Pregnancy, Breastfeeding And Paediatrics Flashcards
What physiological changes occur during pregnancy?
Vascular resistance changes - increased HR and stroke volume
Plasma volume increases - decreased blood viscosity
Coagulation - increased clotting factors and decreased fibrinolysis
Increased renal blood flow
Reduced serum albumin
Increased progesterone - relaxes smooth muscle
Reduced GI motility
What drugs are teratogenic?
Thalidomide Epilepsy drugs Retinoids ACEIs/ARBs Third element (Lithium) Oral contraceptives Warfarin Alcohol Methotrexate Danazol
What drugs affect later pregnancy?
ACEIs Anti-thyroid drugs Benzodiazepines Beta-blockers NSAIDs
How can hyperemesis be managed non-pharmacologically?
Eat smaller meals more frequently
Avoid spicy foods
Avoid caffeine
What are the treatment options for hyperemesis?
1st line - cyclizine, promethazine
2nd line - metoclopramide, ondansetron, prochlorperazine
What is the first line treatment for acid reflux in pregnancy?
Avoid trigger factors, tight clothing, big meals, smoking
Antacid with or without an alginate
What is the second-line treatment for acid reflux in pregnancy?
Omeprazole or ranitidine
What general advice should be given preconception?
Avoid drugs where possible Avoid alcohol, smoking and vitamin A products Reduce caffeine intake Consider taking folic acid 400mcg OD Rubella immunisation
Describe the stages of foetal development
Pre-embryonic
- day 1-17 - fertilisation -> cell division -> embryonic stage
Embryonic
- day 18-56 - organogenesis
Foetal
- day 56 to end - maturation, development, growth
What are the treatment options for gestational diabetes?
1st line - diet and lifestyle modifications, metformin
2nd line - insulin
What drugs are most likely to cross into breast milk?
Basic
Low plasma protein binding
High lipophilicity
What drugs are least likely to cross into breast milk?
Acidic
High protein binding
Low lipophilicity
What drugs should be avoided during breastfeeding?
Amiodarone Aspirin Barbiturates Benzodiazepines Carbimazole COCs Cytotoxic Ephedrine Tetracyclines
How is drug distribution affected in neonates?
Distribution of hydrophilic drugs depends on amount of body water
Distribution of hydrophobic drugs depends on amount of body fat
GFR increases with age
How is drug metabolism affected in neonates?
Efficiency of mechanisms may be impaired
Immaturity of liver and kidneys slows elimination
