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Repro > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

1
Q

When was Thalidomide being prescribed?

A

1958 - 1961

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2
Q

What was wrong with Thalidomide?

A

3,500 deaths in first year of life

>10,000 born with deformities

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3
Q

What is Thalidomide used for now?

A

Leprosy

Myeloma

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4
Q

What drugs don’t cross the placenta?

A

large molecular weight e.g. heparin

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5
Q

What drugs cross the placenta more quickly than others?

A

Small, lipid-soluble drugs

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6
Q

What may effect the absorption of a drug during pregnancy?

A

Morning sickness

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7
Q

What effects the distribution of a drug in pregnancy?

A

Increased plasma volume and fat stores

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8
Q

What causes increased free drug amounts during pregnancy?

A

decreased protein binding

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9
Q

What is Phenytoin assoc. with?

A

Increased liver metabolism of some drugs

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10
Q

How is elimination of drugs during pregnancy effected?

A

Increased GFR

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11
Q

Name 2 drugs where it is important to check concentrations and alter doses according during pregnancy and after delivery?

A

Lithium

Digoxin

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12
Q

When are women more at risk of hypotension when on antihypertensives?

A

2nd trimester

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13
Q

What doses of Folic acid has benefit?

A

400mcg daily for 3 months prior and first 3 months of pregnancy

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14
Q

What is common in the first trimester?

A

Risk of early miscarriage

Organogenesis

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15
Q

When is the greatest teratogenic risk?

A

4th - 11th week

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16
Q

When should drugs be given during the first trimester?

A

Only if benefits outweigh the risks

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17
Q

What problems can arise in the 2nd and 3rd trimester?

A

Intellectual impairment
Behavioural abnormalities
Toxic effects on foetal tissue

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18
Q

What foetal issue can opiates cause?

A

Respiratory depression

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19
Q

What drug can cause bleeding?

A

Warfarin

20
Q

What drugs can cause withdrawal in the foetus?

A

Opiates

SSRI’s

21
Q

What drug was thought to be able to prevent miscarriages?

A

Diethylstilbestrol

22
Q

What were the effects of Diethylstilbestrol?

A

Vaginal adenocarcinoma in girls aged 15-20 whose mothers were exposed to it
Urological malignancy in boys

23
Q

What are seizures associated with in pregnancies?

A 
Lower verbal IQ in child
Hypoxia
Bradycardia
Antenatal death
Maternal death
24
Q

What can antiepileptics cause?

A

Congenital abnormalities

25
Q

What drugs should be avoided?

A

Valproate

Phenytoin

26
Q

What should be taken?

A

Folic acid, 5mg daily

27
Q

Is Insulin safe?

A

yes

28
Q

Are Sulfonylureas safe?

A

No, convert to insulin

29
Q

What happens to BP in the 2nd trimester?

A

Lowers

30
Q

What 3 drugs can treat hypertension in pregnancy?

A

labetalol
Methydopa
Nifedipine MR

31
Q

What antihypertensives should be avoided?

A

ACEi/ARBs

Beta blockers - inhibit foetal growth

32
Q

What drug can be used for N+V?

A

Cyclizine

33
Q

What drugs can be used for UTI’s?

A

Nitrofurantoin
Cefalexin
Trimethorprim (3rd trimester)

34
Q

What drug can be used for pain?

A

Paracetamol

35
Q

What drug can be used for heartburn?

A

Antacids

36
Q

What should all women be assessed for?

A

Risk of VTE

37
Q

What should women with a significant risk of VTE receive?

A

Thrombopropylaxis with LMWH

38
Q

What are risk factors for VTE?

A 
Obesity
Age >35 years
Smoking
Para >3
Previous CS
39
Q

What drug for VTE should be avoided and why?

A

Warfarin.
Early = Teratogenic
Late = Haemorrhage risk

40
Q

What drugs especially enter the breast milk?

A

Small molecules

Fat soluble drugs (Lipophilic)

41
Q

What milk is protein rich?

A

Foremilk

42
Q

What has a higher fat content?

A

Hindmilk

43
Q

What can Phenobarbitone cause?

A

Suckling difficulties

44
Q

What can Amiodarone cause?

A

Neonatal hypothyroidism

45
Q

What can cytotoxics cause?

A

Bone marrow suppression

46
Q

What can benzodiazepines cause?

A

Drowsiness

47
Q

What can Bromocriptine cause?

A

Suppresses lactation

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