Perinatal

Question 1

Lithium risks pregnancy

Answer 1

Epstein anomaly (2x risk vs gen population)
Floppy baby syndrome

Question 2

Epival risks pregnancy

Answer 2

5% neural tube defects
Low IQ
Autism

Question 3

Lamictal risks pregnancy

Answer 3

Low risk clef palate

Question 4

Carbamazpine risks pregnancy

Answer 4

11% craniofacial malformation
2.9% cardiac defect
1% spinal bifida
20% developmental delay

Question 5

Benzo risks pregnancy

Answer 5

Cleft palate, low birth weight, prematurity, low APGAR, withdrawal syndrome, floppy baby syndrome

Prioritize bzds w short/int half life and w/o active metabolites
Ok for PRN/short term use

Question 6

Preferred bzd in pregnancy

Answer 6

Ativan or serax (oxazepam)

-less lipophilic, short/med half life, no active metabolites

Question 7

ATD that pass least in breastmilk

ATD preferred in guidelines (2nd line)

Answer 7

1- Paroxetine, Sertraline, Fluvoxamine

2- Citalopram, escitalopram, sertraline

Question 8

AP that pass least in breastmilk

Answer 8

Quetiapine, olanzapine

Question 9

Incidence of:
-Post-partum blues
-Depression
-Psychosis

Answer 9

Blues: 30-75%
Depression: 10-15%
Psychosis: 0.1-0.2%

Question 10

Onset of:
-Post-partum blues
-Depression
-Psychosis

Answer 10

Blues: 3-5d PP
Depression: 3-6mo
Psychosis: 2-3 weeks, almost always within 8w