Prescribing in pregnancy

Question 1

Epilepsy management in pregnancy?

Answer 1

Antiepileptics increase risk of congenital malformations
- 20-30% risk if on 4 drugs
- Monotherapy is preferred

AVOID phenytoin and sodium valproate

Question 2

Diabetes management in pregnancy?

Answer 2

• Insulin is thought to be safe.
• Requirements change during pregnancy
• Poor control of diabetes increases risk of congenital malformations and intra-uterine deaths

Question 3

Are sulphonylureas safe for pregnancy?

Answer 3

Sulphonylurea are NOT safe
- Convert to insulin

Question 4

What is the consequence of poorly controlled diabetes in pregnancy?

Answer 4

Increases risk of congenital malformations and intra-uterine deaths

Question 5

Hypertension management in pregnancy?

Answer 5

• BP rises during 2nd trimester.
• If needed to treat, use one of:
  
  • Labetalol
  • Methyldopa
• Avoid ACE inhibitor/ARB
• Beta blockers may inhibit foetal growth in late pregnancy

Question 6

Common acute problems + management in pregnancy?

Answer 6

Nausea and vomiting - first line is cyclizine

UTI (follow local guidelines) - nitrofurantoin as first line, amoxicillin or cefalexin as second line

Pain - first line is paracetamol

Heartburn - antacids

Question 7

Pregnant women have a 10 fold increased risk of VTE (venous thromboembolism) compared to non-pregnant. true/false?

Answer 7

True

Question 8

What is leading cause of maternal death in pregnancy?

Answer 8

VTE (venous thromboembolism)

Question 9

Not all women need to be checked for VTE. True/false?

Answer 9

False

All women should be checked

Question 10

What is used to treat suspected or established DVT/PE?

Answer 10

Therapeutic dose LMWH (low molecular weight heparin)

Question 11

Why is warfarin avoided in early and late pregnancy?

Answer 11

Teratogenic in EARLY PREGNANCY

Risk of haemorrhage during delivery in LATE PREGNANCY

Question 12

What are significant risk factors of VTE and what should be used as a preventative measure?

Answer 12

LMWH used as thromboprophylaxis in those with more than 2 of risk factors below:

• Obesity
• Age over 35 yrs
• Smoking
• Para > 3 (had more than 3 children)
• Previous DVT
• Caesarean delivery

Question 13

Both drugs with small molecules and fat soluble (lipophilic) drugs are able to enter breastmilk. true/false?

Answer 13

True

Question 14

What drugs affect breastfeeding?

Answer 14

• Amiodarone – neonatal hypothyroidism
• Cytotoxics – bone marrow suppression
• Benzodiazepines – drowsiness
• Bromocriptine – supresses lactation

Question 15

What are some teratogenic drugs?

Answer 15

ACE inhibitors/ARB Renal hypoplasia

Androgens Virilisation of female foetus

Antiepileptics Cardiac, facial, limb, neural tube defects

Cytotoxics Multiple defects, abortion

Lithium Cardiovascular defects

Methotrexate Skeletal defects

Retinoids Ear, cardiovascular, skeletal defects

Warfarin Limb and facial defects

Mnemonic: “All Around Argentina Comes Lionel Messi’s Right Wing”

Question 16

What is often used as a first line antihypertensive for gestational hypertension?

Answer 16

Labetalol