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S3 Case 3 - Sexual Health > Medication use in Pregnancy > Flashcards

Medication use in Pregnancy Flashcards

1
Q

What is a teratogen?

A

Agent which causes developmental abnormality in an embryo or foetus

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2
Q

What is an example of a serious teratogen?

A

Sodium valproate

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3
Q

What is the lowest risk of epilepsy medications?

A

Gabapentin
Levetiracetam
Clonazepam
Lamotrigine

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4
Q

How is epilepsy managed in pregnancy?

A

Specialist referral required
Dose adjustments = switch from sodium valproate
= dose reduction/withdrawal if seizures well controlled

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5
Q

What effect does drugs have in the 1st trimester?

A

Drugs produce congenital malformations

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6
Q

What effect does drugs have during 2nd + 3rd trimester?

A

Affect growth/functional developmental of foetus
Have toxic effect on foetal tissues

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7
Q

What should pregnant women be vaccinated for?

A

Rubella
Varicella
Hepatitis B if at risk of contracting it

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8
Q

What are examples of drugs that affect the foetus?

A

ACEi
Antimetabolites
Benzodiazepines
Carbamazepine
Warfarin
Lithium
Penicillamine
Phenobarbital
Phenytoin
Tetracycline
Thalidomide
Valproic acid

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9
Q

What is 1st line for morning sickness?

A

Lifestyle changes - sleep hygiene, regular meals, avoid fatty foods, plenty of fluids

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10
Q

What is 2nd line for morning sickness?

A

Antihistamines
eg. cyclizine, promethazine

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11
Q

What is problem with Ondansetron?

A

Can cause cleft lip if used in 1st trimester

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12
Q

Why should women be advised to take folic acid?

A

Reduce likelihood of baby having neural tube defect

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13
Q

What are the NICE guidelines for folic acid?

A

400mcg OD before pregnancy + throughout 1st 12 weeks

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14
Q

Why does GP prescribe 5mg of folic acid?

A

If family history of NTD
Have diabetes, sickle cell anaemia or thalassaemia
Women taking anti-epileptic medication
Woman obese (BMI>30kg)

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15
Q

What else should women be advised to take?

A

VitD 10mcg throughout pregnancy + after if they are breastfeeding

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16
Q

What is the advice on weight?

A

Overweight or obese to lose weight before becoming pregnant

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17
Q

What risks are there being associated with being obese?

A

Neural tube defects
Heart defects
Cleft palate/cleft lip
Limb reduction abnormalities

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18
Q

What is the advice on smoking?

A

Stop smoking prior
= increased risk of miscarriage
AVOID NRT

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19
Q

What is the advice about alcohol?

A

Avoid drinking alcohol due to risk of foetal alcohol spectrum disorder

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20
Q

What advice about OTC?

A

Advised to speak to pharmacist before taking any OT products

21
Q

Should you take herbal remedies?

A

NO

22
Q

What can VitA cause?

A

Congenital defects

23
Q

Should Fe be supplied?

A

No = unpleasant maternal side effects

24
Q

When calculating anti-coagulant dose what weight do you use?

A

Pre-pregnancy weight

25
Q

What Tinzaparin sodium should be used in pregnancy?

A

Formulations without benzyl alcohol (syringes)

26
Q

What do you need to try and do in 1st trimester with medications?

A

Avoid all drugs
= balance risk of disease
= consider non-drug treatment first
= lowest effective dose

27
Q

How is asthma managed?

A

Take medication as prescribed in order to keep asthma well controlled
Requires little modification

28
Q

How is diabetes managed?

A

Oral hypoglycaemic drugs carry risk of teratogenesis + prolong neonatal hypoglycaemia
Switched to insulin

29
Q

How is RA managed?

A

Refer to rheumatologist
Especially if taking NSAIDs + DMARDs

30
Q

How is gastro-oesophageal reflux managed?

A

Some OTC antacid licensed for pregnancy
Avoid antacids with high Na+
OTC H2 antagonists not licensed

31
Q

What is the non-pharmacological management of gastro-oesophageal reflux?

A

Not eat late in the day
Use extra pillows at night to sleep
Avoid chocolate + coffee

32
Q

How is constipation + haemorrhoids managed?

A

Increase fluid + fibre intake
Bulk-forming laxatives + lactulose

33
Q

How are coughs + colds managed?

A

Non-medicated pastilles + simple linctus
Avoid products containing sympathomimetic decongestants

34
Q

How is vaginal discharge managed?

A

Common in pregnancy
Refer if itch, sore, offensive smell, pain on passing urine

35
Q

How is thrush managed?

A

One week course of topical imidazole
Oral treatment AVOIDED

36
Q

What is gestational hypertension?

A

BP >140/90 after 20 weeks of gestation without presence of proteinuria

37
Q

What are the symptoms of gestational hypertension?

A

Oedema
Blurred vision
Upper abdominal pain
Nausea + vomiting

38
Q

What is the definition of pre-eclampsia?

A

BP >140/90 after 20 weeks gestation with either
= proteinuria
= kidney/liver dysfunction

39
Q

If increased risk of pre-eclampsia what is given?

A

75mg aspirin OD

40
Q

What can gestational hypertension do?

A

Reduce blood flow to placenta = foetus receives less oxygen + nutrients

41
Q

What are the drugs choices for gestational hypertension?

A

1st line = beta blocker Labetalol

42
Q

What drugs do you avoid with gestational hypertension?

A

Diuretics
Atenolol
ACEi
AT II receptors

42
Q

What is gestational diabetes?

A

Fasting plasma glucose level of 5.6mmol/L or above
OR 2-hour plasma glucose level of 7.8mmol/L or above

43
Q

What is 1st line treatment for gestational diabetes?

A

Changes in diet
Regular exercise (walking 30mins after meal)

44
Q

What is the only anti-diabetic drug that can be used in pregnancy?

A

Metformin

45
Q

What is foetal alcohol syndrome?

A

Inadequate growth, facial defects, small head + mental retardation

46
Q

What can alcohol lead to?

A

Foetal alcohol syndrome
Miscarriage
Low birth weight

47
Q

What medications MUST be avoided?

A

Statins (stopped 3 months before conception)
Warfarin (swap to tinzaparin)
Isotretinoin (teratogenic)
Lithium

S3 Case 3 - Sexual Health (11 decks)

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