Drugs and vaccines in pregnancy Flashcards
what is a teratogen ?
is an agent that acts during fetal development to produce permanent alterations of form or function
at what time during pregnancy is it most common for fetal abnormalities to happen ?
1st trimester
what type of drugs are completely contraindicated in pregnancy ?
category X medications anticancer chemotherapy ( methotrexate) immunosuppressants (mycophenolate) radioactive chemicals ( iodine 131) isoretinon if really needed termination of pregnancy is indicated
what system is currently used to categorize drugs inn pregnancy ?
PLLR
Pregnancy and lactation labelling rule
what drugs are contraindicated during lactation ?
metronidazole
tetracycline
amiodarone
erotamine
what type of vaccines are contraindicated in pregnancy ?
live attenuated vaccines
what are examples of live attenuated vaccines ?
MMR
BCG
Varicella
for each pregnancy which vaccine is recommended and when ?
influenza shot is recommended at any time during the pregnancy
whooping cough TDaP vaccine is recommended in the 3rd trimester
which group of anti-hypertensive drug should be avoided in pregnancy ?
ACE inhibitors
are there any contraindicated vaccines during breastfeeding ?
no contraindications
what is analgesia ?
loss of pain without loss of motor function or consciousness
what are the causes of pain during the first stage of labour ?
stretch of the cervix during dilation
distention and ischaemia of uterine muscle with buildup of lactate
what are the causes of pain during the second stage of labour ?
stretch of the vagina and perineum
what is pain perception influenced by ?
expectations
age
preparation
emotional support
what narcotic/opioid is given before labour ?
Meperidine hydrochloride (pethidine)
what can be given alongside pethidine to improve its effect ?
an anti-emetic ( promethazine)
what is the antidote to all narcotics ?
naloxone
what indications involving time must be taken into consideration when administering pethidine ?
must be given only when delivery is expected to happen in more than 2 hours to avoid respiratory depression in the newborn
what is the problem with the use of Nulufin as an opioid ?
no antidote
what is the problem with using Morphine sulphate ?
higher association with respiratory depression
what route of analgesia can be given after labour ?
PCA
what does PCA consist of ?
a mixture of opioids, steroids, anti-emetics and PPIs
what are the different types of local analgesia ?
local infiltration anesthesia
pudendal nerve block
paracervical block
what is TAP block ?
transversus abdominal plane block ultrasound
what level does TAP block ?
blocks T10,11,12 intercostal, subcostal nerves , illioinguinal and illohypogastric nerves
what is TAP most effective in ?
post-operative pain
what are the non-pharmacological methods of pain relief ?
TENS Acupuncture Stretching and manipulation Cognitive behaviour therapy Warm water baths
when is general anesthesia used ?
cesarian section
repair of 4th degree perineal tears
instrumental delivery
manual removal of the placenta
what instructions should be given tot he patient before undergoing general anesthesia ?
fast for 6-8 hours
what are examples of IV anesthetics and hypnotics that are used in general anesthesia ?
ketamine ( ketalar)
propofol (diprivan)
thiopental (intraval)
what is the difference between epidural and spinal anesthesia ?
epidural is injected at the epidural space
spinal is injected in the subarachnoid space
what is the problem with using epidural ?
can prevent straining (7az2)
what kind of nerve block would be used during abortions ?
saddle block
what is safer to use during CS general or spinal anesthesia ?
spinal anesthesia
what is the preferred method of analgesia inn vaginal delivery ?
epidural analgesia
what are the drug categories during pregnancy ?
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
