Drugs in pregnancy Flashcards
Describe the effects of alcohol, smoking and drugs on pregnancy
Alcohol: foetal alcohol syndrome
Smoking: Low birth weight, preterm, cerebral palsy, learning difficulties
Marjuana/ectasy/cocaine: low birth weight, withdrawal symptoms, learning & behavioural problems
What does pharmocokinetics mean
- What the body does to a drug
- Movement of the drug, through and out of the body
- The time course: absorption, bioavailiability, distribution, metabolism and excretion
What does pharmocodynamics mean
What the drug does to the body
Biochemical/physiological/molecular effects of the drugs on the body
Receptor binding/post receptor effect
Normal physiologic changes in pregnancy lead to alteration in the pharmacokinetics of the drug and may affect the pharmacodynamics
Effect of Thalidomide on the fetus
Phocomelia isa rare congenital anomaly where the proximal aspect of an extremity is absent with the hand or foot attached directly to the trunk
1st and 2nd line for N&V in pregnancy
1st= **Cyclizine **(antihistamine), prochloroperzine (phenothiazine), Doxylamine/pyridozine (combination product)
2nd line= ondansetron, metoclopramine
1st line treatment of hypertension in pregnancy
Labetolol, Nifedipine, methyldopa, hydralazine
What are some teratogenic medications for treatment of hypertension
ACE inhibitors, angiotensin receptor antagonist – change as soon as pregnancy confirmed
e.g.
ACE: benazipril, rampiril
ARBs: Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan
1st line treatment of epilepsy in pregnancy
Carbamazepine and lamotrigine
+ high dose folic acid
What are some teratogenic medications for epilepsy
Phenobarbitone (cardiac malformations)
Sodium valporate (NTD, facial clefts)
Medications for diabetes in pregnancy
Insulin- safest
Gesgational/T2DM- Metformin
What diabetic drugs must be discontinued in pregnancy
All oral antidiabetic drugs, exceptmetformin hydrochloride, should be discontinued before pregnancy, and substitiuted with insulin therapy
Women with diabetes may be treated withmetformin hydrochloride[unlicensed in T1D] as an adjunct or alternative to insulin in the preconception period and during pregnancy.Metformin hydrochloridecan be continued, orglibenclamideresumed, immediately after birth and during breast-feeding for those with pre-existingType 2 diabetes. All other antidiabetic drugs should be avoided while breast-feeding.
Treatment of thromboembolism in prengnacy
Low molecular weight heparin
What drug should be avoided in treatment of thromboembolism in pregnancy
Warfarin- fetal warfarin syndrome/fetal embryopathy
- Nasal hypoplasia and skeletal abnormalities, including short limbs and digits, and stippled epiphyses, is a well-recognised complication of first trimester warfarin use in pregnancy
Avoid in 1st and third trimester
Directly-acting anticoagulants (DOACs, e.g. apixaban, dabigatran, edoxaban and rivaroxaban)- manufacturer advises to avoid-animal toxicity
What medication is safe to treat asthma in pregnancy
& what medication has potential toxicity
Risk of medication use are lower than risk of untreated asthama
B2 agnonist: albuterol, salbutamol
**Inhaled corticosteroids: **budesonide
Theophyline: potential toxicity
**Systemic corticosteroid: **severe asthma
What medications do we use for treatment of migraines
Paracetamol, sumatriptan (acute), Propanolol (lowest effective dose)
What migraine medication must we be careful with in pregnancy
Ibruprofen: persistant pulmonary hypertension- avoid in 3rd trimester
Are morphine based medications alright to use in pregnancy
No increase in congenital abnormalities
Risk of neonatal respiratory depression and withdrawal
Used as labour analgesia
Avoid codeine during lactation- infant opiate toxicity
What antidepressants & antipsychotics are ok to use in pregnancy
SSRI- selective seritonin reuptake inhibitor
Where its benifits outweigh any potential risks
Risks of destabilisation and maternal relapse must be taken into account when considering discontinuing SSRIs
What antibiotics are generally safe in prengnacy
Penicllin- if no allergy
Macrolide- azithromycin/erythromycin; use if no alternative
Cephlosporins- generally safe
What antibiotics are to be avoided in pregnancy
Tetracycline: effects skeletal development, discoloration of teeth
Sulphonamides: teratogenic; avoid in first trimester, folate anagonist
**Aminoglyclosides: **Auditory or vestibular nerve damage: risk is greatest with streptomycin
Are cancer treatments safe to use in pregnancy?
Most cytotoxic drugs are teratogenic
We must exclude pregnancy before starting these medications
Take specialist advice- if need to start or continue treatment in pregnancy
What corona virus treatments are safe in pregnancy
Hydroxychloquine- no significant risk
Azithromycin: macrolide antibiotic
Toxilizumab
Lopinavir/ritonavir- protease inhibitors- no suggestion of malformations. Effects on preterm delivery, low birth weight & stillbirth have been described undetermined
Corticosteroids
