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Module 308 > Drugs + Pregnancy > Flashcards

Drugs + Pregnancy Flashcards

1
Q

Safer medicines in pregnancy and breastfeeding information consortium

A
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2
Q

Effects of drugs on pregnancy

A

Fertilisation and implantation - 1st 3 months
Organogenesis - 1st 3 months
Growth and development
Drugs at the end of pregnancy

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3
Q

When looking at the effect of drugs on pregnancy, when is most important to consider

A

First 3 months

Fertilisation and implantation - 1st 3 months
Organogenesis - 1st 3 months

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4
Q 
Amoxicillin
Ciprofloxacin
Gentamicin
Nitrofurantoin
Trimethoprim
A

Nitrofurantoin most appropriate

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5
Q
A

Stop it - ACEi are almost always contraindicated
Use calcium channel blocker instead etc amlodopine or nifedipine
Or beta blocker - labetalol

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6
Q

Acne in pregnancy is a problem - why

A

Scaring is a big issue - vitamin A derivates
BUT teratogenicity
Occurs in first three weeks of gestation before pregnancy declares itself
Severe CND, cardiac and craniofacial abnormalities
Not for women of child bearing age unless they practice effective contraception and have received counselling
E.g. isotretinoin (roaccutane)

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7
Q

Sodium valproate - women

A

Sodium valproate prevention programme in child bearing age

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8
Q

Medicines of teratogenic potential - what is available to help prescribing

A

Is guidance to aid people in making choices about types of contraception and when to do a pregnancy test

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9
Q

Other drugs which can cause teratogenicity

A 
Alcohol
Tetracyclines
Warfarin
Antibiotics
Anti thyroid drugs, anticonvulsants, anti hypertensives
Lithium
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10
Q

Pharmacological risks in pregnancy

A

NSAIDs
Opioids
Antidepressants

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11
Q
A

Same way as in non-pregnant

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12
Q

Drug absorption in pregnancy

A

Reduced gastric emptying

Reduced small intestinal mobility

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13
Q

Volume of distribution in pregnancy

A

Increased Vd during pregnancy which may affect loading dose of drug
Vd = dose/plasma conc

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14
Q

Therapeutic window matters in drugs in pregnancy - why?

A

Need to meet minimum dose for therapeutic but issue with toxic levels if window is narrow

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15
Q

32 YO pregnant with epilepsy - well controlled on lamotrigine
Develops increasing frequency of seizures at 32 weeks of pregnancy - what is the mechanism

A

Therapeutic effect decreased

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16
Q

Metabolism - drugs in pregnancy

A
17
Q

Why is the 1st trimester the dangerous for using teratogenic drugs?

A

organogenesis happens, rapidly dividing cells so lots of potential issues

18
Q

Why are tetracyclines contraindicated in pregnancy?

A

can get teeth discolouration of the foetus

19
Q

is trimethoprim safe in pregnancy?

A

No - folate antagonist affects growth

20
Q

Is nitrofurantoin safe in pregnancy?

A

safe early on, some issues in 3rd trimester

21
Q

Which anti-hypertensives are safe to use in pregnancy? (3)

A

Labetalol
hydralazine
Nifedipine

22
Q

Which anti-hypertensive agents are contraindicated in pregnancy?

A

ace inhibitors

ARBs

23
Q

why is isoretinoin contraindicated in women of child bearing age?

A

Teratogenic in first 3 weeks of pregnancy, causes CNS and craniofacial defects

24
Q

isoretinoin - what is this?

A

Roaccutane

25
Q

teratogenic effects of sodium valproate

A

Neural tube defects

Developmental delay

26
Q

teratogenic effects of alcohol

A

Fetal Alcohol syndrome => Leading cause of mental retardation. Also causes micro and holoprosencephaly.

27
Q

teratogenic effects of lithium

A

teratogenic effects of lithium

Ebstein’s anomaly (small RV large RA)

28
Q

teratogenic effects of NSAIDs

A

premature closure of ductus arteriosus

29
Q

are opioids safe in pregnancy?

A

not really, can lead to neonatal respiratory depression especially if used late

30
Q

Are asthma drugs ok in pregnancy?

A

Are asthma drugs ok in pregnancy?

yes, benefit outweighs risk for all of them

31
Q

risk of warfarin in pregnancy

A

foetal/neonatal haemorrhage

nasal hyperplasia

32
Q

Why can protein bound drugs be an issue in pregnancy?

A

relative protein concentration decreases with volume expansion so increased proportion of unbound/active drug

33
Q

how is hepatic metabolism affected during pregnancy?

A

some enzyme induction, some are inhibited

Module 308 (17 decks)

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