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Pharmacology Flashcards

1
Q

Are many drugs licensed for pregnancy

A

NO
Little evidence for almost every drug
Therefore most are prescribed off license

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2
Q

What are the alternative to prescribing in pregnancy

A

Consider non-drug alternatives

e.g. CBT for depression or physio instead of painkillers

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3
Q

What are some general principles for prescribing in pregnancy

A

Lowest effective dose for shortest period
If benefit outweighs risk, prescribe
Older drugs have better safety records

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4
Q

Which drugs can cross the placenta

A

Majority can
small lipid soluble drugs cross fastest
Except large molecular weight drugs like heparin

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5
Q

How can morning sickness affect medication

A

Absorption may be reduced

Particularly in Hyperemesis Gravidarum

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6
Q

What is the effect of pregnancy on renal excretion

A

Increased GFR early on in pregnancy – renally excreted drugs tend to be excreted even more.
Eliminated faster

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7
Q

Which drugs may pregnant women be more sensitive to

A

Hypertensive agents

Can lead to hypotension - particularly in the 2nd trimester

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8
Q

What medications should be started before pregnancy

A

Folic acid 400mcg daily for 3 months prior and first 3 months of pregnancy
This is to prevent neural tube defects

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9
Q

What is the period of greatest teratogenic risk

A

4th -11th week is the critical period

Avoid drugs if at all possible unless maternal benefit outweighs risk to foetus

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10
Q

List common drugs which are teratogenic

A 
ACE inhibitors/ARB		
Androgens			
Antiepileptics			
Cytotoxics			 
Lithium				 
Methotrexate			
Retinoids	
Warfarin
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11
Q

What do common anti-epileptics do to a foetus

A

Cardiac, facial, limb, neural tube defects

Sodium valproate and phenytoin should be avoided

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12
Q

What does lithium do to a foetus

A

Cardiovascular defects

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13
Q

What effects can drugs have in the 2nd trimester

A

Can get intellectual impairment or behavioural abnormalities

It is the functional development that happens at this stage

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14
Q

What is the risk of giving non-steroidal around term

A

Can cause premature closure of DA

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15
Q

What effect do opiates have on a term baby

A

Opiates can cause respiratory depression and withdrawal syndrome later on

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16
Q

Which drugs can cause withdrawal syndromes in a new-born

A

Opiates

SSRIs

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17
Q

What happens to compliance in pregnancy

A

Often becomes poor as women stop taking it out of fear

Ideally discuss medication prior to conception so that its all safe and sorted

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18
Q

What are the risks of having seizures in pregnancy

A

Frequent seizures during pregnancy are associated with lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death

Therefore epileptics need to stay on some form of treatment

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19
Q

How much folic acid should be taken by a woman on anti-epileptics

A

5mg daily

20
Q

What are the risks of uncontrolled diabetes in pregnancy

A

increases risk of congenital malformations and intra-uterine death

21
Q

What diabetes drugs should be avoided in pregnancy

A

Sulfonylureas not safe

Convert patients to insulin

22
Q

Which hypertension drugs should be used in pregnancy

A

If need to treat, use one of Labetalol or Methyldopa

Avoid ACE inhibitors / ARB

23
Q

What naturally happens to BP in the second trimester

A

It falls

24
Q

What is the safest drug to use to treat N and V in pregnancy

A

cyclizine

25
Q

What should you use to treat UTIs in pregnancy

A

Nitrofurantoin, cefalexin, (3rd trimester – trimethoprim)

More prone to UTIs in pregnancy.

26
Q

By how much does pregnancy increase the risk of VTE

A

10x

27
Q

What is the leading cause of maternal death during pregnancy

A

VTE

28
Q

Should pregnant women get VTE prophylaxis

A

YES - if high risk

Give them LMWH

29
Q

How do you treat VTE in pregnancy

A

Treated with LMWH
Avoid warfarin in early pregnancy - teratogenic
Avoid in late pregnancy also - haemorrhage

30
Q

Can drugs get into breastmilk

A

Most do - especially small, fat soluble ones

Few enter in sufficient quantities to cause a problem

31
Q

Which drugs should be avoided in breastfeeding as they accumulate

A 
Phenobarbitone
Amiodarone 
Cytotoxics 
Benzos 
Bromocriptine
32
Q

Which drugs would be used to manage hyperemesis

A

Anti-emetics like cyclizine or prochlorperazine
Ondasentron is very effective but not as much data so 2nd line only
Would use thiamine alongside (usually for 1 week)
Put up to 5mg folic acid
Omeprazole to protect stomach
Fragmin to reduce clot risk

33
Q

What risk does ondansetron (anti-emetic) pose in pregnancy

A

Comes with a small risk of cleft palate in the foetus

Only used if nothing else works and benefit to mum outweighs cleft risk

34
Q

If a woman is on steroids throughout pregnancy, what precaution must be taken in labour and post-natally

A

Their natural stress hormone response will be suppressed by steroid treatment so they will need IV steroids in labour
Would then need to wean them off after delivery

35
Q

Which analgesics can be given in pregnancy

A

Paracetamol
Codeine (oral)
Stronger opiates such as morphine (ora or IV)
Just need to keep an eye on baby as they have had opiate exposure

36
Q

Which analgesics cannot be given in pregnancy

A

Cannot give NSAIDS
In early pregnancy they have been associated with renal atresia
In third trimester they can cause premature DA closure

37
Q

What caution must be taken when using biologics in pregnancy

A

Try and avoid in 3rd trimester as increased placental transfer so will affect foetus

38
Q

Which antibiotics would be used to treat PID in pregnancy

A

Ceftriaxone, metronidazole and doxycycline

39
Q

Which contraception can be put in place immediately after a C-section

A

Can insert a hormonal coil before closing

40
Q

When does breastfeeding act as a contraceptive

A

Only if exclusively breastfeeding, not having periods and baby is under 6 months

41
Q

What are the contraindications to placing a coil post C-section

A
  • Only time you wouldn’t put in the coil is if she is septic or has massive fibroids
42
Q

How soon after birth can mum start taking the combined pill

A

Can’t use combined pill when breastfeeding until at least 6 weeks post-natal
If not breastfeeding she would still need to wait 21 days due to clot risk

43
Q

What factors can affect drug levels in pregnancy

A

Increased blood volume (50% by 34 weeks)
Increased clearance (glomerular filtration rate (GFR) 50% by 24 weeks)
Increased hepatic metabolism
Vomiting
Decreased absorption
Non compliance
Fear of prescribing by medical professionals

Therefore dose adjustment is needed in some cases

44
Q

Which type of steroids are metabolised by the placenta

A

Non-fluoronated such as prednisolone or hydrocortisone
These are metabolised by the placenta so the foetus will get a lower dose

In contrast flurinated are not metabolised so foetal dose is equivalent to maternal dose

45
Q

How can steroid use in pregnancy affect the foetus

A

Long term, high dose steroids may increase the risk of preterm rupture of membranes

Reproduction (16 decks)

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