PREGNANCY AND BREASTFEEDING

Question 1

The risk of foetal exposure to medicine is greatest when?

Answer 1

During the first 12 weeks. Important because most women do not know they are pregnant until week 6 to 10.

Question 2

What are the common conditions that pregnant women will present with in the community pharmacy?

Answer 2

Nausea and vomiting. 
Pain
Heartburn
Constipation
Haemorrhoids
Vaginal thrush

Question 3

What referral symptoms are there in pregnant women suffering from vomiting? [6]

Answer 3

Very dark urination or no urination for 8 hours.
Abdominal pain or fever.
Weakness or feeling faint.
Blood in vomit.
Severe unstoppable vomiting.
Inability to keep fluids/food down for 24 hrs.

Question 4

What advice can we give to pregnant women suffering from vomiting? [5]

Answer 4

NO OTC PRODUCTS.
Eat a biscuit or toast before rising. 
Ginger biscuits. 
Eat small carbohydrate rich snacks throughout the day. 
Drink regular small amounts of water. 
Avoid triggers.

Question 5

How can pain in pregnant women be managed?

Answer 5

Analgesics might be needed for headache, musculoskeletal pain or dental pain.

Question 6

How can back pain in pregnancy be reduced?

Answer 6

Do not stand or sit for too long.
Rest when painful and put feet up.
Wear flat shoes.
Stretch tight muscles and soak in warm baths.

Question 7

What is the only painkiller recommended OTC for pain in pregnancy?

Answer 7

Paracetamol.

Question 8

How can heartburn be treated in pregnant women?

Answer 8

first line is lifestyle.
Second line is simple antacids/alignates at any point in pregnancy.
AVOID PPIs or H2 receptor antagonists.

Question 9

When should pregnant women suffering from heartburn be referred?

Answer 9

No response to treatment.
Inability to eat due to symptoms.
Cause unrelated to pregnancy. (peptic ulcer, IBS)
Alarm symptoms present.

Question 10

Why is it essential to treat constipation in pregnancy?

Answer 10

To avoid haemorrhoids. `

Question 11

How are haemorrhoids treated in pregnancy?

Answer 11

Commonly occur for the first time during pregnancy
Essential to ensure they have been previously diagnosed prior to treatment
Avoid hydrocortisone based preparations

Question 12

How is thrush treated in pregnancy?

Answer 12

REFER.

DR will normally prescribe clotrimazole.

Question 13

How are leg cramps treated in pregnancy?

Answer 13

Stretching exercises and massaging of the muscle during the attack.
NOT QUININE

Question 14

How are coughs and colds treated in pregnancy?

Answer 14

Avoid use of decongestants. 
Paracetamol for symptomatic relief. 
Menthol inhalations for congestion. 
Avoid opioid cough suppressants. 
Demulcents have limited efficacy supporting their use but can be recommended.

Question 15

How is threadworm treated in pregnancy?

Answer 15

No pharmacological therapies.
Strict hygiene.
Referral perhaps.

Question 16

Why should breastfeeding be promoted?

Answer 16

Unique, complex fluid containing energy, all essential nutrients and protection against infection and allergies
More convienent
Cheaper, sterile, easier to digest
Closer bonding, natural
Releases oxytocin – helps uterus contract
Thought to decrease risk of pre-menopausal breast cancer

Question 17

what supplements are recommended in pregnancy?

Answer 17

Folic acid.
Vitamin A (retinol) and pro-vitamin A (beta-carotene)
Calcium and vitamin D
Iron.

Question 18

What advice should be given to a pregnant women seeking treatment for heartburn?

Answer 18

Antacid preparations licenced OTC
Alginates safe as not absorbed
General advice – eat small, frequent meals, avoid trigger foods e.g. spicy or fatty foods, avoid lying flat and do not eat immediately before bed.
Avoid tight fitting clothing
Stop smoking, if applicable

Question 19

How is piles treated in pregnancy?

Answer 19

High fibre diet and plenty of fluids.
Exercise.
Ice pack to alleviate discomfort.
OTC product NOT containing hydrocortisone e.g. Anusol.

Question 20

Why would we recommend a pregnant lady taking Pregaday who is suffering from constipation to stop?

Answer 20

No need to take iron supplementation unless iron deficiency known to be present. Usually ferrous sulphate 200mg or ferrous fumarate 310mg twice a day (instead of three times a day) as this will reduce side effects e.g. constipation.

If advise a laxative, would suggest a bulk forming laxative as first line e.g. fybogel.

Question 21

Which medicines can be used to treat intermittent allergic rhinitis during pregnancy?

Answer 21

Chlorphenamine has traditionally been the antihistamine of choice but can cause sedation.
Loratadine or cetirizine are the antihistamines now recommended for use during pregnancy’

Question 22

What advice can be given to a pregnant woman suffering from intermittent allergic rhinitis?

Answer 22

1st line = allergen avoidance e.g. wrap-around sunglasses, Vaseline around nose, shower after being outside
Sodium cromoglicate eye drops considered safe
Prevalin nasal spray
Saline nasal drops

Question 23

How would you counsel a pregnant woman to use canesten combi?

Answer 23

Creams and pessaries recommended for pregnant women over tablets
Insert the pessaries using a finger instead of using the applicator as using the applicator has a small risk of damaging the cervix (neck of the womb)
Use pessary and cream at night before bed
Apply cream to external areas
Make patient aware that pessaries may:
Be awkward to use
Stain underwear
Damage latex condoms and diaphragms
Cause a mild burning sensation

Question 24

Why are pregnant women recommended to insert pessaries using a finger instead of using the applicator?

Answer 24

Insert the pessaries using a finger instead of using the applicator as using the applicator has a small risk of damaging the cervix (neck of the womb)

Question 25

How can sore nipples during breastfeeding be treated?

Answer 25

Lasinoh
Kamillosan
Provide a barrier to stop skin drying out
Ointment should be wiped off prior to breastfeeding

Question 26

What is mastitis?

Answer 26

Mastitis, an inflammation of the breast tissue
Caused by milk stasis, incomplete emptying or bacteria
entering through cracked skin

Question 27

How does mastitis present?

Answer 27

Breast will appear red, swollen and hot to the touch. Very painful. Fever may be present.

Question 28

How can mastitis be treated OTC?

Answer 28

Refer immediately – risk of breast abscess
Continue to breastfeed or to express milk, as this will help to remove blockage
Rest and plenty of fluids
Avoid tight fitting clothes and bras
Regular paracetamol to ease pain
Breastfeeding technique could be looked at

Question 29

Can a women taking flucloxacillin 500mg qds for mastitis continue to breastfeed?

Answer 29

NO.

Question 30

What advice should be given to mothers of babies with colic?

Answer 30

NO CURE.
Not the mothers fault: does not mean the baby is unwell, that the mother is doing something wrong or that the baby is rejecting them.

The baby will get better eventually. Colic normally stops before the baby is 4-6 months old.