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

Question 4

NSAIDs?

Answer 4

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

Question 5

Phenytoin

Question 6

Sodium valproate

Answer 6

10% risk of major congenital abnormalities inc NTDs
30-40% risk of neurodevelopmental disorders

IF on - high dose folic acid, FM USS

Question 7

Lamotrigine

Answer 7

safe in pregnancy

Question 8

Levetiracetam

Question 9

Lithium

Answer 9

Cardiac malformations inc Ebsteins anomaly
Maternal diabetes insipidus

Question 10

If lithium continued in pregnancy, how to manage?

Answer 10

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 11

Sulfasalazine?

Answer 11

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

Question 12

Azathioprine?

Answer 12

Safe in pregnancy
Fetus cannot convert to active form

Question 13

Tacrolimus

Answer 13

Avoid in pregnancy
Unless refractory/emergency colitis

Question 14

Mycofenalate mofetil

Answer 14

Assoc with congenital abnormalities and miscarriage

Question 15

Carbamazepine

Answer 15

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 16

Signs of lithium toxicity

Answer 16

confusion, hypotension, hyperthermia, seizures, abnormal movements

Question 17

Which psych drugs increase risk of GDM?

Answer 17

second gen antipsychotics - olanzapine, quetiapine

Question 18

Olanzapine?

Answer 18

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