medications and situations Flashcards
What to talk about when a woman is pregnant
Explore re: partner, be aware if he also has psych illness, to give genetic counselling
Discuss about issues with medication, evidence are limiting but reassuring
Impact of untreated mental disorder on patient and baby
discuss that pregnancy is a risk factor for relapse of psychosis/bipolar/depression
Explain the mental health of the mother influences foetal well‐being, obstetric outcome and child development.
What to say when one person say can she stop this meds
Usually the study are limited but reassuring
There is not of study but mostly in larger size study, there seem to be no conclusive evidence of a direct link
This results could be a false positive, or due to cofounder factors, or could be indirectly link to the maternal depression.
We still need to weight the pros and cons, and if the patient is still very stable with tis medication, i would strongly advises against switching as a relapse might cause even more detrimental effect to the the patient and the baby.
Antipsychotics in pregnancy
typical and atypical
Typical: considered to have minimal risk, ?pre-term birth, low birth weight, but not conclusive, ?withdrawal eg agitation, abnormal inc or dec in muscle tone, tremor, sleepiness
atypical: unlikely major risk, gestational diabetes, increased birth weight, withdrawal as above
olanzapine: ?large head circumference, inc gestational diabetes, class c (some adverse effect on animal fetus but nil evidence in humans)
Clozapine, nil risk of malformation, but gestational diabetes and neonatal seizures may be more likely to occur
(class B, ni risk to animal and nil study abut risk in humans)
drug induce hyperprolactinemia may prevent pregnancy, need to switch
NICE recommend to avoid IM, and try oral if possible
Antidepressant in pregnancy
TCA
TCAs have been widely used throughout pregnancy without apparent detriment to the foetus
serotonin withdrawal symptoms: irritability, lethargy, seizure, endocrine and metabolic disturbances, usually mild and self limiting
can inc risk of preterm delivery
SSRI
Not major teratogens
may cuz pulmonary hypertension (late pregnancy), clubfoot, anencephaly, spontaneous abortion
Paroxetine specifically associated with cardiac malformations (class D)
SNRI
venlafaxine is associated with cardiac defects, cleft palate, neonatal withdrawal, poor neonatal adaption syndrome
bupropion can cause ADHD, slight elevated risk of ventricular septal effects
No data for mirtazapine, trazodone
Mood stabilizer for pregnancy
Lithium associated with Epstein’s anomaly, issues with monitoring
toxicity in breatfeeding lithium level during pregnancy as toatl body water inc
NICE suggest lithium to be monitored every 4 weeks until 36 weeks and weekly after, need to stop during labor, and check plasma level 12 hours after her last dose
valproate carbamazepine not good
Lamotrigine quite safe
ADHD Meds for pregnancy and breast feeding
Methylphenidate is not a major teratogen
ADHD drugs, methylphenidate undetectable
Sedatives for pregnancy
breastfeeding
benzodiazepine associated with inc risk of oral cleft in newborns
Will lead to caesarean delivery, low birth weight, neonatal ventilory support, pre term delivery, small for gestational age baby
If give during 3rd trimester: floppy baby
promethazine not teratogenic, but data are limited
The acute use of short‐acting benzodiazepines such as lorazepam and of the sedative antihistamine promethazine is unlikely to be harmful.
Women receiving sedating medication should be strongly advised not to breastfeed in bed as they may fall asleep and roll onto the baby, with a potential risk of hypoxia to the baby.
best avoid sedatives, lorazepam may be considered as its short acting
Antipsychotics and antidepressant for breastfeeding
Antidepressant: sertraline, mirtazapine , usually advisable to cont drug tat has been used
Fluoxetine has highest reported level among ssri
TCA not bad
Antipsychotic are acceptable as well, except clozapine, can consider olanzapine/quetiapine
