Perinatal Mental Health (John Lawton) Flashcards
What is the most common psychoactive drug taken during pregnancy?
Caffeine - stimulant, potentially addictive, can cause withdrawal symptoms
What are the side effects of caffeine?
Agitation Depression Inc HR and BP Weight gain Muscle aches Insomnia Ulcers Oesophageal problems
What risks are associated with not treating mental health problems in pregnancy?
Pregnancy complications
Maternal complications
Relapse
What are the problems associated with depression in pregnancy?
Missed appointments Poor habits / diet Self harm Neglect Use of smoking, alcohol / illicit substances
What should be considered in deciding on treatment during pregnancy?
Which drug, previous response, safety, dose (lowest and shortest time). Chance of relapse if medication is discontinued.
What is monitored during pregnancy if medication is necessary?
Dose, foetal screening, hepatic enzymes, monitoring the neonate
What is a period of gestation and when is it recommended?
First trimester
Period of non treatment because teratogenic risk greatest
Why is poly-pharmacy contraindicated?
Increased risk of teratogenicity
Which antidepressants are associated with lower risk?
Sertraline
Which antipsychotics are associated with lower risk?
Chlorpromazine, trifluoperazine, haloperidol
Olanzapine
Which hypnotics are associated with lower risk?
Promethazine
What general advice would you give to a patient taking anti-depressive medication that is newly pregnant?
Personalised assessment of benefit and risk needed
Do no abruptly discontinue medication
Without clear evidence then the best option is not to switch.
What is generally done if medication is required?
Lowest risk medication is chosen
Regularly review and rationalise choices
What are anti-psychotics monitored for during pregnancy?
Alterations in foetal growth
Monitoring for blood glucose abnormalities where olanzapine or clozapine is prescribed.
Which drugs should be avoided in pregnancy?
Valproate - foetal abnormality and adverse neurodevelopment
As a result, it should not be given to women of child bearing age; an alternative is needed with increased folic acid.
How can drug pharmacokinetics be manipulated?
Avoid breastfeeding at the Tmax of the drug
What form of compounds are retained in milk / accumulate?
Basic compounds because breast milk is > acidic that plasma.
What effect does half life have on breast milk content?
Short T1/2 is ok
Long half life means can accumulate in breast milk - avoid slow release or depot injections.
How can Mw effect drug concentration in breast milk?
Small molecular weight can cross easier
Choosing high Mw is preferable
What are the prescribing considerations in breastfeeding?
Avoid premature or low birth weight Avoid new drugs Side effect profile Half life of the drug Sedating medication advice Reference source (specialist advice)
Which drugs should be avoided in pregnancy?
Fluoxetine
Clozapine
Lithium
BZD
