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Gynaecology > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

1
Q

Terotogenic drugs (8)

A 
ACEI/ARB
Androgens
Antiepileptics
Cytotoxic
Lithium 
Methotrexate
Retinoids (Vit A)
Warfarin
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2
Q

ACEI/ARB

A

renal hypoplasia

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3
Q

Androgens

A

female fetus virilisation

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4
Q

Antiepileptics

A

cardiac
NTD
facial (cleft)

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5
Q

Cytotoxics

A

abortion

Multiple

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6
Q

Lithium

A

cardiac

ebsteins anomaly - RV failure

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7
Q

Methotrexate

A

skeletal abnormalities

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8
Q

Retinoids

A

Ear
Cardiovascular
Skeletal

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9
Q

Warfarin

A

Limb and facial defects

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10
Q

When are teratogenic drugs the worse?

A

week 4 - week 11 (first trimester)

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11
Q

2nd to 3rd trimester: how will drugs affect the development of the fetus

A

growth

functional - intellectual, behavioural

toxic effects on foetal tissue

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12
Q

how do drugs affect the foetus around term?

A

adverse effects on labour

on baby after delivery

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13
Q

How may labour be adversely be affected? (4)

A

progress of labour

adaptation of foetal circulation - premature closure of PDA

Suppression of foetal systems - opiates (respiratory depression)

Bleeding - Warfarin

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14
Q

Adverse effects on baby after delivery?

A

withdrawal syndrome - opiates, SSRI (fluoxetine/citalopram highest levels in breastmilk)

Sedation

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15
Q

diethylstilbestrol was used for what initially? did it work

A

prevention recurrent miscarriage (didnt work)

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16
Q

what delayed effects on the baby did diethylstilbestrol

A

vaginal adenocarcinoma in girls aged 15-20yrs

Urological malignancy in boys

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17
Q

What are epileptic seizures assoc with in untreated women with epilepsy

A

congenital malforms (higher than gen pop)

Frequent seizures = lower verbal IQ, hypoxia, bradycardia, antenatal death, maternal death

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18
Q

Why are there increased seizures in women with epilepsy during pregnancy and by what %

A

10%

non-compliance

changes in plasma conc = persistent vomiting, increased clearance

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19
Q

antiepileptics increase risk of congen malformations by what %

A

20-30% if on 4 drugs

monotherapy preferred

20
Q

what antiepileptic should be avoided

A

valproate

phenytoin (enzyme inducer)

21
Q

What extra precaution to take on antiepileptics

A

folic acid 5mg daily (3m before into 1st trim)

22
Q

%of babies born to women taking antiepileptics will not have major congenital malformations

A

96

benefits of treatment outweigh risks in most cases

23
Q

diabetes whats safe and not safe

A

safe: insulin

not safe: sulfonylureas (convert to insulin)

24
Q

how is treatment affect in DM

A

requirements change during pregnancy

poor control increases risk of congen malform and IUD

25
Q

HT and medications

A 
BP falls during 2nd trimester
If need to treat, use one of:
Labetalol (x severe asthma)
Methyldopa (x depro)
(Nifedipine MR)

Avoid ACE inhibitors / ARB

Beta blockers may inhibit foetal growth in late pregnancy (IUGR)

26
Q

what to use in N/V

A

cyclizine is safest

27
Q

UTI?

A

Amoxicilin or cefalaxin

28
Q

Pain?

A

paracetamol

29
Q

Heartburn?

A

Antacids

30
Q

prevention of VTE

A

encourage to mobilise and hydrate adequately (ALL)

TED stockings

significant risk factors: thromboprophylaxis with LMWH

31
Q

who should thromboprophylaxis by used for (risk factors)

A

2 or more risk factors:

obesity
smoker
>35years
Para >3
Previous DVT
C-section
32
Q

when is thromboprophylaxis with LMWH used?

A

at delivery and up to 7 days post-partum

33
Q

warfarin is pregnancy?

A

AVOID in early - teratogenic

AVOID in late -
risk of haemorrhage during delivery

use LMWH instead

(warfarin is OK in breastfeeding though)

34
Q

Which drugs enter breast milk? (chemistry)

A

small molecules

fat soluble (lipophillic)

few enter in sufficient quantities to cause a problem

35
Q

how can feeding patterns affect the amount?

A

foremilk = protein rich

hindmilk = higher fat content

longer feeds = higher amounts of fat soluble drugs in milk

36
Q

why may drugs accumulate?

A

immature metabolism

37
Q

Drug that is actively concentrated in breast milk

A

phenobarbitone - suckling difficulties

38
Q

Amiodarone in breastfeeding

A

neonatal hypothyroidism

39
Q

Cytotoxics in breastfeeding

A

bone marrow suppresion

40
Q

benzos in breastfeeding

A

drowsiness

41
Q

bromocriptine in breastfeeding

A

suppresses lactation

42
Q

which antibiotic given during pregnancy or in early childhood can cause problems with TEETH

A

tetracyclines - staining of bones and teeth

avoid in kids up to age 8

doxycycline

43
Q

what drug in early preg causes a child with a facial appearance of thin upper lip, indistinct philtrum, short nose, flat midface, epicanthal folds, low nasal bridge, minor ear anormalies..

A

alcohol - FAS

44
Q

Which antiepileptic drug is particularly associated with the following congenital anomaly? - cleft lip

A

phenytoin (but all the antiepileptics too)

45
Q

Which drug taken during pregnancy can cause this problem in female offspring? - adenocarcinoma of the cervix in age 15-20

A

stilbestrol

46
Q

Which antiepileptic drug is particularly associated with the following defects? - NTD (spina bifida, anencephaly)

A

Na Valproate

47
Q

What drugs are contraindicated in breastfeeding?

A

tetracycline

Li

Substance of abuse

Amiodarone

Clozapine

Gynaecology (7 decks)

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