Drugs

Question 1

Paroxetine

Answer 1

Fetal cardiac abnormalities

Question 2

SSRIs e.g. fluoxetine, sertraline

Answer 2

Persistent pulmonary hypertension of the newborn, PPH

Question 3

Dolutegravir

Answer 3

Neural tube defect
Anti-HIV drug, CI in pregnancy
efavirenz or atazenavir preferred

Question 4

NSAIDs?

Answer 4

Avoid after 30w
Neonatal pulmonary HTN and premature closure of ductus arteriosus
Oligohydramnios

Question 5

Phenytoin

Answer 5

heart defects, cleft palate, microcephaly, coagulopathy

Causes fetal hydantion syndrome which should be more appropriately called fetal anti-epileptic drug syndrome.

Major anomalies include heart defects, cleft lip or palate, skeletal malformations, and microcephaly. Minor malformations, including strabismus, hypertelorism, distal digital hypoplasia, nail hypoplasia, clubfoot, and abnormal dermatoglyphic patterns.

Coagulopathy occurs in ~50% of babies born to mothers on phenytoin - deficiency of vitamin K dependent clotting factors - very few of these babies are symptomatic

Question 6

Sodium valproate

Answer 6

10% risk of major congenital abnormalities inc NTDs, hypospadias, facial clefts
30-40% risk of neurodevelopmental disorders

IF on - high dose folic acid, FM USS

Question 7

Lamotrigine

Answer 7

safe in pregnancy
but 2% risk of cardiac defects, facial clefts

Question 8

Levetiracetam

Answer 8

SAFE in preg
but 1% risk of cardiac defects, NTDs

Question 9

Topimarate

Answer 9

anti-epileptic
Avoid in pregnancy, safe in BF
5% risk of cardiac defects, facial clefts, hypospadias

Question 10

Lithium

Answer 10

Cardiac malformations inc Ebsteins anomaly
Maternal diabetes insipidus

Question 11

If lithium continued in pregnancy, how to manage?

Answer 11

Check plasma lithium 4 weekly, then weekly from 36th week
Adjust dose to therapeutic range
Check plasma levels in labour and ensure hydration
Stop lithium in labour
Monitor baby (sedation/hypotonia) and check lithium levels in baby
Avoid breastfeeding
Avoid nephrotoxins

Question 12

Sulfasalazine?

Answer 12

Can be used in pregnancy
Avoid high doses due to risk of fetal nephrotoxicity
Watch for infant diarrhoea

Question 13

Azathioprine?

Answer 13

Safe in pregnancy
Fetus cannot convert to active form

Question 14

Tacrolimus

Answer 14

Avoid in pregnancy
Unless refractory/emergency colitis

Question 15

Mycofenalate mofetil

Answer 15

Assoc with congenital abnormalities and miscarriage

Question 16

Carbamazepine

Answer 16

Major congenital defects including NTDs
Can interfere with vit-K dependent clotting pathway - fetus should have vit K, mum should have active management 3rd stage

Question 17

Signs of lithium toxicity

Answer 17

confusion, hypotension, hyperthermia, seizures, abnormal movements

Question 18

Which psych drugs increase risk of GDM?

Answer 18

second gen antipsychotics - olanzapine, quetiapine

Question 19

Olanzapine?

Answer 19

Agranulocytosis, myocarditis
Increased risk GDM, fetal macrosomia, weight gain
Used for refractory schizophrenia

Question 20

Retinoids?

Answer 20

CNS – hydrocephalus, cortical blindness, nerve palsies and micro-ophthalmia
Craniofacial – microcephaly, micrognathia, low set ears, triangular skull
CVS – tetralogy of Fallot, transposition of the great vessels, VSD & ASD
Thymic defects

Question 21

Nifedipine is contraindicated when?

Answer 21

severe aortic stenosis - vasodilates

Question 22

Drug treatment for idiopathic intracranial hypertension?

Answer 22

Acetazolamide - decreases fluid production in the brain

Question 23

Xonvea is…

Answer 23

doxylamine/pyridoxine

Question 24

Benzos?

Answer 24

cleft palate, floppy baby syndrome

Question 25

Treatment with ursodeoxycholic acid is associated with

Answer 25

Reduction in spontaneous preterm birth under 37 weeks
Does not impact SB rate, therefore not routinely offered

Question 26

First line treatment for cerebral sinus thrombosis?

Answer 26

IV heparin

Question 27

MgS antidote is…

Answer 27

10 ml 10% calcium gluconate given by slow intravenous injection

Question 28

Treatment for acute local anaesthetic toxicity?

Answer 28

Stop local anaesthetic
Give intralipid

Question 29

What test to use to confirm CAH? (high testosterone and 17 OHP)

Answer 29

ACTH stimulation test

Question 30

Warfarin

Answer 30

fetal warfarin syndrome - nasal hypoplasia, skeletal abnormalities - short limbs, stippled epiphyses

Question 31

Naloxone dose in opioid toxicity?

Answer 31

400ucg IV
then 800ucg IV at 1 min intervals if no response (max 2 doses)
then 2mg IV

Question 32

Dolutegravir HIV medication is associated with?

Answer 32

Neural tube defects

Question 33

First line anti-hypertensive for black women post-natally?

Answer 33

Nifedipine
Or amlodipine if previously used