Drugs in Pregnancy Flashcards
Describe a teratogen
Causes abnormality within baby following foetal exposure during pregnancy
When is pregnancy most vulnerable to teratogens?
First half of pregnancy
Affects embryogenesis
What are preventable teratogens?
Alcohol, smoking and drugs
What can alcohol in pregnancy cause?
Foetal alcohol syndrome
What can smoking in pregnancy cause?
Low birth weight, preterm birth, cerebral palsy and learning difficulties
What can drugs like marijuana, ecstasy and cocaine cause during pregnancy?
Low birth weight, withdrawal symptoms, learning and behavioural problems
What is pharmacokinetics?
What the body does to a drug
Movement of drug through and out of the body
Absorption, bioavailability, distribution, metabolism and excretion
What is pharmacodynamics?
What the drug does to the body
Biochemical, physiological and molecular effects of drug
Receptor binding/ post receptor effect
What can normal physiological changes in pregnancy lead to for pharmacokinectics and pharmacodynamics?
Alteration in pharmacokinetics of the drug and may affect the pharmacodynamics
What did thalidomide cause?
Phocomelia
What is first line for nausea and vomiting in pregnancy?
Cyclizine - antihistamine
Prochlorperazine - phenothiazine
Doxylamine/ pyridoxine combination
What is second line for nausea and vomiting in pregnancy?
Ondansetron
Metoclopramide
What can be used to treat hypertension in pregnancy?
Labetolol, nifedipine, methyldopa and hydralazine
What are some hypertension teratogenic medicines?
ACE inhibitors and angiotensin receptor antagonist
Change as soon as pregnancy is confirmed
What are the safest drugs to use for epilepsy in pregnancy?
Carbamazepine and lamotrigine
Always give high dose of folic acid
What does pregnancy change in antiepileptics?
Free serum conc.
What can phenobarbitone cause if taken during pregnancy?
Cardiac malformations
What can sodium valproate cause if taken during pregnancy?
NTD and facial clefts
What is the safest medication to use in diabetes?
Insulin
What medication is given in gestational diabetes/ type 2 diabetes?
Metformin
What thromboembolism medication is safe during pregnancy?
Low molecular weight heparin (LMWH)
What can warfarin cause if taken during pregnancy?
Foetal warfarin syndrome/ foetal embryopathy
Nasal hypoplasia, stippled epiphyses and skeletal abnormalities
Avoid in 1st and 3rd trimesters
Can DOACs (apixaban, dabigatran and rivaroxaban) be used during pregnancy?
Advised to avoid during pregnancy due to animal toxicity
What B2 agonists are used for asthma during pregnancy?
Albuterol and salbutamol
What inhaled corticosteroid can be used for asthma during pregnancy?
Budesonide
What is used for severe asthma during pregnancy?
Systemic corticosteroid used
Can theophylline be taken during pregnancy?
No as potential toxicity
What medications can be taken for headaches and migraines during pregnancy?
Paracetamol
Ibuprofen - avoid in 3rd trimester - persistent pulmonary hypertension
Sumatriptan
Propranolol lowest effective dose
Describe morphine based medicines during pregnancy
No increase in congenital abnormalities
Risk of neonatal resp depression and withdrawal
Used as labour analgesia
Avoid codeine during lactation
What antidepressants and antipsychotics can be taken during pregnancy?
SSRI where benefits of use outweigh the potential risks then they can be indicated
Destabilisation and maternal relapse should be considered
What can lithium cause if taken during pregnancy?
Ebstein’s anomaly - cardiac anomaly
What can diazepam cause if taken during pregnancy??
Cleft lip/ palate
Floppy infant syndrome
What can quetiapine cause if taken during pregnancy?
Large baby and poor neonatal adaption syndrome
What antibiotics are safe to be taken during pregnancy?
Penicillin
Macrolides - azithromycin/ erythromycin only if no alternative
Cephalosporins
What antibiotics should not be taken during pregnancy?
Tetracycline - skeletal development problems and discolouration of teeth
Sulphonamides - teratogenic in 1st trimester and folate antagonist
Aminoglycosides - auditory or vestibular nerve damage
When is the risk of aminoglycosides the greatest if taken during pregnancy?
When taken with streptomycin
Describe cancer treatments during pregnancy
Most cytotoxic drugs are teratogenic
Exclude pregnancy before starting these medications
Take specialist advise
Can hydroxychloquine be used for corona virus treatment during pregnancy?
No significant increased risk of major malformations
No increase in stillbirth, low birth weight or prematurity risks
What corona virus treatments can be taken during pregnancy?
Hydroxyxhloquine
Azithromycin - macrolide antibiotics
Tocilizumab
Lopinavir/ ritonavir - protease inhibitors
Corticosteroids
