Drugs Flashcards
Paroxetine
Fetal cardiac abnormalities
SSRIs e.g. fluoxetine, sertraline
Persistent pulmonary hypertension of the newborn, PPH
Dolutegravir
Neural tube defect
Anti-HIV drug, CI in pregnancy
efavirenz or atazenavir preferred
NSAIDs?
Avoid after 30w
Neonatal pulmonary HTN and premature closure of ductus arteriosus
Oligohydramnios
Phenytoin
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
Sodium valproate
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
Lamotrigine
safe in pregnancy
but 2% risk of cardiac defects, facial clefts
Levetiracetam
SAFE in preg
but 1% risk of cardiac defects, NTDs
Topimarate
anti-epileptic
Avoid in pregnancy, safe in BF
5% risk of cardiac defects, facial clefts, hypospadias
Lithium
Cardiac malformations inc Ebsteins anomaly
Maternal diabetes insipidus
If lithium continued in pregnancy, how to manage?
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
Sulfasalazine?
Can be used in pregnancy
Avoid high doses due to risk of fetal nephrotoxicity
Watch for infant diarrhoea
Azathioprine?
Safe in pregnancy
Fetus cannot convert to active form
Tacrolimus
Avoid in pregnancy
Unless refractory/emergency colitis
Mycofenalate mofetil
Assoc with congenital abnormalities and miscarriage
Carbamazepine
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
Signs of lithium toxicity
confusion, hypotension, hyperthermia, seizures, abnormal movements
Which psych drugs increase risk of GDM?
second gen antipsychotics - olanzapine, quetiapine
Olanzapine?
Agranulocytosis, myocarditis
Increased risk GDM, fetal macrosomia, weight gain
Used for refractory schizophrenia
Retinoids?
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
Nifedipine is contraindicated when?
severe aortic stenosis - vasodilates
Drug treatment for idiopathic intracranial hypertension?
Acetazolamide - decreases fluid production in the brain
Xonvea is…
doxylamine/pyridoxine
Benzos?
cleft palate, floppy baby syndrome
