Drugs in Pregnancy

Question 1

What does a teratogen cause?

Answer 1

•abnormality within the baby following fetal exposure during pregnancy

Question 2

When is the most vunerable part of pregnancy for teratogens?

Answer 2

First half of pregnancy is the most vulnerable- affect embryogenesis

Question 3

What are some preventable teratogens?

Answer 3

• Alcohol- fetal alcohol syndrome
• Smoking- low birth weight, preterm birth, cerebral palsy, learning difficulties
• Marijuana, ecstacy, cocaine- low birth weight, withdrawl symptoms, learning and behavioural problems

Question 4

What are pharmacokinetics?

Answer 4

• What the body does to a drug
• Movement of the drug through, and out of the body
• the time course - absorption, bioavailability, distribution, metabolism, and excretion.

Question 5

What are pharmacodynamics?

Answer 5

• What the drug does to the body
• Biochemical /physiologic/ molecular effects of drugs on body
• Receptor binding/post receptor effect

Question 6

Normal physiologic changes in pregnancy lead to what?

Answer 6

Alteration in the pharmacokinetics of the drug and may affect the pharmacodynamics

Question 7

What did thalidomide cause?

Answer 7

Phocomelia

Question 8

What drugs can be used to treat nausea and vomiting during pregnancy?

Answer 8

• Cyclizine- antihistamine
• Prochloroperazine- phenothiazine
• doxylamine/pyridoxine combination product (Xonvea®) was licensed for the treatment of NVP in the UK in 2018 and can also be offered as a first-line option.
• Second line- ondansetron, metoclopramide

Question 9

What drugs can be used to treat hypertension during pregnancy?

Answer 9

•Labetolol, nifedipine, methyldopa, hydralazine

Question 10

What are teratogenic hypertension medications?

Answer 10

ACE inhibitors, angiotensin receptor antagonist – change as soon as pregnancy confirmed

Question 11

What are some safe epilepsy drugs during pregnancy?

Answer 11

Carbamazepine and lamotrigine-

Question 12

What are some epilepsy medication teratogens during pregnancy?

Answer 12

• Phenobarbitone- cardiac malformations
• Sodium valproate- NTD, facial clefts

Question 13

What should always be given in an epileptic pregnancy?

Answer 13

High dose folic acid

Question 14

What are the NICE guidelines for diabetes during pregnancy?

Answer 14

All oral antidiabetic drugs, except metformin hydrochloride, should be discontinued before pregnancy (or as soon as an unplanned pregnancy is identified) and substituted with insulin therapy.

Women with diabetes may be treated with metformin hydrochloride [unlicensed in type 1 diabetes] as an adjunct or alternative to insulin in the preconception period and during pregnancy, when the likely benefits from improved blood-glucose control outweigh the potential for harm.

Metformin hydrochloride can be continued, or glibenclamide resumed, immediately after birth and during breast-feeding for those with pre-existing Type 2 diabetes.

All other antidiabetic drugs should be avoided while breast-feeding.

Question 15

What is safe treatment for thromboembolism during pregnancy?

Answer 15

Low molecular weight heparin (LMWH)

Question 16

What does warfarin do during pregnancy?

Answer 16

•fetal warfarin syndrome/fetal embryopathy

Question 17

What is important with pregnancy and asthma?

Answer 17

•Risk of medication use are lower than risk of untreated asthama

Question 18

What is safe to use to treat asthma during pregnancy?

Answer 18

B2 agonist- albuterol, salbutamol

Question 19

What are some teratogenic treatments for asthma?

Answer 19

Theophyline- potential toxicity

•Systemic corticosteroid- severe asthama

Question 20

What is a medication for headaches that can have teratogenic effects?

Answer 20

•Ibuprofen- persistent pulm hypertension- avoid in 3rd trimes

Question 21

What is the effect of morphine based medicine during pregnancy?

Answer 21

• No increase in congenital abnormalities
• Risk of neonatal respiratory depression and with drawl
• Used as labour analgesia

Question 22

When should you avoid codenine?

Answer 22

During lactation- infant opiate toxicity

Question 23

What is important about SSRIs in pregnancy?

Answer 23

•Where the benefits of SSRI use outweigh potential risks, use of SSRIs during pregnancy may be indicated. The risks of destabilisation and maternal relapse must be taken into account when considering discontinuing SSRIs

Question 24

What teratogenic effects can lithium cause?

Answer 24

•ebstein’s anomaly- cardiac anomaly

Question 25

What are the teratogenic effects of diazepam?

Answer 25

Old studies clefts lip/palate- floppy infant syndrome

Question 26

What are the teratogenic effects of quetiapine?

Answer 26

Large baby, poor neonatal adaptation syndrome

Question 27

What is important about penicllin during pregnacy?

Answer 27

Generally safe- check allergy

Question 28

What is important about macrolide during pregnacy?

Answer 28

•azithromycin/erythromycin- use only if no alternative

Question 29

What is important about tetracycline during pregnacy?

Answer 29

•do not prescribe, animal studies- effects on skeletal development, discolouration of teeth

Question 30

What is important about sulphonamides during pregnacy?

Answer 30

•teratogenic-avoid in first trimester- folate antagonist

Question 31

What is important about aminoglycosides during pregnacy?

Answer 31

•auditory or vestibular nerve damage -The risk is greatest with streptomycin.

Question 32

What is important about cephalosporins during pregnacy?

Answer 32

generally safe

Question 33

What is important for cancer treatments during pregnancy?

Answer 33

* Most cytotoxic drugs are teratogenic * Exclude pregnancy before starting these medications * Take specialist advice- if needed to start or continue treatmet in pregnancy

Question 34

What is the effect of hydroxychloroquine during pregnancy?

Answer 34

•no significant increased risk of major malformations in general, as well as craniofacial, cardiovascular, nervous system and genitourinary malformations specifically, and no significant increase in stillbirth, low birth weight or prematurity risks.

Question 35

What is the effect of azithromycin during pregnancy?

Answer 35

•Although individual studies have described increased risks of miscarriage and overall malformation following azithromycin use in pregnancy, the majority of studies do not support these findings.

Question 36

What is the effect of toclilizumab during pregnancy?

Answer 36

•Although adverse pregnancy outcomes have been described (including cases of congenital anomaly, miscarriages and preterm deliveries), the crude rates of these events do not generally appear to be notably increased above the background rate.

Question 37

What is the effect of lopinavir during pregnancy?

Answer 37

•Approximately 3,000 exposed pregnancies and do not suggest an increased risk of malformation.[10] Studies investigating neurodevelopmental outcomes have also provided reassuring findings.[10] However, cases of preterm delivery, low birth weight and stillbirth have also been described.[24] Due to data limitations, the risk of these outcomes following maternal lopinavir/ritonavir use in pregnancy is currently undetermined.

Question 38

What is the effect of corticosteroids during pregnancy?

Answer 38

majority of the best quality evidence does not suggest increased risks in either the overall malformation rate, or for specific malformations (including orofacial clefts and cardiac anomalies). The small number of methodologically limited studies investigating miscarriage and intrauterine death risks do not provide reliable evidence of increased risks, and similarly there is no reliable evidence indicating use of systemic corticosteroids impairs fetal growth