3: Prescribing in pregnancy

Question 1

Which anti-emetic drug, given in the 1960s, causes birth defects?

Answer 1

Thalidomide

Question 2

What is the rate of miscarriage in the general population?

Answer 2

25% of women will have a miscarriage during their lifetimes

Question 3

Should pregnant woman not take any drugs?

Answer 3

Need to weigh benefits vs risks

Question 4

What alternative therapies could you consider instead of prescribing a drug for a pregnant woman?

Answer 4

Physiotherapy

CBT

etc.

Question 5

Most drugs (are / aren’t) licensed for use in pregnant women.

Answer 5

aren’t licensed

Question 6

What are the principles of prescribing in pregnancy?

Answer 6

Benefit > Risk

Low dose monotherapy

Consider interactions

Consider breastfeeding

Avoid high risk drugs e.g warfarin

Question 7

Does warfarin cross the placenta?

Answer 7

Yes

And it’s teratogenic

Question 8

Does heparin cross the placenta?

Answer 8

No

And it isn’t teratogenic

Question 9

What common condition in pregnancy may affect the absorption of a drug?

Answer 9

Morning sickness

Question 10

Women tend to (gain / lose) weight during pregnancy.

Answer 10

gain weight

affecting the drug’s volume of distribution

Question 11

What doses of folic acid are given to

a) low risk
b) high risk

women before and during pregnancy?

Answer 11

a) 400 micrograms
b) 5 milligrams

Question 12

Which cholesterol-lowering drugs cause birth defects?

Answer 12

Statins

Question 13

What are some examples of chronic conditions which women may have before pregnancy?

Answer 13

Asthma

Epilepsy

Cardiovascular disease (e.g high cholesterol, HTN)

Diabetes

Rheumatoid arthritis

Question 14

During which period is a foetus at greatest risk of harm from drugs?

Answer 14

1st trimester

0 - 12 weeks

Question 15

At which point in gestation do women usually realise they’re pregnant?

Answer 15

4 weeks

i.e they’ve been taking the teratogenic drug(s) without knowing they’re pregnant

Question 16

Which teratogenic drugs are used in hypertension and cause renal hypoplasia?

Answer 16

ACE inhibitors

ARBs

Question 17

Which drug, used in RA, causes birth defects?

Answer 17

Methotrexate

Question 18

Which drugs, used in severe acne, cause birth defects?

Answer 18

Retinoids

Question 19

Which drugs cause respiratory depression and sedation in newborns?

Why might they be prescribed?

Answer 19

Opioids

Maternal pain relief

Question 20

Apart from respiratory depression, what might be seen in newborn babies whose mothers have been taking opioids?

Answer 20

Withdrawal

Question 21

Pregnancy and its associated symptoms can lower the ___ ___ in epilepsy.

Answer 21

seizure threshold

Question 22

Which anti-epileptic drugs should be avoided in pregnancy?

Answer 22

Sodium valproate

Phenytoin - terminates status epilepticus

Question 23

What dose of folic acid should a woman with epilepsy receive during pregnancy?

Why?

Answer 23

5 milligrams

All anti-epileptic drugs have possibility of causing neural tube defects

Question 24

What percentage of women on anti-epileptics don’t suffer foetal abnormalities?

Answer 24

96%

Question 25

**\_\_\_** control of diabetes may cause birth defects.

Answer 25

**Poor control**

Question 26

Which drug used in **diabetes** is contraindicated in pregnancy?

Answer 26

**Sulphonylureas** so gliclazide

Question 27

Which drugs, used in adult hypertension, should be avoided in pregnancy?

Answer 27

**ACE inhibitors** **ARBs**

Question 28

Which drugs are used to treat **pregnancy-induced hypertension?**

Answer 28

**Methyldopa** **Labetalol** **Nifedipine**

Question 29

**ACEIs and ARBs** cause what kind of birth defect?

Answer 29

**Renal hypoplasia / absence**

Question 30

Which **anti-emetic** is given first line for morning sickness?

Answer 30

**Cyclizine**

Question 31

How is **VTE** prevented in pregnant women?

Answer 31

**Stay mobile** **Stay hydrated** ***If fulfilling risk factors: LMWH e.g dalteparin +/- low dose aspirin***

Question 32

Which anticoagulant drug is **contraindicated** in pregnancy?

Answer 32

**Warfarin**

Question 33

Which anticoagulant drug should be used instead of warfarin in pregnancy?

Answer 33

**LMWH** e.g dalteparin

Question 34

Which antibiotic stains the teeth of young children?

Answer 34

**Tetracycline**

Question 35

Which anti-epileptic drug causes cleft lip and palate?

Answer 35

**Phenytoin**

Question 36

Which anti-epileptic drug is highly associated with spina bifida and anencephaly?

Answer 36

**Sodium valproate**

Question 37

What are some examples of **cytotoxic** drugs used to treat rheumatic diseases?

Answer 37

**Azathioprine** **Cyclophosphamide** **Methotrexate** they're all teratogenic

Question 38

Which **mood stabiliser** is teratogenic?

Answer 38

**Lithium**