Prescribing in pregnancy

Question 1

Which AED is never given to girls of reproductive age unles there is a pregnancy prevention programme?

Answer 1

Sodium valproate (Epilim)

Question 2

Which drug is the most teratogenic?

Answer 2

Valproate

Question 3

What are the teratogenic effects of valproate/ epilim?

Answer 3

Neuropsychiatric problems

Question 4

Which AED can be given in pregnancy?

Answer 4

Lamotrigine

Question 5

Which antibiotics should not be given in the first trmester?

Answer 5

Quinolone antibiotics i.e. ciprofloxacilin because of skeletal abnormalities

Tertracyclines bind calcium and cause yellowing of teeth and because of this for adults never have tertarcyline with milk

Question 6

Which drugs should not be taken by pregnant women in the first trimester?

Answer 6

• Androgens (vorilisation)
• Cirpofloxacilins (skeletal)
• Lithium (Ebsteins)
• Valproate (neuropsych and NTD)
• Retinoids (cranial facial)
• Warfarin (nasal hypoplasia)

CRAWLS (ciprofloxacin, retinoids, androgens, warfarin, lithium, sodium valproate)

Question 7

Which drugs should not be given in second or third trimester?

Answer 7

• ACE inhibitors (because it restricts amniotoc fluid oligoamniohdryos)
• Gentamicin (hearing defects)
• Aspirin
• Opiates (withdrawal syndrome))
• Tetracyclines
• Sulphonamides (hyperbiliribunemia, icterus)

GOAATS - Gentamicin, opiates, ACEi, aspirin, tetracycline, sulphonamides

Question 8

Which drugs cause hyperbilirubinemia and kernitcterus?

Answer 8

Sulphonamides

Question 9

What things should be taken into consideration in omen taking medication and breastfeeding?

Answer 9

1. Is it necessary
2. can it be changed
3. taking at a different time

Question 10

Why are sulphonamides drugs a problem in children?

Answer 10

Displace bilirubin from abumin causing neonatal jaundice

Question 11

Which anticoagulants are OK for pregnant women?

Answer 11

LMWH

Question 12

What is GFR in the neonate compared to the adult? Why is this a problem|?

Answer 12

30-40%

Drugs accumulate

Question 13

How is dosing calculated for children?

Answer 13

Surface area x adult dose

Question 14

What differences are there in babies and adults with absorption? [Consider gastric route, transcutaneous and IM]

Answer 14

Babies have very slow gastric empyting.

Intramusculaar may be less due to less muscle mas

Percutaneous is quicker due to thinner stratum corneum.

Question 15

How is metabolism different in babies compared with adults?

Answer 15

Much slower. Most babies only dveelop metabolic enzymes after birth and these are slow to increase. Caffiene for example can be used as a respiratory stimulate in babies due to longer half life.

Question 16

What is Broselow tape?

Answer 16

The Broselow Tape, also called the Broselow pediatric emergency tape, is a color-coded length-based tape measure that is used throughout the world for pediatric emergencies. The Broselow Tape relates a child’s height as measured by the tape to his/her weight to provide medical instructions including medication dosages, the size of the equipmentthat should be used

Question 17

What syndrome does Cloramphenicol cause in children?

Answer 17

Grey baby syndrome

Question 18

What is Reye’s syndrome?

Answer 18

Mitochondrial and liver damage due to aspirin

Question 19

Why is codeine a problem in children?

Answer 19

Codeine and Tramadol Can Cause Breathing Problems for Children. Those infants can become too sleepy, have difficulty breastfeeding, or have serious breathing problems. That’s why the U.S. Food and Drug Administration is strengthening drug labels for codeine and tramadol to protect children and nursing babies.