Drugs in Pregnancy

Question 1

Describe a teratogen

Answer 1

Causes abnormality within baby following foetal exposure during pregnancy

Question 2

When is pregnancy most vulnerable to teratogens?

Answer 2

First half of pregnancy
Affects embryogenesis

Question 3

What are preventable teratogens?

Answer 3

Alcohol, smoking and drugs

Question 4

What can alcohol in pregnancy cause?

Answer 4

Foetal alcohol syndrome

Question 5

What can smoking in pregnancy cause?

Answer 5

Low birth weight, preterm birth, cerebral palsy and learning difficulties

Question 6

What can drugs like marijuana, ecstasy and cocaine cause during pregnancy?

Answer 6

Low birth weight, withdrawal symptoms, learning and behavioural problems

Question 7

What is pharmacokinetics?

Answer 7

What the body does to a drug
Movement of drug through and out of the body
Absorption, bioavailability, distribution, metabolism and excretion

Question 8

What is pharmacodynamics?

Answer 8

What the drug does to the body
Biochemical, physiological and molecular effects of drug
Receptor binding/ post receptor effect

Question 9

What can normal physiological changes in pregnancy lead to for pharmacokinectics and pharmacodynamics?

Answer 9

Alteration in pharmacokinetics of the drug and may affect the pharmacodynamics

Question 10

What did thalidomide cause?

Answer 10

Phocomelia

Question 11

What is first line for nausea and vomiting in pregnancy?

Answer 11

Cyclizine - antihistamine
Prochlorperazine - phenothiazine
Doxylamine/ pyridoxine combination

Question 12

What is second line for nausea and vomiting in pregnancy?

Answer 12

Ondansetron
Metoclopramide

Question 13

What can be used to treat hypertension in pregnancy?

Answer 13

Labetolol, nifedipine, methyldopa and hydralazine

Question 14

What are some hypertension teratogenic medicines?

Answer 14

ACE inhibitors and angiotensin receptor antagonist
Change as soon as pregnancy is confirmed

Question 15

What are the safest drugs to use for epilepsy in pregnancy?

Answer 15

Carbamazepine and lamotrigine
Always give high dose of folic acid

Question 16

What does pregnancy change in antiepileptics?

Answer 16

Free serum conc.

Question 17

What can phenobarbitone cause if taken during pregnancy?

Answer 17

Cardiac malformations

Question 18

What can sodium valproate cause if taken during pregnancy?

Answer 18

NTD and facial clefts

Question 19

What is the safest medication to use in diabetes?

Answer 19

Insulin

Question 20

What medication is given in gestational diabetes/ type 2 diabetes?

Answer 20

Metformin

Question 21

What thromboembolism medication is safe during pregnancy?

Answer 21

Low molecular weight heparin (LMWH)

Question 22

What can warfarin cause if taken during pregnancy?

Answer 22

Foetal warfarin syndrome/ foetal embryopathy
Nasal hypoplasia, stippled epiphyses and skeletal abnormalities
Avoid in 1st and 3rd trimesters

Question 23

Can DOACs (apixaban, dabigatran and rivaroxaban) be used during pregnancy?

Answer 23

Advised to avoid during pregnancy due to animal toxicity

Question 24

What B2 agonists are used for asthma during pregnancy?

Answer 24

Albuterol and salbutamol

Question 25

What inhaled corticosteroid can be used for asthma during pregnancy?

Answer 25

Budesonide

Question 26

What is used for severe asthma during pregnancy?

Answer 26

Systemic corticosteroid used

Question 27

Can theophylline be taken during pregnancy?

Answer 27

No as potential toxicity

Question 28

What medications can be taken for headaches and migraines during pregnancy?

Answer 28

Paracetamol Ibuprofen - avoid in 3rd trimester - persistent pulmonary hypertension Sumatriptan Propranolol lowest effective dose

Question 29

Describe morphine based medicines during pregnancy

Answer 29

No increase in congenital abnormalities Risk of neonatal resp depression and withdrawal Used as labour analgesia Avoid codeine during lactation

Question 30

What antidepressants and antipsychotics can be taken during pregnancy?

Answer 30

SSRI where benefits of use outweigh the potential risks then they can be indicated Destabilisation and maternal relapse should be considered

Question 31

What can lithium cause if taken during pregnancy?

Answer 31

Ebstein's anomaly - cardiac anomaly

Question 32

What can diazepam cause if taken during pregnancy??

Answer 32

Cleft lip/ palate Floppy infant syndrome

Question 33

What can quetiapine cause if taken during pregnancy?

Answer 33

Large baby and poor neonatal adaption syndrome

Question 34

What antibiotics are safe to be taken during pregnancy?

Answer 34

Penicillin Macrolides - azithromycin/ erythromycin only if no alternative Cephalosporins

Question 35

What antibiotics should not be taken during pregnancy?

Answer 35

Tetracycline - skeletal development problems and discolouration of teeth Sulphonamides - teratogenic in 1st trimester and folate antagonist Aminoglycosides - auditory or vestibular nerve damage

Question 36

When is the risk of aminoglycosides the greatest if taken during pregnancy?

Answer 36

When taken with streptomycin

Question 37

Describe cancer treatments during pregnancy

Answer 37

Most cytotoxic drugs are teratogenic Exclude pregnancy before starting these medications Take specialist advise

Question 38

Can hydroxychloquine be used for corona virus treatment during pregnancy?

Answer 38

No significant increased risk of major malformations No increase in stillbirth, low birth weight or prematurity risks

Question 39

What corona virus treatments can be taken during pregnancy?

Answer 39

Hydroxyxhloquine Azithromycin - macrolide antibiotics Tocilizumab Lopinavir/ ritonavir - protease inhibitors Corticosteroids