Prescribing in pregnancy, breastfeeding, children + miscellaneous topics

Question 1

MHRA - drugs with teratogenic potential

Answer 1

Use highly effective contraception

• Copper IUD OR levonorgestrel IUD
• Progestogen only implant (3 years)

Question 2

Teratogenic drugs

Answer 2

avoid esp during first trimester

• Valproate - PPP
• Isotretinoin - PPP
• Methotrexate + trimethoprim (anti-folate)
• Statin
• Tetracycline
• Warfarin
• Finasteride
• Carbimazole
• ACEi/ARB

Question 3

Drugs present in milk

Answer 3

• Aspirin
• Benzo
• Codeine
• Nasal decongestants
• Antihistamines

Question 4

Drugs that inhibit infants suck reflex

Answer 4

Phenobarbital

Question 5

Drugs that inhibit lactation

Answer 5

Bromocriptine

Question 6

Prescribing in children: hepatic impairment

Answer 6

Caution in preterm neonates + infants - liver enzymes immature

Question 7

Prescribing in children: sugar in liquid med

Answer 7

• Unsuitable in diabetics
• SUGAR-FREE: no fructose, sucrose or glucose

Question 8

Prescribing in children: injections

Answer 8

Avoid IM

• Benzyl alcohol in neonates = fatal toxic syndrome
• Lactose in med - avoid in severe intolerance

Question 9

Miscellaneous topics: continuous sc infusion

Answer 9

• CI: prochlorperazine, chlorpromazine, diazepam
• Standard diluent: water for injection
• Saline 0.9% if irritating drugs or inflammatory reactions at injection site