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Repro > Prescribing in pregnancy > Flashcards

Prescribing in pregnancy Flashcards

1
Q

what do most drugs do across the placenta except which kind of drugs

A

cross it

large molecular weight such as heparin

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2
Q

which kind of drugs cross more quickly across the placenta

A

small lipid soluble drugs

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3
Q

pharmacokinetics of drugs in preg

A

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

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4
Q

which 2 drugs require concentration checks and alter doses during and after delivery

A

lithium

digoxin

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5
Q

changes in pharmacodynamics

A

no significant changed

pregnant woman may be more sensitive to some drugs

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6
Q

what drug is given during pregnancy

A

folic acid 400mcg for 3 months prior to pre conception and first 3 months of pregnancy

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7
Q

risks of drugs in first trimester

A

early miscarriage
organogenesis
period of greatest teratogenic risk is 4-11 weeks

avoid all risks unless maternal benefit outweighs risk to fetus

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8
Q 
ACE/ARB leads to what in fetus
androgens
antiepiletics
cytotoxicx
lithium
methotrexate 
retinoids
warfarin
A

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

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9
Q

effects drugs have on second and third trimesters

A

growth of the fetus
functional development = intellectual impairment, behavioural abnormalities
toxic effects on fetal tissue

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10
Q

adverse effects in labour

A

progress of labour
adaption of fetal circulation - premature closure of DA
suppression of fetal systems -opiates
bleeding - warfarin

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11
Q

what does opiates do

A

respiratory depression

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12
Q

what can lead to withdrawel syndrome in the baby after delivery

A

opiates

SSRIs

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13
Q

what does diethylstilbestrol lead to

A

vaginal adenocarcinoma in girls aged 15-20 in mothers who were exposed to this drug

urological malignancy in boys

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14
Q

mothers with asthma during pregnancy

A

many avoid taking their inhalers

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15
Q

mothers with epilepsy during pregnancy

A

20% stop antiepilectic drugs

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16
Q

incidence of what is higher in women with untreated epilepsy compares to women without epilepsy

A

congenital malformations

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17
Q

why are there increased seizures in 10% of women

A

non compliance

changes in plasma concentrations of drugs - persistent vom and increased clearance

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18
Q

what are frequent seizures during pregnancy associated with

A 
lower verbal IQ in child
hypoxia
bradycardia 
antenatal death 
maternal death
19
Q

what do anti epileptics increase the risk of

A

congenital malformations

20
Q

what anti epileptic drugs should be avoided

A

valproate, phenytoin

21
Q

what drug should be given in women with epilepsy

A

folic acid 5mg daily

22
Q

what drug is not safe in diabetic pregnant women

A

SUs - convert to insulin

23
Q

what does poor control of diabetes lead to

A

increased risk of urogenital malformations and IUD

24
Q

what should be given to treat hypertension

A

labetolol
methyldopa
nifedipine

25
Q

what should be avoided in hypertension

A

ACEI/ARB

26
Q

what can BBs do

A

inhibit fetal growth in late pregnancy

27
Q

treatment for nausea and vomiting in pregnancy

A

cyclizine

28
Q

treatment for UTI in pregnancy

A

Nitro, cefalexine

in 3rd trimester trimethoprim

29
Q

pain in pregnancy

A

paracetamol

30
Q

heartburn in pregnancy

A

antacids

31
Q

what is the increased risk of VTE in pregnancy women compared to non pregnancy mown

A

10 fold increased risk

32
Q

what is the leading cause of maternal death in pregnancy

A

VTE

33
Q

when should treatment be given for VTE in pregnancy

A 
2 or more risk factors:
obesity
>35
smoker
para >3
previous DVT
C sec
34
Q

how long should rx be given in VTE

A

at delivery and up to 7 days post partum

35
Q

treatment of VTE

A

LMWH

36
Q

why should warfarin be avoided

A

teratogenic in early preg

risk of haemorrhage during delivery in late preg

37
Q

what kind of drugs can enter breast milk

A

small molecules

fat soluble drugs

38
Q

what can happen in longer feeds

A

high amount of fat soluble drugs in milk

39
Q

what drug can be actively concentrated in breast milk

A

phenobarbitone - suckling difficulties

40
Q

amiodarone
cytotoxic
BZDs
bromocriptine

effects through breast milk

A

neonatal hypothyroid
bone marrow suppression
drowsiness
surpasses lactation

41
Q

which antibiotic given during pregnancy or early childhood causes staining of ones and teeth

A

tetracycline - avoid in children up to 8

42
Q

which anti epileptic drug can cause cleft lip and palate

A

phenytoin

43
Q

which drug taken during pregnancy can lead to vaginal adenocarcinoma

A

stillbestrol

44
Q

which anti epileptic drug can lead to neural tube defects such as spina bifida and anencephaly

A

valproate

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