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8. Perinatal psychiatry > Pharmacological treatment in pregnancy > Flashcards

Pharmacological treatment in pregnancy Flashcards

1
Q

Most vulnerable period for major infant malformations in relation to medication taken during pregnancy

A

6-10 weeks

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2
Q

Trimester in which drug doses may need to be increased

A

3rd trimester

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3
Q

General treatment principles used for schizophrenia in pregnancy

A

Antipsychotic treatment used throughout pregnancy
If patients already maintained on antipsychotic this is often not changed
Olanzapine often used

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4
Q

General treatment principles used for depression in pregnancy

A

Starting antidepressants is postponed to the 2nd trimester where possible
If a patient is on an antidepressant already with a high risk of relapse they are maintained on that antidepressant
CBT often tried first

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5
Q

General treatment principles used for bipolar affective disorder in pregnancy

A

Most patients who become pregnant on medication are maintained on their medication
Consider stopping mood stabilisers pre pregnancy for women who have been stable for a long time
Avoid valproate

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6
Q

Medications given if valproate or carbamazepine are given during pregnancy

A

5mg OD folic acid and prophylactic vitamin K

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7
Q

TCAs which should be given preferentially during pregnancy

A

Nortriptyline
Desipramine

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8
Q

SSRI which should not be used in pregnancy

A

Paroxetine

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9
Q

Increase in spontaneous abortion with maternal use of SSRIs

A

13.3%

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10
Q

Cardiac malformations linked to maternal use of paroxetine during pregnancy

A

VSD
ASD

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11
Q

SSRIs/SNRIs with the highest risk of neonatal withdrawal syndrome

A

Paroxetine
Venlafaxine

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12
Q

SSRI with the most evidence to suggest its safety in pregnancy

A

Fluoxetine

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13
Q

SSRI with the least placental exposure

A

Sertraline

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14
Q

Risk of infant malformation if lithium is used in the first trimester

A

10%

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15
Q

Increased risk of Ebstein’s anomaly with maternal use of lithium during pregnancy

A

10-20x increased

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16
Q

Absolute risk of Ebstein’s anomoly with maternal use of lithium during pregnancy

A

1 in 1000

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17
Q

Percentage risk of spina bifida in an infant with maternal use of carbamazepine during pregnancy

A

0.5-1%

18
Q

Most common abnormalities caused by maternal use of carbamazepine during pregnancy

A

Fingernail hypoplasia
Developmental delay
Craniofacial defects

19
Q

Most teratogenic mood stabiliser

A

Valproate

20
Q

Risk of birth defects with maternal use of valproate during pregnancy

A

7.2%

21
Q

Congenital anomalies caused by maternal use of valproate during pregnancy

A

Neural tube defects
Digit and limb defects
Congenital cardiac disease - VSD, pulmonary stenosis
Urogenital malformations including hypospadias
Low birth weight

22
Q

Most common adverse effect of maternal use of valproate in pregnancy

A

Low IQ in the child

23
Q

Congenital defect seen with maternal use of lamotrigine during pregnancy

A

Cleft palate

24
Q

Congenital abnormalities seen with maternal use of benzodiazepines during pregnancy

A

Oral cleft malformation
Urinary tract malformation

25
Q

Monitoring requirements for pregnant women remaining on lithium

A

Level taken every 4 weeks

26
Q

Dose requirements for pregnant women remaining on lithium

A

Increased dose required in third trimester
Dose requirement rapidly goes back to usual after delivery

27
Q

Antipsychotic most often used to treat schizophrenia during pregnancy

A

Olanzapine

28
Q

Ultrasound and ECHO monitoring required when lithium is used in pregnancy, to screen for Ebstein’s anomaly

A

6 weeks gestation
18 weeks gestation

29
Q

Risks to infant of SSRI use during pregnancy

A

Neonatal irritability
Spontaneous abortion
Premature birth
Reduced birth weight

30
Q

Risk of neural tube defect when valproate is used during pregnancy

A

1%

31
Q

Physiological change during pregnancy which leads to the most risk during ECT

A

Delayed gastric emptying

32
Q

Risk relating to delayed gastric emptying when giving ECT while pregnant

A

Aspiration

33
Q

Neurocognitive function most affected in children exposed to valproate during pregnancy

A

Verbal IQ

34
Q

Prevalence of Ebstein’s anomoly in the general population

A

1 in 20000

35
Q

Where valproate treatment is deemed necessary in pregnancy, maximum dose limit

A

1000mg/day

36
Q

Drug class which can cause persistent pulmonary hypertension in the infant when taken in late pregnancy

A

SSRIs

37
Q

Antidepressant recommended first line for a pregnant woman

A

Sertraline

38
Q

Infant effects of benzodiazepine use during pregnancy

A

Urinary tract malformations
Oral cleft/malformations
Floppy baby syndrome

39
Q

First line medication for insomnia during pregnancy

A

Promethazine

40
Q

Drugs associated with Ebstein’s anomoly

A

Lithium
Benzodiazepines

41
Q

Monitoring of lithium levels required if continued through pregnancy

A

Monthly until 36 weeks
Weekly after 36 weeks

8. Perinatal psychiatry (4 decks)

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