12. Prescribing in pregnancy – scenarios

Question 1

Nausea medications:

Answer 1

1st Line: Cyclizine, Prochlorperazine, Promethazine, Chlorpromazine
2nd Line: Metoclopramide, Domperidone, Ondansetron

Question 2

Antifungals in pregnancy:

Answer 2

Topical: ‘imidazoles’ clotrimazole, econazole
- Safe to use as pessaries or creams
Systemic antifungals: fluconazole, griseofulvin, terbinafine
- Hepatotoxic, teratogenic, increases miscarriage (avoid pregnancy for 6 moths)

Question 3

Hypertension and pre-eclampsia in pregnancy

Answer 3

• Methyldopa
• B blockers (safe in 3rd trimester)
• Nifedipine (modified release)

Question 4

Hypertensive crisis in pregnancy:

Answer 4

• IV labetalol (avoid in asthmatics) or hydralazine

- Magnesium sulphate

Question 5

Hypertension in pregnancy – contraindicated drugs:

Answer 5

ACE inhibitors, Angiotensin II receptor antagonists

-Both cross placenta quickly, cause lung underdevelopment, IUGR, foetal hypotension

Question 6

Diabetes diagnosis in pregnancy:

Answer 6

Fasting plasma glucose >7 without symptoms or complications, or 6.0-6.9 with symptoms (macrosomia, hydramnios)

Question 7

Warfarin in pregnancy:

Answer 7

1st trimester – embryopathy, midface and nasal hypoplasia

2nd & 3rd trimester – risk of foetal haemorrhage so must be carefully titrated

Question 8

Epilepsy drugs increasing NTD risk:

Answer 8

Valproate, Topiramate, Phenytoin, Oxcarbazepine

Question 9

Safe epilepsy drugs in pregnancy:

Answer 9

Lamotrigine and carbamazepine

Question 10

HIV treatment in pregnancy:

Answer 10

24 weeks until after the pregnancy
Zidovudine (AZT)
Combination (ART)