Pregnancy care

Question 1

what OTC medicine is licensed to treat morning sickness?

Answer 1

no OTC,

Question 2

how many people get morning sickness?

Answer 2

80%

Question 3

is morning sickness most common in your first or second pregnancy

Answer 3

first

Question 4

which women are at risk of having morning sickness

Answer 4

first child
more than one child
experience sickenss with the contraceptive pill

Question 5

if a pregnant lady experiences hyperemesis (protracted and severe) vomiting what do we do

Answer 5

admission to hospital for antiemetics and rehydration

Question 6

2 tips to help with morning sickness?

Answer 6

small frequent meals to keep up blood sugar
biscuits by the bed eat in the morning and wait for 20 minutes to get up
avoid spicy food
avoid alcohol, tea, coffee or milk
suck sugar sweets for travel

Question 7

when in pregnancy does MS occur

Answer 7

round week 5 and ends at about 12 weeks

can sometimes return in the last 3 months

Question 8

what can the GP prescribe for morning sickness?

Answer 8

antihistamines such as promethazine
antiemetics prochlorperazine and domperidone
NOT OTC

Question 9

can vitamin B6 (PYRIDOXINE) be used to help pregnancy? what type of medication is it (legally)?

Answer 9

GSLif under 50mg

NO, its associated with peripheral neuropathies

Question 10

mechanisms of morning sickness?

Answer 10

high levels of human chorionic gonadotriphin stimulate the ovaries to produce oestrogen and progesterone in early pregnancy, but these decrease once the placenta is sufficiently developed to produce the hormones itself
low blood sugar in the morning

Question 11

symptoms of gastro-oesophageal reflux?

Answer 11

burning discomfort in the epigastrum caused by gastric juices moving into the oesophageal sphincter

Question 12

why is GOR common in pregnancy

Answer 12

raised progesterone levels reduce smooth muscle tone

Question 13

can you give high sodium antacids in pregnancy for GOR?

Answer 13

try to avoid as can increase BP- will state which in the BNF

Question 14

what can you commonly recommend for GOR in pregnancy?

Answer 14

gaviscon

Question 15

what type of antacid shouldnt you give for pregnancy GOR

Answer 15

products with bismuth, potentially neurotoxic

Question 16

how to antacids and aliginates work?

Answer 16

precipitate out and form a sponge like raft with buoyancy by CO2 trapped in the matrix
plug in the LOS

Question 17

dose of gaviscon in pregnancy

Answer 17

10-20ml after meals and at bedtime QDS

Question 18

can you give histamine h2 agonists?

Answer 18

not licensed so GP

Question 19

advice to give pregnant lady with GOR?

Answer 19

Ø Eat frequent, small meals to avoid distending the stomach
Ø Do not eat late in the day — give yourself at least three hours after a meal before going to bed
Ø Use extra pillows in bed to sleep in a raised position.
Ø Avoid alcohol, coffee and chocolate — all act to relax the lower oesophageal sphincter

Question 20

when should you refer a pregnant lady with GOR

Answer 20

if combination of lifestyle advice and OTC meds doesnt work

Question 21

why can the frequency of migraines reduce in pregnancy?

Answer 21

due to intracranial vascular changes medicated by P and O so attacks tend to improve

Question 22

when do headaches tend to get worse in pregnancy?

Answer 22

second trimester

Question 23

3 things which causes backache in pregnancy?

Answer 23

strain on the muscles of the back as the uterus enlarges and grows forward

weight gain
in the last 3 months the hormone relaxin softens the muscles and ligaments in readiness for labour so they stretch= back ache

Question 24

what you can give OTC for headache and backache in pregnancy? dose?

Answer 24

paracetamol 1000mg QDS

Question 25

what shouldn't you recommend OTC headache and backache in pregnancy? why

Answer 25

aspirin or ibuprofen/ NSAIDs | delay labour and increase risk of haemorrhage in labour

Question 26

can you give codeine and dihydrocodeine for headache and backache

Answer 26

yes but if taken near term it can cause respiratory depression in the new born.

Question 27

when is constipation most common in pregnancy? caused by (2)?

Answer 27

later stages due to pressure on the GIT | increased progesterone levels decrease intestinal motility

Question 28

recommendations to pregnant lady with constipation?

Answer 28

increase fluids | increase fibre- FIRST LINE

Question 29

OTC relief for constipation in pregnancy?

Answer 29

bulk formin laxatives e.g. ispaghula husk lactulose docusate both have slow action 48 hours to work

Question 30

what can ispaghula husk cause when treating constipation OTC?

Answer 30

abdominal distension and discomfort

Question 31

how does lactulose work?

Answer 31

non absorbed disaccharide which increases intestinal bulk by attracting water into the colon by osmosis

Question 32

which laxatives can you not recommend in pregnancy? why?

Answer 32

STIMULANT senna- theoretical risk of stimulating uterine contractions and inducing early labour- little evidence but one or two doses can be tried if the gentler laxatives fail

Question 33

why are haemorrhoids common in pregnancy

Answer 33

due to straining

Question 34

what can pharmacists recommend in minor cases of haemorrhoids?

Answer 34

bland haemorrhoidal cream or ointments e.g. anusol- contains bismuth oxide (neurotoxic) but acts locally so should be okay

Question 35

non analgesic relief of haemorrhoids

Answer 35

ice pack

Question 36

how much more common is candidiasis in pregnancy, why?

Answer 36

2-10 times more common | due to vagina being rick in glycogen

Question 37

how many women experience varicose veins in pregnancy, what can we recommend

Answer 37

10-20% | support hosiery

Question 38

how many women can suffer from leg oedema, recommend?

Answer 38

80% | rest with legs raised and avoid tight clothes

Question 39

how many suffer from muscle cramps in the calf? when? recommend?

Answer 39

1/3 later in pregnancy (common at night) massage and stretching of the muscles during attacks increasing intake of calcium and potassium

Question 40

what is the itching condition common in pregnancy called? how common?

Answer 40

pruritus gravidarum | in 20%

Question 41

why is pruritus common in pregnancy? when does it occur

Answer 41

from the third month onwards | due to oestrogen induced cholestasis/ hormone changes

Question 42

what can be given OTC for pruritus

Answer 42

soothing lotions such as oily calamine

Question 43

if a lady presents with pruritus what must you do

Answer 43

give relief, refer to midwife or GP

Question 44

why must you refer a woman with pruritus?

Answer 44

potentially serious especially if experienced with jaundice can indicate obstetric cholestasis- renal impairment with leads to billirubin build up in the blood= can cause still birth must be closely monitored

Question 45

hyperpigmentation, when can this occur and why?

Answer 45

due to hormone changes fade within a few weeks of delivery but can stay due to increased levels of melanocyte sstimulating hormone and oestrogen

Question 46

changes in pregnancy regarding hyperpigmentation?

Answer 46

darker nipples and genitalia linea nigra- dark line down the abdomen melasma= brown patches on the face

Question 47

what causes stretch marks? | what can prevent them?

Answer 47

overstretching of the elastic tissue in the skin replaced by collagen scar tissue start red and fade to silver but may never disappear exercise

Question 48

is anything licensed in the UK to stop/ get rid of stretch marks

Answer 48

no

Question 49

advice a pharmacist can give regarding stretch marks

Answer 49

massaging skin with produces containing vitamin E, cocoa butter, collagen and elastin propeietary products

Question 50

what has been used to reduce scarring after pregnancy?

Answer 50

tretinoin

Question 51

TF: most OTC remedies for coughs and colds are C/I in pregnancy

Answer 51

FALSE

Question 52

what to recommend for dry coughs and sore throat in pregaqncy?

Answer 52

simple linctus | sucking on non medicated pastals- help by keepinhg the inflammed tissue of the pharynx moistured

Question 53

what to recommend for chesty coughs in pregancy

Answer 53

steam inhalations e.g. methol or oil based decongestants | works by liquefying and expectorating pharyngeal mucus

Question 54

what should be avoided in pregancy for coughs and colds

Answer 54

systemic sympathomimetic decongestents as they can increase BP

Question 55

role of the pharmacists in managing minor ailments in pregnancy?

Answer 55

respond to symptoms be aware of oTC medications which cannot be used in pregnancy lifestyle advice

Question 56

exhaustive list of the minor ailments pregnant women can experience?

Answer 56

``` monring sickness GOR headache and backache constipation haemorrhoids candidiasis varicose veins, oedema and muscle cramps pruritus stretch marks and hyperpigmentation coughs and colds ```

Question 57

can you give OTC medication for candidiasis?

Answer 57

NO must refer as OTC produces for thrush arent licensed in pregnancy, GP must prescribe

Question 58

can thrush harm babies?

Answer 58

no but can potentially be passed to the baby as it passes the birth canal

Question 59

what is the GP likely to prescribe in candidiasis in pregnancy?

Answer 59

imidazole antifungal