Prescribing in pregnancy Flashcards
what do most drugs do across the placenta except which kind of drugs
cross it
large molecular weight such as heparin
which kind of drugs cross more quickly across the placenta
small lipid soluble drugs
pharmacokinetics of drugs in preg
absorption may be affected by morning sickness
distribution is increased as there is an increase in plasma volume and fat stores
theres increased liver metabolism of some drugs
and due to decreased protein binding theres increased free drug
increased GFR leads to increased elimination of renal excreted drugs
which 2 drugs require concentration checks and alter doses during and after delivery
lithium
digoxin
changes in pharmacodynamics
no significant changed
pregnant woman may be more sensitive to some drugs
what drug is given during pregnancy
folic acid 400mcg for 3 months prior to pre conception and first 3 months of pregnancy
risks of drugs in first trimester
early miscarriage
organogenesis
period of greatest teratogenic risk is 4-11 weeks
avoid all risks unless maternal benefit outweighs risk to fetus
ACE/ARB leads to what in fetus androgens antiepiletics cytotoxicx lithium methotrexate retinoids warfarin
enal hypoplasia
virilisation of female fetus
cardiac, facial, limb, NT defects
multiple defects, abortion
CVS defects
skeletal defects
ear, CVS, skeletal defects
limb and facial defects
effects drugs have on second and third trimesters
growth of the fetus
functional development = intellectual impairment, behavioural abnormalities
toxic effects on fetal tissue
adverse effects in labour
progress of labour
adaption of fetal circulation - premature closure of DA
suppression of fetal systems -opiates
bleeding - warfarin
what does opiates do
respiratory depression
what can lead to withdrawel syndrome in the baby after delivery
opiates
SSRIs
what does diethylstilbestrol lead to
vaginal adenocarcinoma in girls aged 15-20 in mothers who were exposed to this drug
urological malignancy in boys
mothers with asthma during pregnancy
many avoid taking their inhalers
mothers with epilepsy during pregnancy
20% stop antiepilectic drugs
incidence of what is higher in women with untreated epilepsy compares to women without epilepsy
congenital malformations
why are there increased seizures in 10% of women
non compliance
changes in plasma concentrations of drugs - persistent vom and increased clearance
what are frequent seizures during pregnancy associated with
lower verbal IQ in child hypoxia bradycardia antenatal death maternal death
what do anti epileptics increase the risk of
congenital malformations
what anti epileptic drugs should be avoided
valproate, phenytoin
what drug should be given in women with epilepsy
folic acid 5mg daily
what drug is not safe in diabetic pregnant women
SUs - convert to insulin
what does poor control of diabetes lead to
increased risk of urogenital malformations and IUD
what should be given to treat hypertension
labetolol
methyldopa
nifedipine
what should be avoided in hypertension
ACEI/ARB
what can BBs do
inhibit fetal growth in late pregnancy
treatment for nausea and vomiting in pregnancy
cyclizine
treatment for UTI in pregnancy
Nitro, cefalexine
in 3rd trimester trimethoprim
pain in pregnancy
paracetamol
heartburn in pregnancy
antacids
what is the increased risk of VTE in pregnancy women compared to non pregnancy mown
10 fold increased risk
what is the leading cause of maternal death in pregnancy
VTE
when should treatment be given for VTE in pregnancy
2 or more risk factors: obesity >35 smoker para >3 previous DVT C sec
how long should rx be given in VTE
at delivery and up to 7 days post partum
treatment of VTE
LMWH
why should warfarin be avoided
teratogenic in early preg
risk of haemorrhage during delivery in late preg
what kind of drugs can enter breast milk
small molecules
fat soluble drugs
what can happen in longer feeds
high amount of fat soluble drugs in milk
what drug can be actively concentrated in breast milk
phenobarbitone - suckling difficulties
amiodarone
cytotoxic
BZDs
bromocriptine
effects through breast milk
neonatal hypothyroid
bone marrow suppression
drowsiness
surpasses lactation
which antibiotic given during pregnancy or early childhood causes staining of ones and teeth
tetracycline - avoid in children up to 8
which anti epileptic drug can cause cleft lip and palate
phenytoin
which drug taken during pregnancy can lead to vaginal adenocarcinoma
stillbestrol
which anti epileptic drug can lead to neural tube defects such as spina bifida and anencephaly
valproate
