drugs in pregnancy Flashcards by Evie withington

what is a teratogen

causes abnormality within the baby following fetal exposure during pregnancy

usually discovered after increased prevalence of a particular birth defect

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which period of pregnancy is most vulnerable to teratogens

first half - affects embryogenesis

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what is the result of drinking alcohol during pregnancy

fetal alcohol syndrome

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what are examples of preventable teratogens

alcohol
smoking
drugs

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effects of smoking during pregnancy

low birth weight
preterm baby
cerebral palsy
learning difficulties

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effects of marijuana/ecstacy/cocaine during pregnancy

low birth weight
withdrawal symptoms
learning and behavioural problems

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what is pharmacokinetics

what the body does to a drug
movement of the drug through and out of the body
time course - absorption, bioavailability, distribution, metabolism, excretion

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what is pharmacodynamics

what the drug does to the body
biochemical/physiologic/molecular effect of drugs on body
receptor binding/post receptor effect

normal physiological ca

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physiological changes during pregnancy and drugs

normal physiologic changes in pregnancy lead to alteration in the pharmacokinetics of the drug and may affect the pharmacodynamics

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birth defect from thalidomide

phocomelia

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managament of N+V during pregnancy

1st line:
cyclizine - antihistamine
prochloroperazine - phenothiazine
doxylamine/pyridoxine combination product (Xonvea) - licensed for treatment of NVP in UK and can also be offered as 1st line option

2nd line:
ondanestron
metoclopramide

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management of hypertension during pregnancy

labetolol

nifedipine

methyldopa

hydralazine

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what anti-hypertensives are teratogenic

ACEi

angiotension receptor antagonists

change as soon as pregnancy confirmed

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management of epilepsy during pregnancy

change in free serum concentration of antiepileptics

carbamazepine and lamotrigine are safests

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which anticonvulsants are teratogenic and what effects can they cause

phenobarbitone - cardiac malformations

sodium valproate - NTD, facial clefts

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what preventative measures can be taken with anti-epileptics

always give high dose folic acid to prevent NTD

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management of diabetes during pregnancy

insuline is safest

metformin for gestation/T2DM

NICE guidance for oral anti-diabetics

all except metformin should be discontinued before pregnancy (or as soon as pregnancy is identified) and substituted with insulin therapy

women w/ diabetes may be treated with metformin as an adjunct/alternative to insulin in the pre-conception period and during pregnancy

metformin can be continued, or glibenclamide resumed immediately after birth and during BF for those w/ pre-existing T2DM

all other anti-diabetics should be avoided while BF

management of thromboembolism during pregnancy

LMWH - safe

which anti-coagulants shouldn’t be used during pregnancy

warfarin

DOACs - apixaban, dabigatran, edoxaban, rivaroxaban

risks of warfarin use during pregnancy

fetal warfarin syndrome/fetal embyropathy

nasal hypoplasia and skeletal abnormalities (short limbs and digits, slipped epiphysis) - warfarin use in 1st trimester

avoid in 1st and 3rd trimester

asthma management during pregnancy

risk of medicated use are lower than risk of untreated asthma

B2 agonst e.g. albuterol, salbutamol - safe

ICS - budosonide

theophyline - potential toxicity

systemic corticosteroid for severe asthma

management of headaches and migraines during pregnancy

paracetamol

ibuprofen can result in persistent pulmonary HT - avoid in 3rd trimester

sumatriptan for acute treatment of migraine

propanolol in lowest effective dose

morphine based medicines in pregnancy

no increase in congenital abnormalities

risk of neonatal resp depression and withdrawal

used as labour analgaesia

avoid codeine during lactation - infant opiate toxicity

SSRIs during pregnancy

where the benefits \> potential risks, use of SSRIs during pregnancy may be indicated risks of destabilisation and maternal relapse must be taken into account when considering discontinuing SSRIs

lithium during pregnancy

ebsitein's anomaly - cardiac anomaly

diazepam during pregnancy

cleft lip/palate - old studies floppy infant syndrome

quetiapine during pregnancy

large baby poor neonatal adaptation sydrome

use of antidepressants and antipsychotics during pregnancy

weigh risk vs benefits of treatment

penicillin during pregnancy

generally safe check allergy

macrolides during pregnancy

azithromycin/erythromycin use only if no alternative

tetracyclines during pregnancy

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

sulphonamides during pregnancy

teratogenic avoid in 1st trimester folate antagonist

aminoglycosides during pregnancy

auditory or vestibular nerve damage risk is greatest with streptomycin

cephalosporins during pregnancy

generally safe

cancer treatments during pregnancy

most cytotoxic drugs are teratogenic exclude pregnancy before starting take specialist advice if needed to start/continue treatment in pregnancy

saefty of hydroxychloquine for coronavirus during pregnancy

no significant increased risk of major malformations (general as well as craniofacial, CV, nervous and genitourinary malformations specifically) no significant increase in stillbirth, low birth weight or prematurity risks

azithromycin (macrolide) for coronavirus during pregnancy

individual studies have described increased risk of miscarriage and overall malformation following azithromycin use in pregnancy, the majority of studies don't support these findings

toclizumab for coronavirus during pregnancy

although adverse pregnancy outcomes have been described (congenital anomaly, miscarriage and preterm delivery) the rates of these don't generally appear to be increased above the backrgound rate

lopinavir/ritonavir (protease inhibitors) for coronavirus during pregnancy

~3000 exposed pregnancies no suggested increased risk of malformation neurodevelopmental outcomes so far unaffected some cases of preterm delivery, low birth weight and stillbirth risk of these outcomes is currently undetermined

corticosteroids for coronavirus during pregnancy

no suggested increase in either overall malformation or specific malformation (orofacial cleft, cardiac anomalies) rates no reliable evidence for risk of miscarriage or intrauterine death risk no reliable evidence on effect of systemic corticosteroid use impacting on fetal growth