Drugs In Pregnancy Flashcards
Why must we consider the stage of pregnancy a female is at?
First trimester= malformations most likely to happen at this stage
Second and third trimester= problems with growth and development
What mental health issues are seen sometimes in women when they are pregnant and how do we treat it safety?
ANXIETY AND DEPRESSION
-can use non pharmacological therapies such as cognitive behavioural therapy,good for mild to moderate depression but think about the severity.
-pharmacological therapy:
1.tricyclic antidepressants e.g.amitriptyline , these obtain relatively low risks to the foetus but they obtain a high fatality rate in overdose. Thus avoid if suicidal
2.SSRIs - the best option if fluoxetine and paroxetine shouldn’t be used in the first trimester because it is associated with featal heart defeats .All SSRIs carry the small risk of pulmonary hypertension after 20 weeks.
3.Venlafaxine -increased risk of maternal hypertension
4.CDT
What is first line treatment in depression and anxiety in the use of pregnant women?
FLUOXETINE 20MG once a day
This is because it has the least known risks out all of the SSRI drugs
Why do we tend to stay away from prescribing a pregnant lady a few medications at the same time?
SINGLE TREATMENT/MONO THERAPY IS PREFERRED
This is because if we place them on a few medications we are further increasing the risk of problems and side effects and in regards to medication that we use to treat depression and anxiety using 2 or more agents can significantly increase the risk of heart defects developing in the foetus
When do we ween the patients off the antidepressants?
3-4 weeks before the baby is due
When are withdrawn symptoms the worst for antidepressants?
Withdrawal symptoms are the worst with drugs with a shorter half life for example paroxetine and venlafaxine.
What drugs should we be cautious of when dealing with schizophrenia?
1.antipsychotic agents - be aware of the increased risk of gestational diabetes and potential of potential weight gain.
-some drugs e.g. amasulpride can raise prolactin levels, this can reduce the chance of conception.
2.clozapine -switch to a different agent with specialists advice this is because it can cause a granular cytosine in the foetus.
3.olanzapine- associated with weight gain, increased risk of gestational diabetes
4.lithium -can increase the risk of fetal heart defects. Avoid in first trimester, if a women becomes pregnant and there are on lithium this dose should be reduced over 4 weeks and then switch to an alternative treatment. Can switch back if are high risk when in the second trimester.
- Valproate - this is teratogenic , avoid in ladies of child bearing age.
What else can we do for schizophrenia patients ?
We can withdraw therapy if they are mild to moderate and monitor the patient closely, offer CBT to go alongside this.
Women with epilepsy should be prescribed what when they are pregnant?
FOLIC ACID 5MG to avoid the effects of Neural tube defects occurring (defects of the brain and spine)
If a women is wanting to conceive and they have epilepsy what is the process they must undergo?
-they must talk to a specialist who will determine the risk and benefits
-they will determine the last time they had a seizure and if they are 2 years seizure free they can be removed of therapy.
-medication must be withdrawn for a 6 month period and should be monitored to see if they are managing without meds.
How do we treat epilepsy in pregnancy?
-avoid multiple agents where possible
-ideally mono therapy with the most effective medication at the lowest possible dose
-many anti epileptic are cleared via the liver, check dose regularly and check the levels of clearance closely.
Why should we avoid using valproate in pregnancy women in the treatment of epilepsy?
This is because it is teterogenic and can cause development delays and heart defects.
When can valproate be given to a women in the treatment of epilepsy?
It can be used when all other treatments failed, and a treatment plan is put into place with a. Specialist and out has been discussed with the female regarding the risks.
-pregnancy prevention plan, this is consent the patient must sign every year to agree they are aware of an Potential risks this medication can cause.
-they should do a pregnancy test to ensure they are not pregnant before every prescription.
-use effective contraception (long acting reversible contraception)
Copper IUD and progesterone only implant
How are thyroid disorders treated in pregnancy?
-thyroid levels must be monitored regularly in pregnancy this is because the increase in osteogen levels that occur can alter T4,T3 and TSH levels.
When is it important to measure the pregant women’s thyroid?
It is important to check the women is euthyroid before conceiving, this is because the baby replies completely on the mother in the first trimester for development and growth.
