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(I) Symposium: Science Underpinning Practice, Low Yield > OBGYN > Flashcards

OBGYN Flashcards

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1
Q

What are the known teratogens we avoid in pregnancy.

A

Sodium valproate
Carbamazepine
Phenytoin
Warfarin

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2
Q

Exposure to a drug during the pre-embroyonic phase, which lasts until 17th day after conception will either result in survival of intact embryo or death.
(a) True
(b) False.

A

(a) True, known as all or nothing principle.

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3
Q

When is the foetal period and what takes places in this time.

A

56 days onwards organs such as the cerebral cortex and renal glomeruli continue to develop and are susceptible to damage.

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4
Q

Sodium valproate teratogenicity is dose dependent for example neural tube defects.
(a) True
(b) False.

A

(a) True

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5
Q

What is one role listed here that is not a key role of the placenta.
(a) Nutrition
(b) Excretion
(c) Immunity
(d) Endocrine
(e) Oxytocin

A

(e) Oxytocin.

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6
Q

What are the preferred characteristics when thinking about prescribing drugs to pregnant women.

A

Drugs with high molecular weight. Drugs that have high Vd- hydrophilic, ionised in nature.

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7
Q

What drugs are more likely to cross the placenta.

A

Non-ionised, lipid soluble drugs will cross in preference to polar ionised, hydrophilic drugs.

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8
Q

Which drug in this list does NOT cross the placenta.
(a) Diazepam
(b) Insulin
(c) Apixaban
(d) Phenytoin

A

(b) Insulin has a high molecular weight and is hydrophilic.

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9
Q

Which drug in this list does NOT cross the placenta.
(a) Warfarin
(b) Carbamazepine
(c) Enoxaparin
(d) Simvastatin

A

(c) Enoxaparin is large in molecular weight and is also ionised (negatively charged).

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10
Q

What are factors we consider when minimising the risk of drug use during pregnancy.

A
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11
Q

During pregnancy does absorption of drug: increase, decrease or remain the same. Explain reasoning.

A

Absorption of drug increases because cardiac output increases.

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12
Q

During pregnancy what is the drug distribution like concerning: plasma volume and total body water.

A

Plasma volume increases and total body water increase.

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13
Q

True or false: Drugs that have high liver extraction ratio will be metabolised at a greater rate in pregnant women.

A

True.

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14
Q

True or false: Drugs that are cleared renally may experience decrease clearance in pregnant women.

A

False, pregnant women have increased renal perfusion.

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15
Q

During pregnancy, why do women experience shortness of breath.

A

Lungs are being pushed up due to foetus int he uterine taking up more space.

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16
Q

What are the risk associated with an obese pregnant woman.

A

Higher rates of congenital abnormalities.
Increased risk of pre-eclampsia.
Increased risk of gestational diabetes (GDM).

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17
Q

What is the dose of units of Vitamin D recommended to obese pregnant women.

(a) 1000 UI
(b) 500 UI
(c) 1500 UI
(d) 1200 UI

A

(a) 1000 units per day are recommended

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18
Q

During pregnancy, what is the dose of folic acid recommended.

A

5 mg folic acid pre-pregnancy and first trimester.

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19
Q

True of false: During pregnancy, epilepsy monotherapy is recommended whenever possible.

A

True: Risk of malformations and possible neurodevelopmental impairment increase with higher doses, and with polytherapy.

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20
Q

During pregnancy, how are patient on lamotrigine managed. Are they still allowed to take it.

A

Monitoring levels and dose adjustment.
Increase the dose.

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21
Q

With women of child bearing age what additional counselling do you provide if they are on sodium valproate.

A

PPP: Make sure patient is on an effective contraceptive. Educate them that they need to stop valproate if they suspect their pregnant and report to healthcare professional.
Ensure patient card is provided every time valproate in dispensed.

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22
Q

Macrosomia develops when preganat mother has a case of
(a) Uncontrolled diabetes.
(b) Uncontrolled thyroid function
(c) Uncontrolled bipolar disorder
(d) Uncontrolled hypertension.

A

(a) Glucose is able to cross the placenta and this can lead to excessive around the neonate

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23
Q

What are the properties that drug should possess to be considered safer for breastfeeding mothers.

A
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24
Q

How would you manage gestational diabetes.

A

Consider insulin: rapid acting insulin (lispro, Aspart) and continuous insulin infusion therapy/basal insulin treatment (Glargine/Detemir).

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25
Q

What is the HbA1c target in pregnant women.

A

Below 6.5 %.

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26
Q

Can you continue pregnant woman of metformin….

A

Yes: benefits outweigh the risk.

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27
Q

Patient R has just found out that she is pregnant yesterday and comes to your ward for check up. You find out she is a type 1 diabetic woman who is on the following agents:
Lispro
Detemir
Ramipril 10 mg OD
Atorvastatin 20 mg OD- primary prevention atherosclerosis.

(a)What agents would you continue. (b) What agents would you discontinue.

A

(a) Basal-bolus insulin regime can be continued as insulin is not able to pass through the placenta.

(b) Discontinue Ramipril 10 mg OD (ACE-I& ARBs) as there is evidence it can cause renal problem in foetus in 2nd and 3rd trimester. Discontinue Atorvastatin (statins) as there is theoretical evidence that lowering cholesterol can have detrimental effect on foetus growth due to cholesterol inhibition.

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28
Q

When do discontinue ACE-I/ARBS/Statins

A

Before conception or as soon as pregnancy confirmed.

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29
Q

With pregnant women who have chronic condition of hypertension or CHD what are the drugs that can still be used/drugs that are avoided.

A
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30
Q

How is pre-eclampsia diagnosed.

A

Hypertension and proteinuria is both present.
Protein creatinine ratio.
24 hr urine collection.

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31
Q

How is preeclampsia treated.

A
32
Q

First line antihypertensive agent offered to woman during postnatal period for the management of chronic hypertension/Pre-eclampsia

A
33
Q

First line antihypertensive agent offered to black African woman during postnatal period for the management of chronic hypertension/Pre-eclampsia

A
34
Q

For women with hypertension in post natal period, if blood pressure is not controlled with single medicine, what do you consider. And if that option you recommended is not effective what is the next line.

A

Nifedipine and enalapril.
Not effective: add atenolol or labetalol or switch one of the medicine for atenolol or labetalol.

35
Q

In women who are breast-feeding what two drugs do you try to avoid as the it is expressed in the milk.

A

Diuretics
ARBs

36
Q

What anticoagulant is a no go zone when in pregnant women. Why is that the case.

A

Warfarin is teratogenic. Micro-haemorrhages have been reported in the brain.

37
Q

What prophylactic ages are used in management of VTE prophylaxis in pregnant women.

A

LMWH.

38
Q

Are DOACs safe in pregnant women.

A

Not recommended.

39
Q

In pregnant women who have HIV how would you manage their care.

A

Make sure the virus load is non detectable. Improve outcomes by avoid membrane rupture, deliver preferably >32/40 weeks.

40
Q

When HIV pregnant woman delivers her baby, how do we manage her baby.

A
41
Q

What is the treatment management for influenza in pregnant women.

A

Simple treatment: antipyretics (paracetamol); hydration.
Influenza vaccine.

42
Q

What medication is used to end ectopic pregnancy.

A

Methotrexate.

43
Q

What medication is used to terminate pregnancy.

A

Mefeprisone and Misoprostol.

44
Q

What is the FDA classification for this type of drug:
Some risk shown in animal studies but no human studies OR no animal or human studies – benefits may outweigh risks.

A

Category C.

45
Q

What is the FDA classification for this type of drug:
No risk shown in animal studies but no controlled studies in pregnant women OR some fetal risk in animal studies but no risk shown in human studies

A

Category B

46
Q

What is the FDA classification for this type of drug:
Animal or human data have demonstrated fetal harm

A

Category X

47
Q

Rivaroxaban peak plasma concentration is at 3 hrs. Patient KLM comes in and asks you if its okay for her to continue breastfeeding whilst on the DOAC. What would you say…

A

Yes she can still breastfeed as the drug is now being eliminated post peak absorption.

48
Q

High Vd produces: high or low levels of drugs in the breast milk.

A

Low.

49
Q

pKa of <7.2 doesn’t enter the breast milk: true or false.

A

True, the more ionic the drug the less capable of transferring from the maternal plasma to the milk.

50
Q

In patient group who are ultra rapid (a) enzyme their metabolism of codeine is rapid so they produce their active metabolite (b) sooner. In breastfeeding woman this could cause harm/no harm (c) to them.

A

(a) CYP2D6
(b) morphine
(c) harm- it can go into breast milk but it is for a certain subset of group—> North Africa, Ethiopia and Saudi Arabia.

51
Q

Atenolol is a water soluble, low protein binding drugs with half life 6-7 hours. Can it go into the breast milk.

A

Yes it is excreted in the breast milk: can potentially cause beta-2 blockade+hypoglycaemia in infants.

52
Q

True or False: Neonatal hypotension has been associated with Catopril and enalapril, and so generally ACE-I are avoided in breast feeding mothers.

A

(a) True.

53
Q

In breastfeeding what anti-epileptic drug requires careful monitoring.
(a) Carbamazepine
(b) Levetiracetam
(c) Lamotrigine
(d) Valporate

A

(c) Lamotrigine requires careful slow monitoring due to risk of sedation/rash in neonates. The rest of the anti-epileptic are fine in breast-feeding.

54
Q

Which drug can cause Reyes syndrome in neonates when breastfeeding.

A

Aspirin Note can be used at low dose 75 mg OD but is stopped if child has temperature or is unwell.

55
Q

What calcineurin inhibitor is still allowed in breastfeeding mothers.

A

Tacrolimus.

56
Q

What is the name of the drug that produces an active 6-MP metabolite that is still allowed to be used in breastfeeding even though low concentrations excreted in breastmilk.

A

Azathioprine.

57
Q

Which drug from this list stimulates breast milk production.
(a) Domperidone
(b) Bromocriptine
(c) Cabergoline
(d) Insulin

A

(a) Domperidone

58
Q

Which drug from this list suppresses lactation.
(a) Domperidone
(b) Bromocriptine
(c) Cabergoline
(d) Insulin

A

(b) +(c)

59
Q

Which ONE of statements are true for characteristics desired of a drug to be breastfeeding mother
(a) Milk to plasma ratio of greater than 1.5
(b) Milk to plasma ratio of less than 1
(c) Long half life
(d) Highly hydrophilic

A

(b) Milk plasma ratio less than 1 because it means more drug is in the plasma than in the milk.

60
Q

Which ONE of statement is false for the drug characteristics of drug to be given to breastfeeding mother
(a) Milk to plasma ratio of less than 1
(b) Short half life
(c) Low molecular
(d) High plasma binding (>90%)

A

(c) High MW usually means lower transfer to milk.

61
Q

Amikacin has pKa of 6.7 is it safe to give to a breastfeeding mother.

A

pKa less than 7.2 is preferred because it is ionised and less capable to transfer to milk.

62
Q

High Vd generally produces low milk levels.
True or False

A

True, high Vd means that drug has propensity to leave the plasma and enter extravascular compartments of the body. Whereas low Vd means more is in blood circulation and less distributed so it can likely enter into the breastmilk.

63
Q

Which of the following medicines is not safe to use during pregnancy.
(a) Paracetamol
(b) Gaviscon
(c) Labetolol
(d) Isotretinoin

A

(d)

64
Q

Which ONE of the following is NOT suitable for managing hypertension in breastfeeding mother.
(a) Labetalol
(b) Methyldopa
(c) Ramipril
(d) Amlodipine

A

(c) Ramipril (+ lisinopril, perinodopril are not suitable)

65
Q

Which ONE of the following populations are known as ultra-metabolisers of codeine and thus codeine should NOT be prescribed in woman who are breastfeeding
(a) African Americans
(b) Chinese
(c) Hispanics
(d) Saudi Arabians

A

(d) [ Active CYP2D6 gene duplications reached the highest frequencies of 28.3% and 10.4% in Algeria and Saudi Arabia].

66
Q

What is the first line agent for breastfeeding mother who is of an African origin.

A

CCB (nifedipine or amlodipine).

67
Q

Which ONE of the following agents is has to be MONITORED during breastfeeding.
(a) Carbamazepine
(b) Lamotrigine
(c) Levetiracetam
(d) Valproate
(e) Phenytoin

A

(b) Lamotrigine monitor serum concentration.

68
Q

Which ONE of the following agents should be AVOIDED during breastfeeding
(a) Lamotrigine
(b) Enalapril
(c) Pravastatin
(d) Methyldopa

A

(c)

69
Q

Which ONE of the following agents should be AVOIDED in breastfeeding mothers.
(a) Aspirin
(b) Insulin
(c) Catopril
(d) Metformin
(e) Tacrolimus

A

A. Aspirin should be avoided—> Reyes Syndrome [ tacrolimus=only 0.23% enter maternal milk]

70
Q

Which ONE of the following agents can be still given to breastfeeding mothers.
(a) Azathioprine
(b) Ramipril
(c) Codeine
(d) Perindopril

A

(a)

71
Q

What agent is given to pregnant women at high risk of pre-eclampsia.

A

75-100 mg Aspirin

72
Q

Which ONE is NOT recommended in treating pregnant women with chronic diabetes.
(a) Atrovastatin
(b) Metformin
(c) Lantus
(d) Insulin

A

(a) Statins are not recommended.

73
Q

Which ONE is NOT recommended in treating pregnant women with chronic diabetes.
(a) Ramipril
(b) Metformin
(c) Lantus
(d) Insulin

A

(a)ACE-inhibitors should be stop before conception and soon as pregnancy in confirmed (even enalapril)

74
Q

What is the treatment recommended for pre-eclampsia

A

Labetolol
Nifedipine
Methyldopa
Hydralazine
Magnesium sulphate

75
Q

Which ONE of the agents SHOULD be avoided during the post-natal period.
(a) Enalapril
(b) Nifedipine
(c) Amlodipine
(d) Spirnolactone
(e) Atenolol

A

(d)

76
Q

In pregnancy why is the albumin and red blood cell levels low.

A

In pregnancy plasma volume increases by 50% and red blood cells by 305 therefore there is physiological hemodilution. This hemodilution leads to decreased serum albumin levels beginning in the first trimester.

(I) Symposium: Science Underpinning Practice, Low Yield (5 decks)

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