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HLC A > A1 Pregnancy - minor ailments and drug use > Flashcards

A1 Pregnancy - minor ailments and drug use Flashcards

1
Q

what should always be considered before using any drugs during pregnancy?

A

benefits and risks should always be weighed up

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2
Q

what timescale of pregnancy is considered the first trimester?

A

1-12 weeks

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3
Q

what timescale of pregnancy is considered the second trimester?

A

13-27 weeks

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4
Q

what timescale of pregnancy is considered the third trimester?

A

28-40 weeks

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5
Q

when is start of pregnancy measured from and why?

A
  • from last day of last period
  • day of conception is too hard to measure
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6
Q

describe the pre-embryonic stage of development in pregnancy

A
  • first of 3 stages
  • 0-17 days
  • implantation of fertilised ovum occurs
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7
Q

describe the embryonic stage of development in pregnancy

A
  • second of 3 stages
  • 18-56 days
  • major organ system development and foetus starts to take on human shape
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8
Q

describe the foetal stage of development in pregnancy

A
  • third of 3 stages
  • 8-38 weeks
  • maturation, development and growth occurs
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9
Q

state some reasons why drugs are used in pregnancy generally (not health conditions drugs are used for)

A
  • woman may have taken medicines unaware they are pregnant
  • woman may want to get pregnant but need essential treatment for chronic condition
  • require treatment for a medical condition after knowing they are pregnant (eg. hypertension)
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10
Q

describe changes to absorption that occur in pregnancy

A
  • reduced gut motility
  • increased skin blood circulation
  • increased lung function
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11
Q

does having reduced gut motility in pregnant women significantly affect absorption of drugs?

A

not many consequences are seen due to this on drug uptake in the gut

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12
Q

describe changes to distribution that occur in pregnancy

A
  • reduced plasma proteins
  • increased plasma volume
  • increased body water
  • increased fat disposition
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13
Q

in pregnancy, there are reduced plasma proteins in the blood. what can this cause in regard to drugs?

A

decrease in binding of acidic drugs
eg. phenytoin

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14
Q

describe change to metabolism that occur in pregnancy

A

enzyme induction typically increased

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15
Q

enzyme induction is typically increased during pregnancy. what does this mean for drugs? what must be done to certain drugs?

A
  • effects on drugs difficult to predict
  • monitor drugs with narrow therapeutic range (eg. anti-epileptic drugs)
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16
Q

enzyme induction is typically increased during pregnancy, what does this mean for the use of methadone and phenytoin?

A

may need higher maintenance doses

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17
Q

enzyme induction is typically increased during pregnancy, what does this mean for the use of theophylline?

A

may need lower doses

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18
Q

describe changes to elimination that occur in pregnancy, give an example relating to 2 specific drugs

A
  • increased glomerular filtration
  • increased penicillin & digoxin elimination
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19
Q

definition of teratogenesis

A

an agent that directly or indirectly causes structural or functional abnormalities in the foetus, or child after birth, which may not become apparent until later life

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20
Q

state the 3 principles of teratogenesis

A
  • timing of exposure
  • differences in susceptibility
  • dose-response relationships
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21
Q

explain how timing of exposure to teratogens affects pregnancy if the timing is in the pre-embryonic phase

A
  • ‘all or nothing’ principle
  • either death of embryo of complete rejuvenation occurs
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22
Q

explain how timing of exposure to teratogens affects pregnancy if the timing is in the embryonic phase

A
  • greatest risk of major birth defects
  • risk posed depends on drugs taken
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23
Q

explain how timing of exposure to teratogens affects pregnancy if the timing is in the foetal phase

A
  • less susceptible to toxic effects but some structural / functional abnormalities and growth retardation
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24
Q

how can some drugs harm the foetus even if they don’t cross the placenta barrier? give an example

A

eg. insulin
- doesn’t cross the barrier but glucose does
- glucose concentration is dependent on insulin

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25
describe and explain the dose-response curves of teratogens and some general information on teratogenic effects
- teratogenic effects are dose-dependent - dose-response curve is steep - cumulative exposure of drug to foetus is important
26
explain what is meant by a steep dose-response curve
- small increase in dose can lead to big change in response from foetus
27
what drugs are most likely to cross the placenta?
- most drugs will cross - high molecular weight drugs won't - easier for lipid-soluble, unionised drugs to cross than polar, ionised drugs
28
examples of high molecular weight drugs that do not cross the placenta
insulin heparin
29
what advice on contraception should be given to men taking Finasteride?
finasteride is excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant
30
what advice on contraception should be given to men taking Griseofulvin?
- effective contraception required during and for at least 1 month after administration to women (oral methods can be made less effective so additional barrier methods are required) - men should avoid fathering a child during and for at least 6 months after administration
31
what issues can arise from maternal drug use in the latter stages of pregnancy?
- allergic drug reactions (rare) - reduced capacity for drug elimination (accumulation) - withdrawal effects
32
how are withdrawal effects minimised in neonates?
morphine oral solution used to wean babies off methadone
33
what may beta blockers induce in neonates?
neonatal hypoglycaemia
34
state some key principles for drug use in pregnancy
- consider non-drug treatment first - only use drugs when necessary - consider period of gestation - avoid new drugs - avoid polypharmacy - lowest effective dose for minimum time - don't use known teratogens - know what questions to ask - know where to look for info
35
pre-conception advice for women
- avoid all drugs, alcohol, herbal remedies, smoking and vitamin A products - folic acid daily supplementation - seek specialist advice for chronic illnesses requiring drug treatment
36
when should folic acid be taken surrounding pregnancy and when should a higher dose be taken?
- should be taken prior to conception and in the first 12 weeks of pregnancy - higher dose should be taken if the couple is at higher risk of having a baby with a neural tube defect
37
why may a couple be at a higher risk of having a baby with a neural tube defect?
- if either parents have a neural tube defect - if the woman is coeliac, diabetic or on antiepileptic medication
38
what is the OTC sale of medicines limited by in pregnancy?
limited by manufacturer's licensing restrictions
39
what is gastro-oesophageal reflux disease?
- minor ailment in pregnancy - burning or painful discomfort - reflux of stomach juices into lower oesophagus due to pressure of foetus on the stomach
40
dietary advice to help with gastro-oesophageal reflux disease in pregnancy?
- adopt healthy eating habits - eat smaller meals more frequently - avoid known irritants (chocolate, fatty or spicy foods, fruit juices, coffee, alcohol)
41
known irritants for gastro-oesophageal reflux disease in pregnancy
chocolate fatty or spicy foods fruit juices coffee alcohol
42
lifestyle advice to help with gastro-oesophageal reflux disease
- do not eat within 3 hours of going to bed - raising the head of the bed - avoid medicines if appropriate - stop smoking if possible
43
what particular medicines should be avoided if possible during pregnancy to reduce gastro-oesophageal reflux disease?
sedatives calcium channel antagonists antidepressants non-steroidal anti-inflammatory drugs
44
treatment options for gastro-oesophageal reflux disease in pregnancy
- antacids and alginates are recommended for mild symptoms that aren't controlled by lifestyle changes - if not adequately controlled with OTC or lifestyle advice, refer to GP who may prescribe PPI such as omeprazole
45
example of an alginate that can be given OTC to pregnant women suffering with gastro-oesophageal reflux disease
Gaviscon advance (R)
46
diet and lifestyle advice for constipation in pregnant women
- increase fluid intake - increase fibre intake - increased physical activity (in an appropriate manner for being pregnant)
47
how much fluid should a pregnant woman being having each day?
8-10 cups of water or non-caffeinated drinks each day
48
foods high in fibre
- wheat, oat or bran cereals - whole grain pasta, bread and rice - beans and lentils - fruit and veg
49
describe laxative choices in pregnancy
- 1st choice is Fybogel Hi-Fibre (R) - alternative is lactulose
50
treatment option for piles in pregnant women
topical haemorrhoids cream or ointment containing mild astringents or antiseptics eg. Anusol (R)
51
what must be obtained before a pregnant patient can get any OTC treatment for haemorrhoids?
a confirmed diagnosis from a GP or midwife
52
what products should only be used on piles in pregnant women if they have been prescribed by a doctor?
preparations containing anaesthetics or corticosteroids
53
diet and lifestyle advice for piles in pregnant women, explain this advice
- sufficient fibre and fluid intake - promotes soft stools
54
describe thrush in pregnant women and state the course of action
- more prevalent in pregnant women than the rest of the population - typically seen vaginally - all suspected thrush cases in pregnant women should be referred to GP
55
treatment options for thrush in pregnant women
- doctor may prescribe a topical antifungal which could be a cream or pessaries - if symptoms are unresponsive they may prescribe oral fluconazole
56
give an example of a topical antifungal drug a doctor may prescribe to a pregnant woman with thrush
clotrimazole
57
what advice should you give to pregnant women for inserting pessaries?
use fingers, not applicator applicator may cause damage to the cervix
58
why can only a doctor prescribe fluconazole to pregnant women for thrush?
it isn't licensed for use by pregnant women
59
overall course of action for a pregnant woman presenting with nausea and vomiting
- no licensed treatments in pregnant people - give lifestyle and diet advice and if it doesn't work they must be referred to a GP
60
lifestyle and diet advice for pregnant people presenting with nausea and vomiting
- drink plenty - rest and sleep - avoid triggers - eat small, frequent, protein-rich meals, low in carbs and fat - avoid drinking cold, tart or sweet beverages - eat plain biscuits about 20 minutes before getting up - acupressure to the wrist (eg. anxiety wristbands) - ginger
61
red flags to look for pregnant women presenting with nausea and vomiting
- very dark urine or no urination for more than 8 hours - abdominal pain or fever - severe weakness or feeling faint - vomiting blood - repeated, unstoppable vomiting - inability to keep down food or fluids for 24 hours
62
only pharmacological treatment for pain in pregnant women
- restricted to paracetamol only - only take if needed
63
non-pharmacological treatment for pain in pregnancy
- exercise / physiotherapy - TENS (transcutaneous electrical nerve stimulation)
64
when can TENS be used for pain in pregnant women?
early stages of labour
65
why are pregnant women restricted to paracetamol only as a pharmacological treatment for pain?
ibuprofen and aspirin are not licensed for during pregnancy
66
non-pharmacological advice for a pregnant woman with hay fever
- wash clothes after being outside - shut windows - vaseline round nose to catch pollen
67
advice on decongestants in pregnant women struggling with hay fever
- avoid them - could reduce blood flow in the placenta and baby alongside the nasal membranes of the mother (proper function)
68
if non-pharmacological advice for pregnant woman suffering with hay fever didn't work, what is the course of action?
- Loratadine and Cetirizine are the most often prescribed tablets - there is no evidence to show they can't be used in pregnancy it in the BNF it says manufacturer advises to avoid use (they don't want to be blamed)

HLC A (5 decks)

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