PREGNANCY AND PRESCRIBING Flashcards

1
Q

2 Questions to consider when a woman on medication wants to become pregnant

A

is the drug safe?
is the drug necessary?
is there any safer alternative
what is the effect of the drug on pregnancy
what is the effect of pregnancy on the drug
is any extra monitoring needed? for mum or the baby
What pre-pregnancy counseling points can you give?

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2
Q

what evidence base practice resources do you have for women wanting to become pregant?

A

toxbase
uktis
Bnf
Bumps

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3
Q

why is nicotine a no in pregnancy?

A

causes growth restriction and can cause a stillbirth

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4
Q

why is alcohol a no in pregnancy?

A

can cause fetal alcohol syndrome causing low ears, low IQ and neurodevelopmental issues

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5
Q

why is cocaine a no in pregnancy?

A

It can cause blood clots in the placenta so the womb seperates

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6
Q

define preconception

A

before pregnancy

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7
Q

define 1st trimester

A

1- 13 weeks

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8
Q

define 2nd trimester

A

13-28 weeks

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9
Q

define 3rd trimester

A

after 28 weeks

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10
Q

define postpartum

A

after birth

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11
Q

what physiological changes happen during the 1st trimester

A
  • increase blood volume by 40%
  • faster kidney clearance
  • gut motility decreases
  • increase in sex binding hormone in the blood
  • placenta grows
  • transfer of drugs from mothers blood flow to fetus blood flow
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12
Q

why is methotrexate a no?

A

it is highly teratogenic

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13
Q

why is active iodine a no?

A

it is highly toxic to the fetus

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14
Q

why is warfarin a no and what is the alternative

A

it can give the baby birth abnormalities
instead give heparin
mother can continue on warfarin but has to consent to the risk

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15
Q

why is spironolactone a no?

A

cause androgenicity of female fetus

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16
Q

why is folic acid good for a fetus?

A
  • vitamin b9
  • it prevents fetus neural defects and spinal Bifida
  • it helps babies brain development
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17
Q

what is a teratogenic agent?

A

an agent that can disturb the development of the embryo or fetus
- it can alter organ growth due to the placenta transfer

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18
Q

is paracetamol safe in pregnancy?

A

yes

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19
Q

when should you avoid NSAIDs in pregnancy

A

in the third trimester

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20
Q

Are opiates safe in pregnancy?

A

no, they carry the risk of neonatal withdrawal if taken for long periods of time

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21
Q

can women stay on SSRIs?

A

yes if the risk outweighs the benefits

gives the fetus withdrawal effects so needed to give the fetus doses for 48h postpartum

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22
Q

what does the placenta do to diabetic patients?

A
  • it produces lots of hormones which are anti-insulin so the blood sugar levels rise
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23
Q

which diabetic drugs are not safe to use in pregnancy?

A

GLP2

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24
Q

which diabetic drugs are safe to use in pregnancy?

A

Insulin and metformin

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25
Q

what happens if diabetes is left untreated during pregnancy?

A
  • miscarriage
    structural abnormalities
    CV disease for the mother
26
Q

what do you monitor for a diabetic pregnant woman?

A

HbA1c levels, diet and lifestyle

27
Q

what is the risk to the baby of a woman with diabetes

A

the child can be born overly large

28
Q

what is the bp aim for pregnant women

A

130/80

29
Q

what can hypertension do to a pregnant woman?

A

they can affect placenta function

30
Q

what hypertensive drugs are safe during pregnancy?

A

alpha-methyl DOPA
nifedipine
labetalol (orally and IV)
hydralazine

31
Q

what hypertensive drugs are not safe during pregnancy?

A

ace inhibitors and diuretics

32
Q

are beta-blockers are safe during pregnancy?

A

Most of them are as they do not cross the placenta.

EXCEPT for atenolol

33
Q

why is atenolol not safe during pregnancy?

A

a risk of developmental effects which can cause a stillbirth
use fetal monitoring which looks for a small gestational age

34
Q

what is the safest ace inhibitor during pregnancy

A

enalapril - must do fetal monitoring

35
Q

are ace inhibitors safe during pregnancy?

A

they can cause renal issues, growth restrictions, skull disorders, and lung hypoplasia

36
Q

what is preeclampsia?

A

when fluids leak out the valves causing odema in pregnancy to give furosemide

37
Q

is aspirin safe during pregnancy?

A

yes

38
Q

is antiarrhythmics safe during pregnancy?

A

amiodarone is okay to use but can only be used short term as it does cross the placenta

39
Q

are antiepileptic drugs safe to use during pregnancy?

A

no carbamazepine, sodium valproate,phenytoin, phenobarbitone are all teratogenic and cause organ deficits snd cardiac congenital deficits

40
Q

what is the effect of the feotus ith anticonvulsant

A

-low set ears, thin lips, teeth that don’t form properly, broad nasal bridge and hypoplastic nails and digits.

41
Q

is a Symbicort inhaler safe

A

yes

42
Q

what are the fetal concerns when a mother has asthma >

A

growth restrictions and neonatal hypoxia

43
Q

what are the concerns for a pregnant asthmatic woman

A

pre-eclampsia , hypertension, and vaginal hemorrhage

44
Q

why are steroids used in pregnancy?

A

they can help mature the baby for a premature birth

45
Q

are steroids safe to use in pregnancy?

A

only prednisolone is as the placenta metabolises 80-90% so the fetus only receives a small amount

46
Q

what ebp resources do you have for women who want to breastfeed?

A

briggs , schafer , Bumps and Lactmed

47
Q

are ibuprofen and paracetamol safe to breaastfeed on ?

A

yes

48
Q

what are the advantages of breastfeeding for the baby?

A

IGM - which is produced in response to an infection
IGA- only present in first milk after pregnancy
IGE- maternal antibodies for baby
reduces risk of sudden infant death

49
Q

what are the advantages of breastfeeding for mum?

A
  • low blood pressure
  • increase baby bonding time
  • decrease risk of osteoporosis
  • protection over the breast and ovarian cancer
50
Q

does a drug get into babies

A

all medicines pass through to breast milk but absorption by the baby differs

51
Q

which medicines need to be avoided whilst breastfeeding?

A

Toxic drugs such as cocaine or cytotoxic agents

52
Q

why are medications with a low maternal plasma concentration good for breastfeeding?

A

they are less likely to transfer into the breast milk and cause complications for the baby

53
Q

why are medications with low bioavailability good for breastfeeding?

A

it will not lead to significant systemic concentrations in infants

54
Q

which medicines are not absorbed from a babies gut

A

gentamycin, vancomycin, and insulin.

55
Q

is amoxicillin safe during pregnancy?

A

it is safe due to the acid and base balance.

Breast milk is slightly acidic and ionizes amoxicillin which is a weak base in the breast milk.

56
Q

is it good for breastfeeding if the drug has a high protein binding capacity?

A

yes as only free drugs can pass into the breast milk

57
Q

is it good for breastfeeding if the drug has a high-fat solubility ( high lipophilicity)?

A

no as breast milk is fat in water emulsion, so lipophilic meds dissolve in the fatty globules in the breast milk

58
Q

what MW of drugs get into breast milk?

A

under 300

59
Q

is it good for breastfeeding if the drug has a high half-life?

A

no , it has an increased risk of accumulating in the baby and an increased risk of side effects

60
Q

is absorption affected in a pregnant woman?

A

no , bioavailability is not altered during pregnancy

but the mother does have an increased blood flow and a delayed gastric emptying time with a prolonged GI transit time.

61
Q

is distribution affected in pregnant women?

A

yes increased Vd due to increased plasma volume meaning a decrease in C0 bad Cmax

62
Q

Is protein binding affected in pregnant women?

A

yes, albumin concs decrease in trimester 2 therefore more free drugs in the blood meaning they have a higher pharmacological effect. Must monitor concentrations to avoid toxicity during pregnancy