Medication use in Pregnancy Flashcards
What is a teratogen?
Agent which causes developmental abnormality in an embryo or foetus
What is an example of a serious teratogen?
Sodium valproate
What is the lowest risk of epilepsy medications?
Gabapentin
Levetiracetam
Clonazepam
Lamotrigine
How is epilepsy managed in pregnancy?
Specialist referral required
Dose adjustments = switch from sodium valproate
= dose reduction/withdrawal if seizures well controlled
What effect does drugs have in the 1st trimester?
Drugs produce congenital malformations
What effect does drugs have during 2nd + 3rd trimester?
Affect growth/functional developmental of foetus
Have toxic effect on foetal tissues
What should pregnant women be vaccinated for?
Rubella
Varicella
Hepatitis B if at risk of contracting it
What are examples of drugs that affect the foetus?
ACEi
Antimetabolites
Benzodiazepines
Carbamazepine
Warfarin
Lithium
Penicillamine
Phenobarbital
Phenytoin
Tetracycline
Thalidomide
Valproic acid
What is 1st line for morning sickness?
Lifestyle changes - sleep hygiene, regular meals, avoid fatty foods, plenty of fluids
What is 2nd line for morning sickness?
Antihistamines
eg. cyclizine, promethazine
What is problem with Ondansetron?
Can cause cleft lip if used in 1st trimester
Why should women be advised to take folic acid?
Reduce likelihood of baby having neural tube defect
What are the NICE guidelines for folic acid?
400mcg OD before pregnancy + throughout 1st 12 weeks
Why does GP prescribe 5mg of folic acid?
If family history of NTD
Have diabetes, sickle cell anaemia or thalassaemia
Women taking anti-epileptic medication
Woman obese (BMI>30kg)
What else should women be advised to take?
VitD 10mcg throughout pregnancy + after if they are breastfeeding
What is the advice on weight?
Overweight or obese to lose weight before becoming pregnant
What risks are there being associated with being obese?
Neural tube defects
Heart defects
Cleft palate/cleft lip
Limb reduction abnormalities
What is the advice on smoking?
Stop smoking prior
= increased risk of miscarriage
AVOID NRT
What is the advice about alcohol?
Avoid drinking alcohol due to risk of foetal alcohol spectrum disorder
What advice about OTC?
Advised to speak to pharmacist before taking any OT products
Should you take herbal remedies?
NO
What can VitA cause?
Congenital defects
Should Fe be supplied?
No = unpleasant maternal side effects
When calculating anti-coagulant dose what weight do you use?
Pre-pregnancy weight
What Tinzaparin sodium should be used in pregnancy?
Formulations without benzyl alcohol (syringes)
What do you need to try and do in 1st trimester with medications?
Avoid all drugs
= balance risk of disease
= consider non-drug treatment first
= lowest effective dose
How is asthma managed?
Take medication as prescribed in order to keep asthma well controlled
Requires little modification
How is diabetes managed?
Oral hypoglycaemic drugs carry risk of teratogenesis + prolong neonatal hypoglycaemia
Switched to insulin
How is RA managed?
Refer to rheumatologist
Especially if taking NSAIDs + DMARDs
How is gastro-oesophageal reflux managed?
Some OTC antacid licensed for pregnancy
Avoid antacids with high Na+
OTC H2 antagonists not licensed
What is the non-pharmacological management of gastro-oesophageal reflux?
Not eat late in the day
Use extra pillows at night to sleep
Avoid chocolate + coffee
How is constipation + haemorrhoids managed?
Increase fluid + fibre intake
Bulk-forming laxatives + lactulose
How are coughs + colds managed?
Non-medicated pastilles + simple linctus
Avoid products containing sympathomimetic decongestants
How is vaginal discharge managed?
Common in pregnancy
Refer if itch, sore, offensive smell, pain on passing urine
How is thrush managed?
One week course of topical imidazole
Oral treatment AVOIDED
What is gestational hypertension?
BP >140/90 after 20 weeks of gestation without presence of proteinuria
What are the symptoms of gestational hypertension?
Oedema
Blurred vision
Upper abdominal pain
Nausea + vomiting
What is the definition of pre-eclampsia?
BP >140/90 after 20 weeks gestation with either
= proteinuria
= kidney/liver dysfunction
If increased risk of pre-eclampsia what is given?
75mg aspirin OD
What can gestational hypertension do?
Reduce blood flow to placenta = foetus receives less oxygen + nutrients
What are the drugs choices for gestational hypertension?
1st line = beta blocker Labetalol
What drugs do you avoid with gestational hypertension?
Diuretics
Atenolol
ACEi
AT II receptors
What is gestational diabetes?
Fasting plasma glucose level of 5.6mmol/L or above
OR 2-hour plasma glucose level of 7.8mmol/L or above
What is 1st line treatment for gestational diabetes?
Changes in diet
Regular exercise (walking 30mins after meal)
What is the only anti-diabetic drug that can be used in pregnancy?
Metformin
What is foetal alcohol syndrome?
Inadequate growth, facial defects, small head + mental retardation
What can alcohol lead to?
Foetal alcohol syndrome
Miscarriage
Low birth weight
What medications MUST be avoided?
Statins (stopped 3 months before conception)
Warfarin (swap to tinzaparin)
Isotretinoin (teratogenic)
Lithium
