Prescribing in Pregnancy Flashcards
what drugs cannot cross the placenta?
large molecule weight drugs i.e. heparin
what drugs cross the placenta most easily?
small, lipid soluble drugs
what should be given prior to conception and for how long?
folic acid 400mg daily for three months prior to conception
then also for the first three months of pregnancy
when is the period of greatest teratogenic risk?
4-11 weeks
when could drug exposure result in intellectual and behavioural abnormalities?
second and third trimesters
what possible adverse effects can drugs have on labour?
impacts on progress
premature closure of DA
suppression of foetal systems
bleeding
name a drug that can cause bleeding in labour
warfarin
name a drug that can suppress a foetal system during labour
opiates
can cause respiratory depression
why can there be an increase in the number of seizures experienced by epileptic patients during pregnancy?
non compliance
changes in plasma concentrations of drugs
what are frequent epileptic seizures in pregnancy associated with?
lower IQ hypoxia bradycardia antenatal death maternal death
what is the preferred management structure for epilepsy in pregnancy and why?
mono therapy
more drugs = more risk of malformations
what anti-epileptics should be avoided in pregnancy?
valproate
phenytoin
what dose of folic acid should women with epilepsy take during pregnancy?
5mg daily
is insulin a safe option during pregnancy?
yes
however, requirements will change during pregnancy
what does poor diabetic control increase risk of?
congenital malformation
intra-uterine death
what diabetic drug is not safe in pregnancy and what change should be made?
sulphonylureas
change to insulin
what happens to blood pressure in pregnancy?
falls in the second trimester
what are the three options for anti-hypertensives in pregnancy?
labetalol
methyldopa
nifedipine MR
what anti-hypertensives should be avoided in pregnancy and why?
ACE + ARBs
can cause foetal abnormalities
what effect can beta blockers have in pregnancy?
may inhibit foetal growth in late pregnancy
what is the first line anti-emetic in pregnancy?
cyclizine
what antibiotics can be used to manage UTI in pregnancy?
nitrofurantoin
cefalexin
trimethoprim (in third trimester)
what is the first line analgesic in pregnancy?
paracetamol
what prophylaxis is given for VTE in pregnancy, who gets it and when?
LMWH
those with two or more risk factors
at delivery and for up to seven days postpartum
what are the risk factors for VTE in pregnancy?
obesity age >35 smoking para >3 previous DVT C section
why should warfarin be avoided in pregnancy?
teratogenic
risk of haemorrhage during delivery
how is VTE treated in pregnancy?
therapeutic dose of LMWH