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MRCPSYCH_B_MENTOR&More_ART > Pregnancy & Breastfeeding > Flashcards

Pregnancy & Breastfeeding Flashcards

1
Q

The psychotropics licensed to be used in pregnancy or breatfeeding in the UK?

A

None!

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2
Q

Three meds that women are advised not to breatfeed if on them?

A

Carbamazepine
Lithium
Clozapine

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3
Q

what is the rate of spontaneous abortion?

A

10-20%

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4
Q

Risk of spontaneous major malformation in baby?

A

2-3%

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5
Q

the share percentage drugs are blamed for in all malformations?

A

5%

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6
Q

Risk for valproate to cause malformation?

A

1-2%

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7
Q

Risk for carbamazepine to cause malformation?

A

1%

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8
Q

Valproate and carbamazepine in childbearing age women?

A

NICE advises against using them.

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9
Q

when can valproate and carbamazepine be used in childbearing age women?

A

if other options are unsuitable
&
a pregnancy prevention is in place

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10
Q

the challenge with lamotrigine use in pregnancy?

A

it requires frequent level check as it fluctuate

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11
Q

Lithium ability to cross placenta

A

Lithium moves across placenta as free&easy as possible

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12
Q

what can lithium lead to?

A

Epstein’s anomaly

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13
Q

absolute risk of Ebstein’s anomaly?

A

1:1000

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14
Q

whan can lithium be justified to be given to pregnant women?

A

if antipsychotics did not work (NICE)

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15
Q

do lithium enters breast milk?

A

yes and can cause toxicity in baby

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16
Q

frequency of checking lithium in pregnancy?

A

every 4 week until 36 weeks
then weekly

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17
Q

your patient on lithium becomes pregnant, what you’re gonna do?

A

Consider to stop th drug gradually over 4 weeks, if she’s well
and
Switch to an antipsychotic

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18
Q

Risk of benzodiazeppine use in pregnancy

A

oral clefts in newborns and floppy baby

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19
Q

when you might consider benzodiazepine in pregnany

A

in severe anxeity and agitation (Short term)

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20
Q

which antideppressant are not to be given in pregnancy?

A

MAOIS

Due to risk o f hypertensive crisis & congenital malformation

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21
Q

which SSRI cross placenta the least?

A

Sertraline

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22
Q

which SSRI shows safest profile in pregnancy

A

Fluoxetine

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23
Q

Risk of TCA in pregnancy?

A

neonatal withdrawal syndrome

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24
Q

what is neonatal withdrawal syndrome?

A

baby withdrawns from TCA in last trimmester

Agitation, irritability, resppiratory distress, endocrine and metabolic disturbances and seizure

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25
Q

your patient is on antipsychotic and becomes pregnant, what you do?

A

if there is risk of relapse, continue

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26
Q

Depot antipsychotics in pregnancy and breatfeeding?

A

Do not offer

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27
Q

when can dopot antipsychotic be considered in pregnant or breastfeeding patient?

A

if there history of non-adherence to tablets
and
history of good response to depots

28
Q

pregnancy with no hx of SSRI

A

initiate sertraline

29
Q

Pregnancy with hx of antideprpessants

A

initiate what has worked well before

30
Q

drugs with risk of neonatal withdrawal syndrome in pregnancy?

A

Paroxetine
Venlafaxine

31
Q
A
32
Q

for breastfeeding post-natal depression w/out hx of antidepressant

A

Sertraline & Mirtazapine (NICE +paroxetine)

33
Q

for breastfeeding post-natal depression with hx of antidepressant

A

initiate what has worked well before

34
Q

for breastfeeding post-natal depression with no response to SSRIs

A

NICE suggests imipramine or nortryptiline

35
Q

which TCA to avoid in breastfeeding?

A

DOXEPIN

36
Q

if a patient on antipsychotic gets pregnanty what to do?

A

if likely to relapse continue

37
Q

antipsychotics with most reproductive safety data

A

Quetiapine
Risperidone
Olanzapine
Halopridol

38
Q

which antipsychotic crosses placenta the least?

A

Quetiapine

39
Q

if a patient on antipsychotic starts to breastfee, what is your advice

A

continue on what has already worked

40
Q

which antipsychotic not to be given in breastfeeding?

A

C L O Z A P I N E

41
Q

Safest antipschotic in breast feeding?

A

quetiapine & Olanzapine

42
Q

mood stabilizers in pregnancy and breastfeeding

A

No no no

43
Q

Sedative in pregancyy?

A

Promethazine (widely used but little data)

44
Q

Benzodiazepine for sedation in pregnancy?

A

Do not use it in late stages due to floppy baby

45
Q

Sedative for breastfeeding

A

Lorazepam

46
Q

NICE recommendation for treating mild depression in pregnancy?

A

facilitated self-help

47
Q

NICE recommendation for treating moderate to severe depression?

A

high intensityy psychological intervention
or
TCA, SSRI or SNRI if preferred

48
Q

NICE recommendation for treating moderate to severe depression in pregnancy with history of depression?

A

go streight to TCA, SSRI or SNRI

49
Q

NICE recommendation for a patient with mild to moderate depression on SSRI/TCA becomes pregnant?

A

Consider stopping gradually and recommend facilitated self help

50
Q

NICE recommendation for treating mild anxiety in pregnancy?

A

facilitated self-help

51
Q

NICE recommendation for treating anxiety disorder in pregnancy?

A

high-intensity psychological intervention

52
Q

NICE recommendation for a patient with mild to moderate anxiety on SSRI/TCA becomes pregnant?

A

Consider stopping gradually and recommend high intensity psychological intervention

53
Q

NICE recommendation for treating bipolar depression in pregnancy?

A

Pscy. Intervention

54
Q

NICE recommendation for treating mania or psychosis in pregnancy?

A

antipsychotics

55
Q

NICE recommendation for treating schizophrenia with high risk fo relapse in pregnancy?

A

CBT or family intervention

56
Q

NICE recommendation for patients with bipolar in pregnancy?

A

offer prophylactic antipsychotic if lithium stops

57
Q

NICE recommendation for patients with bipolar in pregnancy on antipsychotic who develops mania any way

A

1- increase th dose or
2-Switch dose or
3-start on lithium

58
Q

Concern about SSRI in pregnancy?

A

Cadiac malformation and Persistent Pulmonary Hypertention of newborn but not proven

59
Q

Concern about antipsychotics in pregnancy?

A

no strong evidence

60
Q

concern about valproate in pregnancy

A
  • Spina bifida
    -Atrial septal defects
    -Cleft palate
    -Hypospedia
    -Polyydactyly
    -Craniosynostosis
61
Q

Concern about lithium in pregnancy

A

Ebstein’s anomalies

62
Q

Concern about alcohol in pregnancy

A

cleft lip/palate
foetal alcohol syndrome

63
Q

Concern about carbamazepine in pregnancy

A

spina bifida

64
Q

Concern about diazepam in pregnancy

A

craniofacial defects (not replicated in other studies)

65
Q

Steroids

A

Craniofacial defect (BNF is not convinced)

66
Q
A

MRCPSYCH_B_MENTOR&More_ART (47 decks)

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