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Y3 repro > drugs in pregnancy > Flashcards

drugs in pregnancy Flashcards

1
Q

what is a teratogen

A

causes abnormality within the baby following fetal exposure during pregnancy

usually discovered after increased prevalence of a particular birth defect

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2
Q

which period of pregnancy is most vulnerable to teratogens

A

first half - affects embryogenesis

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3
Q

what is the result of drinking alcohol during pregnancy

A

fetal alcohol syndrome

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4
Q

what are examples of preventable teratogens

A

alcohol
smoking
drugs

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5
Q

effects of smoking during pregnancy

A

low birth weight
preterm baby
cerebral palsy
learning difficulties

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6
Q

effects of marijuana/ecstacy/cocaine during pregnancy

A

low birth weight
withdrawal symptoms
learning and behavioural problems

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7
Q

what is pharmacokinetics

A

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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8
Q

what is pharmacodynamics

A

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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9
Q

physiological changes during pregnancy and drugs

A

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

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10
Q

birth defect from thalidomide

A

phocomelia

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11
Q

managament of N+V during pregnancy

A

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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12
Q

management of hypertension during pregnancy

A

labetolol

nifedipine

methyldopa

hydralazine

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13
Q

what anti-hypertensives are teratogenic

A

ACEi

angiotension receptor antagonists

change as soon as pregnancy confirmed

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14
Q

management of epilepsy during pregnancy

A

change in free serum concentration of antiepileptics

carbamazepine and lamotrigine are safests

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15
Q

which anticonvulsants are teratogenic and what effects can they cause

A

phenobarbitone - cardiac malformations

sodium valproate - NTD, facial clefts

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16
Q

what preventative measures can be taken with anti-epileptics

A

always give high dose folic acid to prevent NTD

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17
Q

management of diabetes during pregnancy

A

insuline is safest

metformin for gestation/T2DM

18
Q

NICE guidance for oral anti-diabetics

A

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

19
Q

management of thromboembolism during pregnancy

A

LMWH - safe

20
Q

which anti-coagulants shouldn’t be used during pregnancy

A

warfarin

DOACs - apixaban, dabigatran, edoxaban, rivaroxaban

21
Q

risks of warfarin use during pregnancy

A

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

22
Q

asthma management during pregnancy

A

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

23
Q

management of headaches and migraines during pregnancy

A

paracetamol

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

sumatriptan for acute treatment of migraine

propanolol in lowest effective dose

24
Q

morphine based medicines in pregnancy

A

no increase in congenital abnormalities

risk of neonatal resp depression and withdrawal

used as labour analgaesia

avoid codeine during lactation - infant opiate toxicity

25
Q

SSRIs during pregnancy

A

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

26
Q

lithium during pregnancy

A

ebsitein’s anomaly - cardiac anomaly

27
Q

diazepam during pregnancy

A

cleft lip/palate - old studies

floppy infant syndrome

28
Q

quetiapine during pregnancy

A

large baby

poor neonatal adaptation sydrome

29
Q

use of antidepressants and antipsychotics during pregnancy

A

weigh risk vs benefits of treatment

30
Q

penicillin during pregnancy

A

generally safe

check allergy

31
Q

macrolides during pregnancy

A

azithromycin/erythromycin

use only if no alternative

32
Q

tetracyclines during pregnancy

A

do not prescribe

animal studies - effects on skeletal development, discolouration of teeth

33
Q

sulphonamides during pregnancy

A

teratogenic

avoid in 1st trimester

folate antagonist

34
Q

aminoglycosides during pregnancy

A

auditory or vestibular nerve damage

risk is greatest with streptomycin

35
Q

cephalosporins during pregnancy

A

generally safe

36
Q

cancer treatments during pregnancy

A

most cytotoxic drugs are teratogenic

exclude pregnancy before starting

take specialist advice if needed to start/continue treatment in pregnancy

37
Q

saefty of hydroxychloquine for coronavirus during pregnancy

A

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

38
Q

azithromycin (macrolide) for coronavirus during pregnancy

A

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

39
Q

toclizumab for coronavirus during pregnancy

A

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

40
Q

lopinavir/ritonavir (protease inhibitors) for coronavirus during pregnancy

A

~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

41
Q

corticosteroids for coronavirus during pregnancy

A

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

Y3 repro (47 decks)

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