Prescribing in Pregnancy Flashcards
Which anti coagulant does not cross the placenta and is therefore considered safe in pregnancy
Unfractionated heparin (large molecular weight)
What are the four components of pharmacolkinetics
Absorption
Distribution
Metabolism
Elimination
How is absorption affected in pregnancy
Morning sickness
Distribution
More fat store
Increased plasma volume
Distriubution increases
Metabolism
Decreased protein binding results in increased free drug
Increased liver metabolism of some drugs (phenytoin)
Elimination
GFR increases so renally excreted drugs are eliminated quicker
Name drugs which have narrow therapeutic windows
Lithium
Digoxin
what drugs may pregnant women be more sensitive too
Antihypertensives- can cause hypotension in 2nd trimester
When should folic acid be taken
for three months prior to and up to first 12 weeks of pregnancy
When is the period of greatest tetatrogenic risk
4th-11th week
Name teratogenic drugs
ACE/ARBs Androgens Antiepilptics Cytotoxics Lithium Methotrexate Retinoids Warfarin
ACE/ARBs
renal hypoplasia
androgens
virilisation of femal foetus
antiepileptics
cardiac, facial, limb, neural tube defects
cytotoxins
defects, abortion
lithium
CVS defects
methotrexate
skeletal defects
Retinoids
ear, CVS, skeletal defects
Warfarin
limb and facial defects
What was DES shown to cause
vaginal adenocarcinoma in the daughters of those exposed during pregnancy
Urological malignancy was also found in sons of those exposed
What are frequent sezures in pregnancy associated with
lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death
Which antiepileptics should be avoided in pregnancy
valproate
phenytoin
Monotherapy prefered
What additional precaution should be taken for women with epilepsy in pregnancy
5mg (higher dose) of folic acid
Is insulin safe in pregnancy
yes
Are sulphonylureas safe in pregnancy
no
what is the safes anto emetic
cyclizine
what antibiotic is the best to use in pregnancy for a UTI
amoxicillin
cefalexin
is paracetemol safe
yes
Are antacids safe
yes
what is the leading cause of maternal death in pregnancy
VTE - assess all women for their risk
How should those with a high risk of VTE be treated
LMWH at delivery and 7 days post partum
What are the risk factors for VTE in pregnancy
obesity age more than 35 para more than 3 previous DVT C section
treat if more than 2
Amioderone in breasfeeding
neonatal hypothyroidism
cytotoxics in breastfeeding
bone marrow suppression
Benzodiazepines
drowsiness
Bromocriptine
suppresses lactation
Which antibiotic given during pregnancy or early childhood can cause teeth staining
tetracyclines
which antiepileptic is particularly associated with cleft palate
phenytoin
which antiepileptic drug is particularly associated with anencephaly and spinabifida
valproate
