Pharmacology - Drug treatment in pregnancy, breastfeeding and the neonate Flashcards
what happens to gastric emptying for oral preparations in pregnancy
a.delayed
b.accelerated
a.delayed
what happens to concentrations of lipid and water soluble drugs in pregnancy
a.increase
b.decrease
b.decrease
total body water and fat increase so drug spread over a larger volume
what happens to drug protein binding in pregnancy
a.increase
b.decrease
b.decrease
increased free (active) drug concentrations
what happens to the clearance of drugs that depend on liver enzyme activity in pregnancy eg phenytoin and theophylline
a.increased clearance
b.decreased clearance
a.increased clearance
increased renal plasma flow in pregnancy has what effect on the elimination of renally cleared drugs eg penicillins
a.increased elimination
b.decreased elimination
a.increased elimination (doubles)
factors influencing placental transfer
lipid/water solubility
molecular size
protein binding
metabolism
which type of molecule passes the placenta most easily
a.large,lipid soluble,unbound , non polar
b.small, lipid soluble, unbound, non polar
c.large, water soluble, bound , polar
d.small, water soluble, unbound , polar
b.small, lipid soluble, unbound, non polar
which drugs effect blastocyst formation at 0-16 days
a.cytotoxic/ alcohol
b.teratogens
c.alcohol, nicotine,radioactive iodine, corticosteroids
a.cytotoxic/ alcohol
which drugs effect organogenesis day 17-60
a.cytotoxic/ alcohol
b.teratogens
c.alcohol, nicotine,radioactive iodine, corticosteroids
b.teratogens
which drugs effect cell and organ maturation day 60 days- term
a.cytotoxic/ alcohol
b.teratogens
c.alcohol, nicotine,radioactive iodine, corticosteroids
c.alcohol, nicotine,radioactive iodine, corticosteroids
which drugs should be avoided in pregnancy
(7As and DMARDS)
ACEi / ARBS
Anticonvulsants - phenytoin, carbamazepine
Antibiotics - tetracyclines, trimethoprim, metronidazole
Antipsychotics - lithium
Antithyroid - carbimazole, propylthiouracil
Anticoagulant - warfarin, DOACS
Abuse - alcohol, opioids , cigarettes
DMARDS- methotrexate
administration during which trimester has the greatest risk
a.first
b.second
c. third
a.first
what was caused by taking thalidomide during pregnancy
a. phocomelia
b.dwarfism
c. trisomy 18
a. phocomelia
prescribing during which trimester should be AVOIDED unless exceptional circumstances
a.first
b.second
c.third
a.first
what should be used instead of ACEi in pregnancy
a.propanolol
b.timolol
c.sotalol
d.labetalol
d.labetalol
what is given first line to treat nausea and vomiting in pregnancy
a.promethazine
b.labetalol
c.prednisolone
d.metoclopamide
a.promethazine
what is given 2nd line to treat nausea and vomiting in pregnancy
a.promethazine
b. labetalol
c.prednisolone
d.metoclopamide
d.metoclopamide
if poor response to first line after 24 hr reassessment
what should be given for asthma in pregnancy
a.inhalers
b. ACEi
c.promethazine
a.inhalers
prednisolone ok if needed
which drug should be given for hypertension in pregnancy
a.metoclopamide
b.propanolol
c. warfarin
d.labetalol
d.labetalol
which drug should be given for hypertension in pregnancy
a.metoclopamide
b.propanolol
c. warfarin
d.labetalol
d.labetalol
first line antibiotic for UTIs in pregnancy
a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin
b.nitrofurantoin
second line antibiotic for UTIs in pregnancy
a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin
c. amoxicillin
or cefalexin
which of these are relatively safe anticoagulants in pregnancy
a.heparin
b.warfarin
c.DOACs
a.heparin
AVOID other 2
what is more of a risk in pregnancy and so referral to a specialist is required
a. anticonvulsants
b.seizures
b.seizures
both risky
drugs which should be prescribed with caution in breastfeeding
dont always like icecream on tasty cakes
diazepam
alcohol
lithium
iodine
opiods
tetracyclines
corticosteroids
dont always like icecream on tasty cakes
absorption of topical agents eg steroids is .. in neonates
a.increased
b.decreased
a.increased
intramuscular absorption is…….. in neonates
a.increased
b.decreased
b.decreased
reduced muscle mass
rectal absorption eg of diazepam , theophyllines in neonates is …
a.increased
b.decreased
c.efficient
c.efficient
in older children body water % is greater so loading dose for aminoglycosides, digoxin , aminophylline is ……….. (based on body weight)
a.greater
b.lower
a.greater
in neonates albumin binding is …………………….. increasing risk of drug billirubin interactions
a.increased
b.decreased
b.decreased
impaired oxidation in neonates increases the concentration of which drugs
a.metoclopamide and promethazine
b. nitrofurantoin and cefalexin
c.warfarin , diazepam and theophylline
d.warfarin and DOACS
c.warfarin , diazepam and theophylline
impairment of what process leads to increased risk of toxicity of drugs metabolised this way eg chloramphenicol
a.oxidation
b.reduction
c.metabolism
d.glucoronidation
d.glucoronidation
a reduction in dose of renally cleared drugs based on body weight due to reduced GFR in neonates is applicable to which drugs
a.aminoglycosides, aminophylline, digoxin
b.promethazine, metoclopamide
c.warfarin, diazepam , theothylline
d.penicillins , digoxin , aminoglycosides
d.penicillins , digoxin , aminoglycosides
grey baby syndrome is associated with increased serum levels of which drugs in neonates
a.diazepam
b.warfarin
c.theophylline
d.digoxin
e.chloramenphicol
e.chloramenphicol
at what point is renal function normal and so normal doses based on body weight can be used
a.3 months
b.4 months
c.5 months
d.6 months
d.6 months
faster than normal oxidation leads to what effect
a.exagerrated / toxic responses
b.failure to respond to standard doses
c.acute haemolysis following treatment with number of drugs
d.prolonged apnoea
b.failure to respond to standard doses
slower than normal oxidation leads to what effect
a.exagerrated / toxic responses
b.failure to respond to standard doses
c.acute haemolysis following treatment with number of drugs
d.prolonged apnoea
a.exagerrated / toxic responses
glucose 6 phosphate dehydrogenase defficiency leads to what effect
a.exagerrated / toxic responses
b.failure to respond to standard doses
c.acute haemolysis following treatment with number of drugs
d.prolonged apnoea
c.acute haemolysis following treatment with number of drugs
pseudocholinesterase leads to what effect
a.exagerrated / toxic responses
b.failure to respond to standard doses
c.acute haemolysis following treatment with number of drugs
d.prolonged apnoea
d.prolonged apnoea
rules for prescribing in neonates
dose based on body SA
paediatric formulary
special adjustements especially if premature
avoid new drugs
all women 13-60 should be presumed pregnant until proven otherwise
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