Drugs in Pregnancy

Question 1

most drugs cross the placenta except

Answer 1

large molecular weight eg heparin

Question 2

how do small, lipid soluble drugs cross the placenta

Answer 2

the cross more quickly

Question 3

how does the volume of distribution change in pregnancy

Answer 3

increased plasma volume and fat stores which increases volume of distribution

Question 4

how does the pharmacokinetics change in pregnancy

Answer 4

absorption may be affected by morning sickness
increased plasma volume and fat sores which increases VD
decreased protein binding-increased free drug
increased liver metabolism of some drugs-phenytoin
elimination of renally excreted drugs increases-increased GFR

Question 5

name some teratogenic drugs

Answer 5

ACEI/ARB, androgens, antiepileptics, cytotoxics, lithium, methotrexate, retinoids, warfarin

Question 6

what do ACEI/ARB cause in pregnancy

Answer 6

renal hypoplasia

Question 7

what do androgens cause in pregnancy

Answer 7

virilisation of female foetus

Question 8

what do antiepileptics do

Answer 8

cardiac, facial, limb, neural tube defects

Question 9

what do cytotoxics do

Answer 9

multiple defects, abortion

Question 10

what does lithium do

Answer 10

cardiovascular defects

Question 11

what does methotrexate do

Answer 11

skeletal defects

Question 12

what does retinoids do

Answer 12

ear, cardiovascular, skeletal defects

Question 13

what does warfarin do

Answer 13

limb and facial defects

Question 14

what did diethysetilbestrol aim to do

Answer 14

prevent recurrent miscarriages

Question 15

what did diethylstilbestrol cause

Answer 15

vaginal adenocarcinoma in young girls whose mothers were exposed to it and urological malignancy in boys

Question 16

epilepsy medication issues

Answer 16

there are increased seizures in 10% of women due to non compliance and persistent vomiting and increased clearance of the drug

Question 17

what are the recommendations of drug therapy in epilepsy

Answer 17

avoid valproate and phenytoin
give extra folic acid-5mg daily
monotherapy is preferred
96% babies born to women taking antiepileptics will not have major congenital malformations

Question 18

is insulin thought to be safe in pregnancy

Answer 18

yes

Question 19

are sulfonylureas safe in pregnancy

Answer 19

no

Question 20

what happens to BP in 2nd trimester

Answer 20

it falls

Question 21

what is the worry with B blockers

Answer 21

they may inhibit foetal growth in late pregnancy

Question 22

regardless of risk all women who are pregnant should be encouraged to do what

Answer 22

mobilise and be adequately hydrated

Question 23

those with significant risk factors for VTE GET

Answer 23

Thromboprophylaxis with LMWH

Question 24

what are the risk factors for VTE

Answer 24

obesity, age>35, smoking, para>3,

Question 25

what is contained in foremilk

Answer 25

protein rich

Question 26

what is contained in hindmilk

Answer 26

higher fat content

Question 27

in terms of drugs longer feeds mean

Answer 27

higher amounts of fat soluble drugs in milk

Question 28

which drugs can cause problems with breastfeeding

Answer 28

phenobarbitone-suckling difficulties 
amiodarone-neonatal hypothyroidism 
cytotoxic-bone marrow suppression 
benzodiazepines-drowsiness 
bromocriptine-suppress lactation

Question 29

what can phenobarbitone cause

Answer 29

suckling difficulties

Question 30

what can amiodarone cause

Answer 30

neonatal hypothyroidism

Question 31

what can cytotoxics cause

Answer 31

bone marrow suppression

Question 32

what can benzodiazepines cause

Answer 32

drowsiness

Question 33

what can bromocriptine do

Answer 33

suppress lactation

Question 34

which drug can cause teeth staining

Answer 34

tetracycline

Question 35

which drug can cause cleft lip and palate

Answer 35

phenytoin

Question 36

which drug can cause neural tube defects and anencephaly

Answer 36

sodium valproate through neural tube defects