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Obs and Gynae > prescribing in pregnancy > Flashcards

prescribing in pregnancy Flashcards

1
Q

what anti emetic was prescribes to thousands of women caused lots of babies to be born deformed?

A

thalidomide

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2
Q

what drugs dont pass the placenta?

A

Most drugs cross
-except large molecular weight drugs such as heparin

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3
Q

what drugs cross the placenta more quickly

A

small, lipid soluble drugs

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4
Q

what is affected when taking meds with morning sickness:
A- absorption
B- distribution
C- metabolism
D- elimination

A

A- Absorption

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5
Q

what occurs to plasma volume in pregnancy?

A

increases

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6
Q

what occurs to protein binding in pregnancy and what affect does this have?

A

Decreased protein binding
-this leads to increased free drug

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7
Q

what occurs to liver metabolism of certain drugs such as phenytoin in pregnancy?

A

increased liver metabolism of certain drugs

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8
Q

what occurs to elimination of renally excreted drugs in pregnancy and what affect does this have on GFR?

A

increase elimination of renally excreted drugs
-increased GFR in pregnancy

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9
Q

what occurs to BP in second trimester of pregnancy?

A

it drops and goes back up in 3rd trimester

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10
Q

what should be given to women for 3 months prior and first 3 months of pregnancy?

A

they should take folic acid 400mcg

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11
Q

why are pregnant women given folic acid?

A

to prevent neural tube defects and microcephaly in foetus

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12
Q

what time is the period of greatest teratogenic risk?

A

1st trimester especially between 4th and 11th week of pregnancy

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13
Q

what can occur if drug exposure in 2nd + 3rd trimester of pregnancy

A

-foetal intellectual impairment and behavioural abnormalities

-Growth of foetus may be affected

-Toxic effects on foetal tissue

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14
Q

what affect does taking opiates during pregnancy have on the foetus?

A

-can cause respiratory depression
-can cause neonatal abstincence syndrome (NAS) which is basically withdrawal

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15
Q

what affect does taking warfarin during pregnancy have on foetus and mother?

A

fetus= limb and facial defects

mother= risk of haemorrhage during labour

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16
Q

risks of taking SSRIs during pregnancy?

A

first trimester= congenital heart defects, congenital malformations (especially when taking paroxetine)

third trimester= persistent pulmonary hypertension in neonates

also may experience withdrawals

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17
Q

what changes are made to medication for epileptics who are pregnant

A

avoid valproate and phenytoin
higher dose of folic acid

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18
Q

what diabetic meds arent safe in pregnancy

A

sulfynurea
so convert this to insulin

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19
Q

what hypertensive meds should be used in pregnancy?

A

-labetalol
-methyldopa

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20
Q

what hypertension meds should be avoided in pregnancy?

A

ACEI/ ARB

21
Q

1st line med for N+V in pregnancy?

A

cyclizine

22
Q

1st line med UTI in pregnancy

A

Nitrofurantoin, cefalexin

in third trimester- trimethoprim

23
Q

1st line med for pain in pregnancy

A

paracetamol

24
Q

1st line med for heartburn in pregnancy

A

anti acids

25
Q

does pregnancy increase risk of VTE?

A

yes by about 10x

26
Q

what meds should pregnant women with significant 2 or more VTE risk receive?

A

LMWH (up to 7 days post partum as well)

2 or more of:
obesity
>35 years
smoking
>3 pregnancies
ceserean delivery
previous DVT

27
Q

what are risks for VTE?

A

LMWH (up to 7 days post partum as well)

2 or more of:
obesity
>35 years
smoking
>3 pregnancies
ceserean delivery
previous DVT

28
Q

treatment for venous thromboembolism in pregnancy?

A

LMWH

-avoid warfarin as this risks haemorrhage during delivery

29
Q

difference between foremilk and hindmilk?

A

foremilk- protein rich
hindmilk- fat rich

30
Q

what can amiodarone cause if passed through breast milk?

A

neonatal hypothyroidism

31
Q

what can cytotoxics cause if passed through breast milk?

A

bone marrow suppression

32
Q

what can benzodiazepines cause if passed through breast milk?

A

drowsiness

33
Q

what can bromocriptine cause if passed through breast milk?

A

suppress lactation

34
Q

treatment?

A
35
Q
A

give LMWH
-ideally teach her how to inject herself each day

36
Q
A

tetracycline
-can give staining of bones and teeth (avoid in pregnancy and children up to 12 years)

37
Q
A

alcohol
-this is fetal alcohol syndrome

38
Q
A

phenytoin
-cleft lip and palate

39
Q

(vaginal adenocarcinoma)

A

stillbestrol

40
Q
A

Valproate
-causes neural tube defects (spina bifida on left)

41
Q

what med should be taken for RA in pregnancy?

A

stop methotrexate
-start hydroxychloroquine

42
Q

what changes are there to the mum in pregnancy?

A

-Increased plasma volume + fat stores
-increased liver metabolism for some drugs
-decreased protein binding (due to lower albumin levels)

43
Q

what does increased plasma volume and fat stores lead to?

A

increases the volume of distribution around body (higher dose of drug is required to achieve a given plasma concentration)

44
Q

what does increased liver metabolism to certain drugs do?

A

puts more stress onto liver

45
Q

why are there decreased levels of albumin ?

A

due to higher overall volume

46
Q

what does decreased protein binding do to the body? (this is due to lower albumin levels)

A

it means that there is more free drug circulating the body

47
Q

who is at higher risk of neural tube defects and require + mg of folic acid?

A

-previous NTD
-taking anti epileptics
-Coeliac disease
-Diabetes
-Thalassaemia trait
-BMI >30 (obese)

48
Q

what medication is given for pain?

A

paracetamol

49
Q

who is given 400ug folic acid?

A

every pregnant woman until 12th week

Obs and Gynae (61 decks)

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