retardation)
- Spontaneous miscarriage in 1st trimester
Drug abuse: cocaine
- Vasoconstrictor
- Placental abruption, growth and mental retardation, spontaneous miscarriage
Drug abuse: heroin or opiates
- Vasoconstrictor
- Spontaneous miscarriage, growth retardation, placental abruption
- Neonatal withdrawal symptoms
- Respiratory depression
Ecstasy and LSD:
- No withdrawal but delayed neonatal development
Anti-emetics in pregnancy:
Safe: Prochlorperazine, Ondansetron, Metoclopramide, Domperidone, Cyclizine
SE: drowsiness, muscle spasm
Hyperemesis gravidarum treatment:
Anti-emetics + Thiamine 1.5mg OD + Prednisolone 16mg OD + Parental fluids
Antacids in pregnancy :
Simple (Ca, Mg, Aluminium)
H2 blockers: Cimetidine, Ranitidine
PPI: Omeprazole
Analgesics in pregnancy:
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
Laxatives in pregnancy:
- Lactulose, Glycerine suppositories: not absorbed, safe
Laxatives to avoid in pregnancy:
Senna, bisacodyl (cause contractions), purgatives with Mg, Na – cause electrolyte imbalance
Antifungals in pregnancy:
Topical (safe as pessaries or creams): Clotrimazole, Econazole