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MY REVISION - PSA > PREGNANCY > Flashcards

PREGNANCY Flashcards

1
Q

TERATOGENICITY
which drugs are known teratogens?

A
  • ACEi and ARBs
  • cytotoxic agents
  • sex hormones, progestogens + oestrogens
  • lithium salts
  • thalidomide
  • warfarin
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2
Q

TERATOGENICITY
what is the most vulnerable time for exposure?

A

during 1st trimester

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3
Q

PHARMACOKINETICS
which contraceptive options are ineffective with enzyme inducers e.g. carbamazepine?

A

COCP
POP
progestogen only implant

alternative options = copper IUD, levonorgestrel-releasing IUS or depo injection

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4
Q

PHARMACOLOGY

A

copper IUD,
levonorgestrel-releasing IUS
depo injection

if they want to continue oral contraception they will require at least 50 micrograms of ethinylestradiol either continuously or tri-cycling

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5
Q

what are the considerations for safe prescribing in pregnancy?

A
  • is the drug necessary (avoid systemic antibacterials in acne)
  • where possible avoid medicines in 1st trimester
  • avoid drugs that are known to be harmful
  • avoid new medicines due to lack of safety data
  • avoid polypharmacy as the risk of harm is increased
  • consider adjusting dosage based on maternal physiology and pharmacokinetics (important for drugs with narrow therapeutic range)
  • advise against OTC medications
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6
Q

ANALGESIA
is paracetamol safe during pregnancy?

A
  • short courses + occasional use is considered safe
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7
Q

ANALGESIA
are NSAIDs safe during pregnancy?

A

they should be avoided in pregnancy
particularly in 3rd trimester (associated with premature closure of ductus arteriosus)

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8
Q

ANALGESIA
are opioids safe during pregnancy?

A
  • limited information
  • prolonged use during pregnancy = neonatal withdrawal syndrome
  • use shortly before delivery = neonatal respiratory depression
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9
Q

ANTI-SEIZURE MEDICATIONS
how much is the risk of birth abnormalities increased when taking anti-seizure medications?

A

2-3 x increased risk (10% risk)

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10
Q

ANTI-SEIZURE MEDICATIONS
what are the most common birth abnormalities from anti-seizure medication?

A
  • heart defects
  • orofacial clefts
  • GU malformations
  • neural tube defects
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11
Q

ANTI-SEIZURE MEDICATIONS
is sodium valproate used in pregnancy?

A
  • highly teratogenic
  • must not be started in patients <55yrs without good reason
  • require pregnancy prevention programme
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12
Q

ANTI-SEIZURE MEDICATIONS
which anti-seizure medications are safe in pregnancy?

A
  • lamotrigine
  • levetiracetam
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13
Q

ANTI-SEIZURE MEDICATIONS
which anti-seizure medications are contraindicated in pregnancy?

A
  • carbamazepine
  • phenytoin
  • phenobarbital
  • topiramate
  • sodium valproate
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14
Q

ANTI-SEIZURE MEDICATIONS
if a patient is on enzyme inducers e.g. carbamazepine and they require emergency contraception which is the best option?

A
  • best = copper IUD
  • other option = double normal dose of levonorgestrel (1.5mg to 3mg)
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15
Q

can statins be used during pregnancy?

A

no they should be stopped

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16
Q

HTN
what is the management for HTN in pregnancy?

A

1st line = labetalol
2nd line = nifedipine (if asthmatic)

if neither are suitable
3rd line = methyldopa (must be stopped within 2 days of birth)

17
Q

DIABETES
are oral blood glucose lowering drugs safe in pregnancy?

A
  • metformin = safe + can be continued
  • all others (e.g. gliclazide, gliptins, gliflozins) = not safe and should be stopped during pregnancy
18
Q

THYROID DYSFUNCTION
what happens to thyroxine requirements during pregnancy?

A

requirements increase by 30-50% from very early pregnancy

19
Q

THYROID DYSFUNCTION
how are thyroid levels maintained during pregnancy?

A
  • check TFTs as soon as pregnancy is confirmed
  • ensure trimester specific reference ranges are used
  • perform TFTs regularly (especially in first 20wks)
  • thyroxine requirements remain elevated in breastfeeding
20
Q

VACCINATIONS
is MMR vaccine allowed during pregnancy?

A

no - it is a live vaccine

21
Q

VACCINATIONS
which vaccinations are recommended during pregnancy?

A
  • influenza
  • COVID-19
  • pertussis (whooping cough)
22
Q

VACCINATIONS
when is the pertussis (whooping cough) vaccine given during pregancy?

A

16-32 weeks of pregnancy

MY REVISION - PSA (5 decks)

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