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Reproduction and the growing child > Drugs in pregnancy and the newborn > Flashcards

Drugs in pregnancy and the newborn Flashcards

1
Q

What are the potential effects that teratogens can induce?

A
  1. Chromosomal abnormalities
  2. Impairment of implantation of he conceptus
  3. Resorption or abortion of the early embryo
  4. Structural malformations
  5. IUGR
  6. Foetal death
  7. Functional impairment in the neonate e.g. deafness
  8. Behavioural abnormalities
  9. Mental retardation
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2
Q

What are common teratogens?

A
  • Infections
  • Physical agents/chemicals
  • Medicines
  • Alcohol
  • Tobacco
  • Cocaine
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3
Q

Explain how tobacco and cocaine exert teratogenic effects

A

Tobacco: causes vasoconstriction, hypoxia and CO poisoning which can lead to problems in foetal development and death

Cocaine: causes vasoconstriction and hypoxia, bad for maternal health

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4
Q

Give some common problems to male reproduction

A
  1. Chemotherapeutic agents e.g. methotrexate
  2. Other therapeutic agents
  3. Food additives and contaminants
  4. Industrial chemicals
  5. Metals e.g. leads
  6. Pesticides
  7. Steroids
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5
Q

Where is data on teratogens obtained?

A
  1. Epidemiological studies and human case reports

2. Pre-clinical studies in animals or from in vitro studies

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6
Q

Give some problems with identifying teratogens

A
  1. Most birth defects occur rarely
  2. Most suspected teratogens increase the risk of malformations slightly
  3. All compounds that are accepted as human teratogens have produced defects in animals, usually rodents
  4. Data on human exposure to most drugs and chemicals are scarce women of childbearing age are not routinely tested
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7
Q

Give some problems with animal reproductive studies for human risk assessment

A

Variation in sensitivity between species arises because of differences in:

  1. Metabolism
  2. Pharmacokinetics
  3. Genetic factors
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8
Q

Give an example of classic behavioural teratology

A

Foetal alcohol syndrome

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9
Q

Give some signs of foetal alcohol syndrome

A
  1. Epicanthal folds
  2. Microcephaly
  3. Short palpebral fissures
  4. Low set ears
  5. Minor ear abnormalities
  6. Flat midface
  7. Indistinct philtrum
  8. Small chin
  9. Thin upper lip
  10. Short nose
  11. Low nasal bridge
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10
Q

Give examples of drugs which have foetotoxic effects during the 1st trimester

A
  1. Androgens
  2. Oestrogens
  3. Warfarin
  4. Retinoids
  5. Diethylstilboestrol
  6. Anti-epileptics
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11
Q

Give examples of drugs associated with possible foetotoxic effects after 1st trimester

A
  1. Anti-epileptics
  2. Narcotics
  3. Warfarin
  4. Anti-depressants
  5. Benzodiazepines
  6. ACE inhibitors
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12
Q

What are different factors which may affect dosing in pregnancy?

A
  1. Placental transfer of drugs
  2. Pharmacokinetic changes
    - During pregnancy, there is an increase in maternal metabolism, maternal excretion, volume of distribution, body water, liver metabolism and lung function
    - During pregnancy there is a decrease in GI motility and serum albumin (higher conc of unbound free drug)
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13
Q

What are some principles of prescribing in pregnancy?

A
  • Only give the drug when necessary: risk vs benefit
  • Use lowest effective dose for shortest time possible
  • Consider the stage of pregnancy
  • Avoid all drug treatment in first trimester wherever possible
  • Avoid new drugs
  • Avoid poly-pharmacy
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14
Q

Give some common ailments for pain during pregnancy

A
  1. Paracetamol
  2. Codeine if paracetamol is insufficient
  3. NSAID - usually ibuprofen for inflammatory pain 28/40 but SHOULD NOT be given after as they cause premature closure of ductus arteriosus (leads to backflow of blood in heart)
  4. Tramadol
  5. Amitryptyline
  6. Opiates
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15
Q

Give some common ailments in pregnancy for nausea/vomiting

A
  1. Non-pharmacological management: small, high carb, low fat, frequent meals
  2. Pharmacological management:
    - 1st choice: cyclizine or promethazine
    - 2nd choice: prochlorperazine/metclopromide
    - Treatment for resistant symptoms - Ondansetron
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16
Q

What is treatment for hyperemisis gravidarum? (severe nausea and vomiting such that weight loss and dehydration occur)

A
  1. Hospitalisation
  2. Fluid and electrolyte replacement
  3. Thiamine for prevention of Wernicke’s encephalopathy
  4. Pyridoxine (severe cases)
  5. Consider corticosteroids (severe cases)
  6. Exclude other pathology if continues into 2nd trimester
17
Q

Give some common ailments in pregnancy for constipation

A
  1. Non-pharmacological management:
    - Increase fibre
    - Increase fluids
    - Increase exercise
  2. Pharmacological management:
    - Bulk-forming laxatives
    - Lactulose
    - Glycerin suppositories
    - Bisacodyl
    - Senna
    - Docusate sodium - low sodium
18
Q

Give some common antibiotics which can be used during pregnancy

A
  1. Penicillins and cephalosporins
  2. Erythromycin and clindomycin
  3. Nitrofurantoin, trimethoprim and co-trimozazole - only if no folate deficiency
  4. Azithromycin, clarithromycin, metronidazole, ciprofloxacin, and fusidic acid
  5. Quinolones and tetracyclines

Reproduction and the growing child (22 decks)

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