Drugs and vaccines in pregnancy

Question 1

what is a teratogen ?

Answer 1

is an agent that acts during fetal development to produce permanent alterations of form or function

Question 2

at what time during pregnancy is it most common for fetal abnormalities to happen ?

Answer 2

1st trimester

Question 3

what type of drugs are completely contraindicated in pregnancy ?

Answer 3

category X medications 
anticancer chemotherapy ( methotrexate)
immunosuppressants (mycophenolate)
radioactive chemicals ( iodine 131)
isoretinon
if really needed termination of pregnancy is indicated

Question 4

what system is currently used to categorize drugs inn pregnancy ?

Answer 4

PLLR

Pregnancy and lactation labelling rule

Question 5

what drugs are contraindicated during lactation ?

Answer 5

metronidazole
tetracycline
amiodarone
erotamine

Question 6

what type of vaccines are contraindicated in pregnancy ?

Answer 6

live attenuated vaccines

Question 7

what are examples of live attenuated vaccines ?

Answer 7

MMR
BCG
Varicella

Question 8

for each pregnancy which vaccine is recommended and when ?

Answer 8

influenza shot is recommended at any time during the pregnancy
whooping cough TDaP vaccine is recommended in the 3rd trimester

Question 9

which group of anti-hypertensive drug should be avoided in pregnancy ?

Answer 9

ACE inhibitors

Question 10

are there any contraindicated vaccines during breastfeeding ?

Answer 10

no contraindications

Question 11

what is analgesia ?

Answer 11

loss of pain without loss of motor function or consciousness

Question 12

what are the causes of pain during the first stage of labour ?

Answer 12

stretch of the cervix during dilation

distention and ischaemia of uterine muscle with buildup of lactate

Question 13

what are the causes of pain during the second stage of labour ?

Answer 13

stretch of the vagina and perineum

Question 14

what is pain perception influenced by ?

Answer 14

expectations
age
preparation
emotional support

Question 15

what narcotic/opioid is given before labour ?

Answer 15

Meperidine hydrochloride (pethidine)

Question 16

what can be given alongside pethidine to improve its effect ?

Answer 16

an anti-emetic ( promethazine)

Question 17

what is the antidote to all narcotics ?

Answer 17

naloxone

Question 18

what indications involving time must be taken into consideration when administering pethidine ?

Answer 18

must be given only when delivery is expected to happen in more than 2 hours to avoid respiratory depression in the newborn

Question 19

what is the problem with the use of Nulufin as an opioid ?

Answer 19

no antidote

Question 20

what is the problem with using Morphine sulphate ?

Answer 20

higher association with respiratory depression

Question 21

what route of analgesia can be given after labour ?

Answer 21

PCA

Question 22

what does PCA consist of ?

Answer 22

a mixture of opioids, steroids, anti-emetics and PPIs

Question 23

what are the different types of local analgesia ?

Answer 23

local infiltration anesthesia
pudendal nerve block
paracervical block

Question 24

what is TAP block ?

Answer 24

transversus abdominal plane block ultrasound

Question 25

what level does TAP block ?

Answer 25

blocks T10,11,12 intercostal, subcostal nerves , illioinguinal and illohypogastric nerves

Question 26

what is TAP most effective in ?

Answer 26

post-operative pain

Question 27

what are the non-pharmacological methods of pain relief ?

Answer 27

``` TENS Acupuncture Stretching and manipulation Cognitive behaviour therapy Warm water baths ```

Question 28

when is general anesthesia used ?

Answer 28

cesarian section repair of 4th degree perineal tears instrumental delivery manual removal of the placenta

Question 29

what instructions should be given tot he patient before undergoing general anesthesia ?

Answer 29

fast for 6-8 hours

Question 30

what are examples of IV anesthetics and hypnotics that are used in general anesthesia ?

Answer 30

ketamine ( ketalar) propofol (diprivan) thiopental (intraval)

Question 31

what is the difference between epidural and spinal anesthesia ?

Answer 31

epidural is injected at the epidural space | spinal is injected in the subarachnoid space

Question 32

what is the problem with using epidural ?

Answer 32

can prevent straining (7az2)

Question 33

what kind of nerve block would be used during abortions ?

Answer 33

saddle block

Question 34

what is safer to use during CS general or spinal anesthesia ?

Answer 34

spinal anesthesia

Question 35

what is the preferred method of analgesia inn vaginal delivery ?

Answer 35

epidural analgesia

Question 36

what are the drug categories during pregnancy ?

Answer 36

``` category A - safe Category B - no evidence of risk k Category C - risk cannot be ruled out Category D - positive evidence of risk Category X - contraindicated inn pregnancy ```