drug use in pregnancy- chronic conditions

Question 1

what considerations should you have when prescribing/choosing medication for pregnant women?

Answer 1

-risk of discontinuation symptoms
use for the shortest possible time
-use lowest effective dose
-risk/benefit
-stage of pregnancy
-non-pharmacological alt
-safety of drugs
-patient preference
-how to minimise potential adverse effects

Question 2

what is used to treat depression in pregnant women?

Answer 2

CBT-fluoxetine-lowest dose for shortest time
tricyclic antidepressants
SSRI’s- not in first trimester- firsk of HPT/ foetal heart/ withdrawl effects can occur
venlafaxine- short half life/ withdrawl effects can occur
non-pharmacological would be best

Question 3

what is used to treat pregnant women with schizophrenia?

Answer 3

• Antipsychotics- may cause gestational diabetes/ excess weight
• Raised prolactin levels- some e.g. amosoldaride can reduce their ability to conceve
• Clozapine- requires specalist impute due to risk of granulcytosis
• Olanzapine- risk of weight gain/ diabetes
• Lithium- avoid in first trimester- if already on- reduce over 4 weeks and switch onto alt agent
• Valproate- avoid in child baring age

Question 4

how would one medications differ with severiity?

Answer 4

mild- withdraw, monitor and CBT
moderate- VBT
severe- CBT and low dose of medication

Question 5

what medication is given to pregnant women for bipolar disorder?

Answer 5

quetiapine
risperidone
pregnant women should not be given depo injections

Question 6

what is the risks associated with a mother who is epleptic to the baby?

Answer 6

10% have congenital malformations

increased risk of NTD ( neural tube defects)- 5mg folic acid daily

Question 7

when can a pregnant women be taken off her epleptic medication?

Answer 7

if seizure free for 2 years- may be safe to taper down and withdraw medication
need to make sure they are stable without medication
withdrawn over 6 month period
consider risk/benefit

Question 8

what is ideally recommended when treating pregnant women in eplipsy?

Answer 8

avoiding multiple agents where possible
monotherapy with most effective medication at the lowest dose
avoid the use of sodium valporate
higher doses of folic acid
dose adjustments in each trimester
avoid combination products

Question 9

what happens if a person is taking valporate and pregnant?

Answer 9

they should be informed of the risks
they should carry a valporate card at all times
they should be given a PIL
may also be used for migrane/ menatl health- both still not recommended
asked to do pregnancy tests regularly

Question 10

what are the 3 highly effectve methods of contraception?

Answer 10

long-acting reversible contraception
copper intra-uterine device
progesterone-onlt implant

Question 11

how is hypothyroidism managed during pregnancy?

Answer 11

–Ideally -optimal control prior to pregnancy–Dose adjustments likely to be required–Monitoring

Question 12

how is hyperthyroidism managed during pregnancy?

Answer 12

–Monitoring
–Propylthiouracil
–Carbimazole

Question 13

what are people with diabetes mellitus at developing?

Answer 13

NTD- give 5mg folic acid
–Miscarriage
–Pre-eclampsia
–Pre-term labour

Question 14

if a pregnant women has diabetes how should she be treated?

Answer 14

May be advised to use metformin as an adjunct or alternative to insulin

Question 15

is insulin safe for use in pregnancy?

Answer 15

yes
rapid acting
isophane -NPH insulin
insufficent evidence for use in long acting insulin
does not cross placenta

Question 16

what other considerations should be made for comorbidities associated with diabetes in pregnant women?

Answer 16

ACE inhibitors and ARBs
•Hypertension
•Slow progression of nephropathy
•Discontinue before pregnancy or ASAP after confirmed–

Statins
•Discontinue before pregnancy or ASAP after confirmed

Question 17

if someone has hypertension how should they be managed in pregnancy?

Answer 17

Pre-pregnancy advice
•Specialist referral
•Lifestyle
•Weight management
•Exercise
•Healthy eating
•Restrict sodium intake
•Review medication
•ACE inhibitors/ARBs
•Thiazide and thiazide-like diuretics
•Target BP•<135/85 mmHg

Question 18

what are the treatment options for hpt in pregnancy?

Answer 18

• Labetalol
• Nifedipine
• Methyldopa

Question 19

what postnatal care should be done with hpt?

Answer 19

• Monitor BP after birth
• Target <140/90 mmHg
• Review antihypertensive treatment

Question 20

what are the drugs that are safe to use for asthma during pregnancy?

Answer 20

•Beta 2 agonists
•Inhaled steroids
•Oral steroids
Prednisolone is the preferred oral corticosteroid

Question 21

how should one stay well during pregnancy if they have asthma?

Answer 21

–Stop smoking–Flu vaccination–Asthma review–Medication adherence

Question 22

why is the first trimester important for a baby if a woman has a thyroid disorder?

Answer 22

as the babys thyroid is not developed so is dependent on the mother
may require an extra 25-50mg/day

Question 23

how is hyperthyroidism treated per trimester?

Answer 23

• Propylthiuracil- first trimester
• Carbimazole- from second trimester
• Block thyroid and switch to maintenance dose
• Lowest dose of single agent as less likely to cross placenta