Meds in pregnancy + BG

Question 1

Venlafaxine

Answer 1

B2

Question 2

C - may have or be suspected of causing harmful effects without malformations, may be reversible

Answer 2

Sertraline
Citalopram
Fluoxetine

Question 3

Effects of drugs on pregnancies (generic)

Answer 3

3-8 weeks post conception = organogenesis

Miscarriage
Structural anomalies
IUGR/LBW
Preterm birth

Neonatal toxicity + withdrawal
PN developmental affects on cognition

Question 4

Lithium

Answer 4

Mood stabiliser, class D (irreversible damage, only to be used if other meds ineffective)

Cardiac anomalie - Ebstein anomaly, tricuspid vavlve/RV affected, goes from 1 in20 000 baseline to 1 in 1000.

PN effects: low apgars, apnea, brady or tachy, cadiac arrythmias, feeding difficulties, lethargy or oma, poor suck/grasp/Moro, seizures

Question 5

Neonatal toxicity and withdrawal (all antipsyhotics)

Answer 5

AbN movements (dyskinesia)
AbN tone
Agitation
Crying
Hyperactivity
Hyperreflexia
Irritability
Motor restlessness
Sedation
Tremor
Hypotension
Tachycardia
Difficulties feeding/breathing
GI dysfunction

Question 6

Sodium valproate

Answer 6

Anticonvulsant/mood stabilizer
All class D except leviteracetam 

Increased malformations: NTD, orofacial, congenital
Minor: fetal anticonvulant syndrome: dysmorphic, broad nasal bridge, hypertelorism, hypoplastic nails, hypoplastic mid face

Requced IQ, poor language, autism, ADHD

Question 7

Anticonvulsants

Answer 7

All D except leviteracetam B3

d - irreversible damage
B3 - possible animal fetal damage, unclear re humans

Question 8

A
B
C
D

Answer 8

A - tried in lots of pregnant women and okay
B - limited (1-limited numbers humans, no effect animals, 2-few animal studies only, no effect 3-some effect animals ?humans)
C - reversible human issues
D - irreversible
X - risk outweighs benefit

Question 9

SSRIs

Answer 9

All class C except paroxetine is D
C-harmful effects  without malformations 

Persistent pulmonary hypertension of newborn
Congenital malformation
Poor neonatal adaption syndrome