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PHA223 > drugs in pregnancy > Flashcards

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
Q

What causes thrush in pregnancy?

A

increased oestrogen levels

23
Q

thrush treatment

A 
topical clotrimazole (pessary for 7 days)
oral is c/i
24
Q

NSAIDs and pregnancy

A

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
Q

signs to look out for with cramps in legs

A

persistent pain
swelling
redness/warmth
(pre-eclampsia)

26
Q

signs of anaemia

A

SOB
poor concentration
poor appetite
muscle weakness

27
Q

when to treat for anaemia (Hb levels)

A

Hb < 11 g/dl at booking

Hb < 10.5 g/dl at 28 weeks

28
Q

treatment for anaemia

A

oral: ferrous sulfate 200mg TDS
IV: Ferinject

29
Q

signs of DVT

A

unilateral leg swelling

red, warm tender, painful

30
Q

signs of PE

A

sudden unexplained difficulty in breathing
chest pain
haemoptysis (coughing up blood)

31
Q

treatment for VTE

A

LMWH - tinzaparin, dalteparin, enoxaparin

32
Q

What not to give for VTE?

A

warfarin

DOACs

33
Q

warfarin in pregnancy

A

foetal warfarin syndrome

  • upper airway obstruction
  • skeletal/brain defects
  • haemorrhage risk
  • nasal hypoplasia
  • CNS defects
33
Q

risk factors for gestational diabetes

A

BMI > 30
previous gestational diabetes
FH of diabetes
family origin

33
Q

glucose tolerance test for diabetes if 1+ risk factor

A

between 24-28 weeks
fast before test (8-10hrs)
given 75g glucose drink
bloods rechecked after 2hrs

34
Q

signs of gestational diabetes

A

increased thirst
increased urinary frequency
dry mouth
tiredness

35
Q

oral hypoglycaemic agents for geatational diabetes in pregnancy

A

metformin

glibenclamide

36
Q

complications with gestational diabetes

A 
large baby
premature birth (<37 weeks)
pre-eclampsia
complications with the baby
still birth
37
Q

BP levels for gestational hypertension

A

140/90 mmHg

38
Q

treatment for hypertension (140/90 - 159/109 mmHg)

A

labetolol
aim 135/85 mmHg
meaure BP once/twice a week

39
Q

treatment for severe hypertension (> 160/110 mmHg)

A

hospital
labetolol
aim 135/85 mmHg
measure BP every 15-30 mins until < 160/110 mmHg

40
Q

What is pre-eclampsia?

A

high BP and proteinuria

41
Q

risk factors for pre-eclapmsia

A 
hypertension during previous pregnancy
CKD
autoimmune disease
T1DM/T2DM
chronic hypertension
42
Q

treatment for pre-eclampsia if high risk

A

aspirin 150mg daily from 12 weeks until birth

43
Q

signs of pre-eclampsia

A 
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
Q

pre-eclampsia treatment for hpt 140/90 - 159/109 mmHg

A

labetalol

monitor BP every 2 days

44
Q

pre-eclampsia treatment for BP severe (> 160/110 mmHg)

A

hospital

monitor BP every 15-30 mins

45
Q

What conditions to take 5mg folic acid?

A

epilepsy

diabetes

46
Q

ACEI/ARB/statins during pregnancy

A

discontinue before pregnancy

teratogenic

47
Q

hypertension and pregnancy BP target

A

135/85 mmHg

48
Q

treatment options for hypertension in pregnancy

A

1 - labetolol
2 - nifedipine
3 - methyldopa

49
Q

BP target for hypertension after birth

A

< 140/90 mmHg

50
Q

lifestyle advice for hypertension

A

weight management
exercise
healthy eating
restirct sodium intake

PHA223 (43 decks)

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