Pregnancy & Breastfeeding -1 Flashcards
The psychotropics licensed to be used in pregnancy or breatfeeding in the UK?
None!
Three meds that women are advised not to breatfeed if on them?
Carbamazepine
Lithium
Clozapine
what is the rate of spontaneous abortion?
10-20%
Risk of spontaneous major malformation in baby?
2-3%
the share percentage drugs are blamed for in all malformations?
5%
Risk for valproate to cause malformation?
1-2%
Risk for carbamazepine to cause malformation?
1%
Valproate and carbamazepine in childbearing age women?
NICE advises against using them.
when can valproate and carbamazepine be used in childbearing age women?
if other options are unsuitable
&
a pregnancy prevention is in place
the challenge with lamotrigine use in pregnancy?
it requires frequent level check as it fluctuate
Lithium ability to cross placenta
Lithium moves across placenta as free&easy as possible
what can lithium lead to?
Epstein’s anomaly
absolute risk of Ebstein’s anomaly?
1:1000
whan can lithium be justified to be given to pregnant women?
if antipsychotics did not work (NICE)
do lithium enters breast milk?
yes and can cause toxicity in baby
frequency of checking lithium in pregnancy?
every 4 week until 36 weeks
then weekly
your patient on lithium becomes pregnant, what you’re gonna do?
Consider to stop th drug gradually over 4 weeks, if she’s well
and
Switch to an antipsychotic
Risk of benzodiazeppine use in pregnancy
oral clefts in newborns and floppy baby
when you might consider benzodiazepine in pregnany
in severe anxeity and agitation (Short term)
which antideppressant are not to be given in pregnancy?
MAOIS
Due to risk o f hypertensive crisis & congenital malformation
which SSRI cross placenta the least?
Sertraline
which SSRI shows safest profile in pregnancy
Fluoxetine
Risk of TCA in pregnancy?
neonatal withdrawal syndrome
what is neonatal withdrawal syndrome?
baby withdrawns from TCA in last trimmester
Agitation, irritability, resppiratory distress, endocrine and metabolic disturbances and seizure
your patient is on antipsychotic and becomes pregnant, what you do?
if there is risk of relapse, continue
Depot antipsychotics in pregnancy and breatfeeding?
Do not offer
when can dopot antipsychotic be considered in pregnant or breastfeeding patient?
if there history of non-adherence to tablets
and
history of good response to depots
pregnancy with no hx of SSRI
initiate sertraline
Pregnancy with hx of antideprpessants
initiate what has worked well before
drugs with risk of neonatal withdrawal syndrome in pregnancy?
Paroxetine
Venlafaxine
for breastfeeding post-natal depression w/out hx of antidepressant
Sertraline & Mirtazapine (NICE +paroxetine)
for breastfeeding post-natal depression with hx of antidepressant
initiate what has worked well before
for breastfeeding post-natal depression with no response to SSRIs
NICE suggests imipramine or nortryptiline
which TCA to avoid in breastfeeding?
DOXEPIN
if a patient on antipsychotic gets pregnanty what to do?
if likely to relapse continue
antipsychotics with most reproductive safety data
Quetiapine
Risperidone
Olanzapine
Halopridol
which antipsychotic crosses placenta the least?
Quetiapine
if a patient on antipsychotic starts to breastfee, what is your advice
continue on what has already worked
which antipsychotic not to be given in breastfeeding?
C L O Z A P I N E
Safest antipschotic in breast feeding?
quetiapine & Olanzapine
mood stabilizers in pregnancy and breastfeeding
No no no
Sedative in pregancyy?
Promethazine (widely used but little data)
Benzodiazepine for sedation in pregnancy?
Do not use it in late stages due to floppy baby
Sedative for breastfeeding
Lorazepam
NICE recommendation for treating mild depression in pregnancy?
facilitated self-help
NICE recommendation for treating moderate to severe depression?
high intensityy psychological intervention
or
TCA, SSRI or SNRI if preferred
NICE recommendation for treating moderate to severe depression in pregnancy with history of depression?
go streight to TCA, SSRI or SNRI
NICE recommendation for a patient with mild to moderate depression on SSRI/TCA becomes pregnant?
Consider stopping gradually and recommend facilitated self help
NICE recommendation for treating mild anxiety in pregnancy?
facilitated self-help
NICE recommendation for treating anxiety disorder in pregnancy?
high-intensity psychological intervention
NICE recommendation for a patient with mild to moderate anxiety on SSRI/TCA becomes pregnant?
Consider stopping gradually and recommend high intensity psychological intervention
NICE recommendation for treating bipolar depression in pregnancy?
Pscy. Intervention
NICE recommendation for treating mania or psychosis in pregnancy?
antipsychotics
NICE recommendation for treating schizophrenia with high risk fo relapse in pregnancy?
CBT or family intervention
NICE recommendation for patients with bipolar in pregnancy?
offer prophylactic antipsychotic if lithium stops
NICE recommendation for patients with bipolar in pregnancy on antipsychotic who develops mania any way
1- increase th dose or
2-Switch dose or
3-start on lithium
Concern about SSRI in pregnancy?
Cadiac malformation and Persistent Pulmonary Hypertention of newborn but not proven
Concern about antipsychotics in pregnancy?
no strong evidence
concern about valproate in pregnancy
- Spina bifida
-Atrial septal defects
-Cleft palate
-Hypospedia
-Polyydactyly
-Craniosynostosis
Concern about lithium in pregnancy
Ebstein’s anomalies
Concern about alcohol in pregnancy
cleft lip/palate
foetal alcohol syndrome
Concern about carbamazepine in pregnancy
spina bifida
Concern about diazepam in pregnancy
craniofacial defects (not replicated in other studies)
Steroids
Craniofacial defect (BNF is not convinced)
