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drugs in pregnancy Flashcards

1
Q

What are teratogens?

A

administration of a drug that can cause structural/functional abnormalities in the foetus or child after birth

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2
Q

factors that influence the amount of drug that will reach the foetus

A 
drug factors
maternal plasma levels
half life
molecular weight
transfer of similar agents
presence/absence of placental metabolising enzymes
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3
Q

BMI aim for pregnancy

A

18.5 - 24.9

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4
Q

folic acid and pregnancy

A

helps to prevent neural tube defects
400mcg daily
3 months before conception

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5
Q

1st line option for smoking cessation

A

CBT (cognitive behavioural therapy)

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6
Q

what to avoid for smoking cessation in pregnancy

A

e-cigarettes
bupropion
varenicline

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7
Q

What supplements should be taken in pregnancy?

A

folic acid

vitamin D

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8
Q

What to avoid in diet during pregnancy?

A 
vitamin A supplements/food high in vit A
unpasteurised milk/cheese
ripened soft cheese
raw eggs
caffeine
some seafood
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8
Q

high risk folic acid dose

A

5mg

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8
Q

vitamin D dose

A

10mcg

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9
Q

What vaccination should be given during pregnancy?

A

Tdap between 27-36 weeks

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10
Q

natural treatments for nausea and vomiting

A

ginger

wrist acupressure

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11
Q

antiemetics for nausea and vomiting

A

promethazine (1st line)
cyclizine (1st line)
metoclopramide, prochlorperazine, ondansetron

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12
Q

What is severe vomiting/dehydration/weight loss known as?

A

hyperemesis gravidarum

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13
Q

1st line for heartburn/dyspepsia

A

lifestyle advice

  • small frequent meals
  • don’t eat within 3 hrs of sleep
  • avoid irritant
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14
Q

2nd line for heartburn/dyspepsia (after lifestyle)

A

antacids and alginates

  • Gaviscon Advance
  • Peptac
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14
Q

3rd line for heartburn/dyspepsia

A

acid suppressing medications

  • ranitidine
  • omeprazole
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15
Q

1st choice for constipation treatment after lifestyle

A

bulk forming laxatives

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16
Q

2nd choice for constipation

A

lactulose

macrogol

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17
Q

What laxatives should not be given during pregnancy?

A

stimulant laxatives (Senna)

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18
Q

What should be avoided for UTI and why?

A

trimethoprim

  • folate antagonist
  • CV defects
  • neural tube defects
  • oral clefts
  • hyperbilirubinaemia
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19
Q

treatment for UTI

A

nitrofurantoin
penicillins
cephalosporins

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20
Q

dose of nitrofurantion for UTI

A

IR: 50mg QDS for 7 days
MR: 100mg BD for 7 days

21
Q

When should penicillins/cephalopsorpis be given for a UTI?

A

if nitrofurantion has no response within 48hrs

22
What causes thrush in pregnancy?
increased oestrogen levels
23
thrush treatment
``` topical clotrimazole (pessary for 7 days) oral is c/i ```
24
NSAIDs and pregnancy
block blastocyst implantation cardiovascular defects if taken after 30 weeks persistent pulmonary hypertension of neonate if used in 3rd trimester patnet ductus arteriosus cleft palete
25
signs to look out for with cramps in legs
persistent pain swelling redness/warmth (pre-eclampsia)
26
signs of anaemia
SOB poor concentration poor appetite muscle weakness
27
when to treat for anaemia (Hb levels)
Hb < 11 g/dl at booking | Hb < 10.5 g/dl at 28 weeks
28
treatment for anaemia
oral: ferrous sulfate 200mg TDS IV: Ferinject
29
signs of DVT
unilateral leg swelling | red, warm tender, painful
30
signs of PE
sudden unexplained difficulty in breathing chest pain haemoptysis (coughing up blood)
31
treatment for VTE
LMWH - tinzaparin, dalteparin, enoxaparin
32
What not to give for VTE?
warfarin | DOACs
33
warfarin in pregnancy
foetal warfarin syndrome - upper airway obstruction - skeletal/brain defects - haemorrhage risk - nasal hypoplasia - CNS defects
33
risk factors for gestational diabetes
BMI > 30 previous gestational diabetes FH of diabetes family origin
33
glucose tolerance test for diabetes if 1+ risk factor
between 24-28 weeks fast before test (8-10hrs) given 75g glucose drink bloods rechecked after 2hrs
34
signs of gestational diabetes
increased thirst increased urinary frequency dry mouth tiredness
35
oral hypoglycaemic agents for geatational diabetes in pregnancy
metformin | glibenclamide
36
complications with gestational diabetes
``` large baby premature birth (<37 weeks) pre-eclampsia complications with the baby still birth ```
37
BP levels for gestational hypertension
140/90 mmHg
38
treatment for hypertension (140/90 - 159/109 mmHg)
labetolol aim 135/85 mmHg meaure BP once/twice a week
39
treatment for severe hypertension (> 160/110 mmHg)
hospital labetolol aim 135/85 mmHg measure BP every 15-30 mins until < 160/110 mmHg
40
What is pre-eclampsia?
high BP and proteinuria
41
risk factors for pre-eclapmsia
``` hypertension during previous pregnancy CKD autoimmune disease T1DM/T2DM chronic hypertension ```
42
treatment for pre-eclampsia if high risk
aspirin 150mg daily from 12 weeks until birth
43
signs of pre-eclampsia
``` high BP swelling of face/eyes/hands difficulty breathing/panting vision changes nausea after mid pregnancy headache that doesn't go away weight gain ```
43
pre-eclampsia treatment for hpt 140/90 - 159/109 mmHg
labetalol | monitor BP every 2 days
44
pre-eclampsia treatment for BP severe (> 160/110 mmHg)
hospital | monitor BP every 15-30 mins
45
What conditions to take 5mg folic acid?
epilepsy | diabetes
46
ACEI/ARB/statins during pregnancy
discontinue before pregnancy | teratogenic
47
hypertension and pregnancy BP target
135/85 mmHg
48
treatment options for hypertension in pregnancy
1 - labetolol 2 - nifedipine 3 - methyldopa
49
BP target for hypertension after birth
< 140/90 mmHg
50
lifestyle advice for hypertension
weight management exercise healthy eating restirct sodium intake

PHA223 (43 decks)

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