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GERR > Pharmacology - Drug treatment in pregnancy, breastfeeding and the neonate > Flashcards

Pharmacology - Drug treatment in pregnancy, breastfeeding and the neonate Flashcards

1
Q

what happens to gastric emptying for oral preparations in pregnancy

a.delayed
b.accelerated

A

a.delayed

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2
Q

what happens to concentrations of lipid and water soluble drugs in pregnancy

a.increase
b.decrease

A

b.decrease

total body water and fat increase so drug spread over a larger volume

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3
Q

what happens to drug protein binding in pregnancy

a.increase
b.decrease

A

b.decrease

increased free (active) drug concentrations

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4
Q

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

a.increased clearance

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5
Q

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

a.increased elimination (doubles)

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6
Q

factors influencing placental transfer

A

lipid/water solubility
molecular size
protein binding
metabolism

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7
Q

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

A

b.small, lipid soluble, unbound, non polar

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8
Q

which drugs effect blastocyst formation at 0-16 days

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

A

a.cytotoxic/ alcohol

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9
Q

which drugs effect organogenesis day 17-60

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

A

b.teratogens

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10
Q

which drugs effect cell and organ maturation day 60 days- term

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

A

c.alcohol, nicotine,radioactive iodine, corticosteroids

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11
Q

which drugs should be avoided in pregnancy

(7As and DMARDS)

A

ACEi / ARBS
Anticonvulsants - phenytoin, carbamazepine
Antibiotics - tetracyclines, trimethoprim, metronidazole
Antipsychotics - lithium
Antithyroid - carbimazole, propylthiouracil
Anticoagulant - warfarin, DOACS
Abuse - alcohol, opioids , cigarettes
DMARDS- methotrexate

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12
Q

administration during which trimester has the greatest risk

a.first
b.second
c. third

A

a.first

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13
Q

what was caused by taking thalidomide during pregnancy

a. phocomelia
b.dwarfism
c. trisomy 18

A

a. phocomelia

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14
Q

prescribing during which trimester should be AVOIDED unless exceptional circumstances

a.first
b.second
c.third

A

a.first

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15
Q

what should be used instead of ACEi in pregnancy

a.propanolol
b.timolol
c.sotalol
d.labetalol

A

d.labetalol

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16
Q

what is given first line to treat nausea and vomiting in pregnancy

a.promethazine
b.labetalol
c.prednisolone
d.metoclopamide

A

a.promethazine

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17
Q

what is given 2nd line to treat nausea and vomiting in pregnancy

a.promethazine
b. labetalol
c.prednisolone
d.metoclopamide

A

d.metoclopamide

if poor response to first line after 24 hr reassessment

18
Q

what should be given for asthma in pregnancy

a.inhalers
b. ACEi
c.promethazine

A

a.inhalers

prednisolone ok if needed

19
Q

which drug should be given for hypertension in pregnancy

a.metoclopamide
b.propanolol
c. warfarin
d.labetalol

A

d.labetalol

20
Q

which drug should be given for hypertension in pregnancy

a.metoclopamide
b.propanolol
c. warfarin
d.labetalol

A

d.labetalol

21
Q

first line antibiotic for UTIs in pregnancy

a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin

A

b.nitrofurantoin

22
Q

second line antibiotic for UTIs in pregnancy

a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin

A

c. amoxicillin

or cefalexin

23
Q

which of these are relatively safe anticoagulants in pregnancy

a.heparin
b.warfarin
c.DOACs

A

a.heparin

AVOID other 2

24
Q

what is more of a risk in pregnancy and so referral to a specialist is required

a. anticonvulsants
b.seizures

A

b.seizures

both risky

25
Q

drugs which should be prescribed with caution in breastfeeding

dont always like icecream on tasty cakes

A

diazepam
alcohol
lithium
iodine
opiods
tetracyclines
corticosteroids

dont always like icecream on tasty cakes

26
Q

absorption of topical agents eg steroids is .. in neonates

a.increased
b.decreased

A

a.increased

27
Q

intramuscular absorption is…….. in neonates

a.increased
b.decreased

A

b.decreased

reduced muscle mass

28
Q

rectal absorption eg of diazepam , theophyllines in neonates is …

a.increased
b.decreased
c.efficient

A

c.efficient

29
Q

in older children body water % is greater so loading dose for aminoglycosides, digoxin , aminophylline is ……….. (based on body weight)

a.greater
b.lower

A

a.greater

30
Q

in neonates albumin binding is …………………….. increasing risk of drug billirubin interactions

a.increased
b.decreased

A

b.decreased

31
Q

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

A

c.warfarin , diazepam and theophylline

32
Q

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

A

d.glucoronidation

33
Q

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

A

d.penicillins , digoxin , aminoglycosides

34
Q

grey baby syndrome is associated with increased serum levels of which drugs in neonates

a.diazepam
b.warfarin
c.theophylline
d.digoxin
e.chloramenphicol

A

e.chloramenphicol

35
Q

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

A

d.6 months

36
Q

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

A

b.failure to respond to standard doses

37
Q

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

a.exagerrated / toxic responses

38
Q

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

A

c.acute haemolysis following treatment with number of drugs

39
Q

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

A

d.prolonged apnoea

40
Q

rules for prescribing in neonates

A

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

41
Q

al

A

GERR (53 decks)

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