Drugs in Pregnancy and the Newborn Flashcards
In normal / young / fit and healthy mothers, what is the background risk of congenital malformations?
2-3%
Define “teratogen”
An agent administered to a mother which directly or indirectly causes structural / functional abnormalities in the foetus or child after birth
Give an example of a drug which causes Transplacental carcinogenicity
Diethylstilboestrol
Give examples of facial phenotypic features observed in Foetal Alcohol Syndrome
- Microcephaly
- Indistinct philtrum
- Flat midface
- Low set ears, minor ear abnormalities
- Thin upper lip
- Low nasal bridge
- Small chin
What is the recommendation of drinking alcohol during pregnancy?
No clear recommendation, should avoid alcohol altogether (atleast for first 3 months)
What are the two major types of Inheritance?
Mendelian
Multifactorial / Polygenic
Spina bifida is caused by a failure in the fusion of?
The caudal neural tube
How can Spina bifida be prevented in 70% of cases?
Folic acid supplementation during pregnancy
What factors may influence what dose of a drug you prescribe to a pregnant woman?
- Transfer of drug (passive + facilitate diffusion, active transport)
- Molecular weight
- Lipid solubility
- Ionisation
- Protein binding
- Chemical structure
- Pharmacokinetic changes (blood flow)
Drugs of what size can freely pass through the Placenta?
< 600 Daltons
What kinds of drugs do not cross the placenta at all? Give 2 examples
Large molecular weight drugs > 1000 Daltons, i.e. Insulin and Heparin
Lithium when taken by pregnant women increases the risk of what in a foetus?
Ebstein’s anomaly
Assuming the first day of the pregnancy is the first day of the LMP, when does ovulation occur?
Week 2 after LMP
The period of maximal susceptibility to teratogenic effects is usually when?
First 10 weeks post conception
An embryo is defined as an embryo from what weeks?
What about a foetus?
Embryo: Week 2 - 9
Foetus: Week 9 - 38
Androgens taken by the mother can have what effect on the foetus during the first trimester?
Masculinisation of the female foetus
Oestorgens taken by the mother can have what effect on the foetus during the first trimester?
Feminisation of the male foetus
Warfarin taken by the mother can have what effect on the foetus during the first trimester?
Craniofacial / cardiovascular / CNS defects
Antiepileptics taken by the mother can have what effect on the foetus during the first trimester?
Facial defects / mental retardation / neural tube defects
Antiepileptics taken by the mother can have what effect on the foetus after the first trimester?
Possible mental retardation, autism, aspergers
Narcotics taken by the mother can have what effect on the foetus after the first trimester?
Neonatal respiratory depression
Warfarin taken by the mother can have what effect on the foetus after the first trimester?
Foetal harmorrhage, CNS abnormalities
Benzodiazepines taken by the mother can have what effect on the foetus after the first trimester?
Floppy infant syndrome, neonatal respiratory depression, withdrawal symptoms
ACE Inhibitors taken by the mother can have what effect on the foetus after the first trimester?
Oligohydramnios (too little amniotic fluid)
Following the Thalidomide tragedy, what Post-Marketing surveillance was introduced?
- Yellow Card
- Congenital malformation registries
- UK Teratology
Information Service - UK Epilepsy & Pregnancy Register
What is the Black Triangle which may appear after a drug name?
Pharmacovigiliance, indicates medication is new to the market, or that existing medicine is being used for a new reason or by a new route of administration
Describe the steps of the Pain Ladder for a pregnant woman
- Phase I Non-Pharmacological Paracetamol Codeiene NSAID Paracetamol + Codeiene NSAID + Codeine
- Phase II
Tramadol - Phase III
Amitriptyline - Phase IIII
Opiates
When should NSAIDs not be given during a pregnancy?
Not be given after 28/40 weeks
NSAID use after 28 weeks can lead to..?
Premature closure of the Ductus Arteriosus
Describe the Stepwise management for Nausea and Vomiting in Pregnant women
- Non-pharmacological
- Pharmacological
First choice: Cyclizine / Promethazine
Second choice: Prochlorperazine / Metoclopramide
Describe the Stepwise management for Constipation
- Non-pharmacological management
2. Laxatives, Lactulose, Senna, Glycerine suppositories
Severe nausea, vomiting and weight loss in pregnancy refers to..?
Hyperemesis Gravidarum
Describe the first two steps in the Stepwise use of Antibiotics
- Penicillins and Cepalosporins
2. Erythromycin and Clindamycin
Tetracyclines should be avoided at what stage of pregnancy?
After 15 weeks gestation
