Drugs in pregnancy

Question 1

Symptomatic Bacteriuria

Management

Answer 1

i) Send urine culture
ii) 7 Days antibiotic therapy (Nitorfurantoin, cefalexin, trimethoprin AND folate 5mg).
iii) Send another urine culture to test for cure
iv)

Question 2

Asymptomatic Bacteruria

Management

Answer 2

i) send another confirmatory sample
ii) If second culture is positive 7 day antibiotic therapy (Nitrofurantoin, cefalexin, trimethoprin AND folate 5mg).
iii) Urine cultures at every visit

Question 3

Risks of smoking in pregnancy

There are 5

Answer 3

i) Miscarriage
ii) Pre-Term Labour
iii) Stillbirth
iv) IGUR
v) Sudden Unexpected Death in infancy

Question 4

Risks of smoking in pregnancy (There are 5)

Answer 4

i) Fetal Alcohol Syndrome
ii) Learning Difficulties
iii) Abnormal Facies: Smooth philtrum, thin vermillion, small palpebral fissures
iv) IUGR & restricted growth postnatally
v) Microcephaly

Question 5

Cocaine

Answer 5

i) Hypertension in pregnancy
ii) Placental Abruption
iii) Prematurity
iv) Neonatal Abstinence Syndrome

Question 6

Heroin

Answer 6

i) Neonatal Abstinence Syndrome

Question 7

Which of these anti epileptics is considered safe in:

1. Pregnancy
2. Breastfeeding

a) Sodium Valproate
b) Carbamezapine
c) Phenytoin
d) Lamotrigine

Answer 7

1. b) Carbamezapine, d) Lamotrigine
   a) Sodium Valproate is associated with significant risk of neurodevelopmental delay
   c) Phenytoin is associated with risk of cleft palate
2. All of them

Question 8

Which antibiotic classes should be avoided in pregnancy?

Answer 8

Tetracyclines (Doxycycline)
Aminoglycosides (Amikacin)
Sulphonamides and trimethoprim
Quinolones

Question 9

Symptomatic UTI in 9 week pregnant lady

Management

Answer 9

Nitrofurantoin (As first trimester trimethoprim is contraindicated)

Send MSU

Question 10

Treatment for postnatal depression

Answer 10

SSRI - paroxetine and sertraline

Fluoxetine should be avoided due to half life

Support from mother through health visitor, partner etc.

Question 11

What Anti HIV prophylaxis do you give to new borns if mum has HIV

Answer 11

Zidovudine for 4 weeks and start within4 hours

HIV DNA PCR before discharge, at 6 and 12 weeks

Test for HIV antibody at 18 months

Consider PCP prophylaxis if positive

Question 12

How do you manage mum with HIV during pregnancy

Answer 12

viral load greater than 400 - has to have a pre labour c section

If on monotherapy (zidovudine) you have a pre term c section