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Reproduction > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

1
Q

Do most drugs cross placenta?

A

Yes, except LMW drugs e.g. Heparin

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2
Q

What drugs cross more quickly than others?

A

Small, lipid soluble

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3
Q

How is absorption effected in pregnancy?

A

Morning sickness

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4
Q

How is distribution effected in pregnancy?

A

Volume of distribution increased due to increased PV and fat stores
Decreased protein binding, so increased free drug

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5
Q

How is metabolism effected in pregnancy?

A

Increased liver metabolism of some drugs e.g. phenytoin

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6
Q

How is elimination effected in pregnancy?

A

Elimination of renally excreted drugs increases- increased GFR

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7
Q

Are pharmacodynamics effected in pregnancy?

A

No significant changes- pregnant women can be more sensitive to some drugs e.g. hypotension with antihypertensives in 2T

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8
Q

What should be taken pre-conception?

A

Folic acid 400mcg daily for 3 months prior and first 3 months of pregnancy
Safest drug therapy for existing chronic conditions

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9
Q

When is the period of greatest teratogenic risk?

A

4th to 11th week

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10
Q

Describe drug use in 1T?

A

Avoid drugs if at all possible unless maternal benefit outweighs risk to fetus

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11
Q

What teratogenic effects can ACEI/ARBs have?

A

Renal hypoplasia

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12
Q

What teratogenic effects can androgens have?

A

Virilisation of female fetus

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13
Q

What teratogenic effects can antiepileptics have?

A

Cardiac, facial, limb, neural tube defects

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14
Q

What teratogenic effects can cytotoxics have?

A

Multiple defects, abortion

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15
Q

What teratogenic effects can lithium have?

A

CV defects

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16
Q

What teratogenic effects can methotrexate have?

A

Skeletal defects

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17
Q

What teratogenic effects can retinoids?

A

Ear, CV, skeletal defects

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18
Q

What teratogenic effects can warfarin have?

A

Limb and facial defects

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19
Q

What can opiates around term?

A

Respiratory depression

20
Q

What can warfarin cause around term?

A

Bleeding

21
Q

What did diethylstilbestrol cause?

A

Vaginal adenocarcinoma in girls aged 15-20yo whose mothers took drug
Urological malignancy in boys

22
Q

Can untreated epilepsy lead to congenital malformations?

A

Yes- incidence higher than that of women without epilepsy

23
Q

Why does pregnancy increase seizures in 10% of women?

A

Non-compliance

Changes in plasma concentrations of drugs: persistent vomiting, increased clearance

24
Q

What are frequent seizures during pregnancy associated with?

A 
Lower verbal IQ
Hypoxia
Bradycardia
Antenatal death
Maternal death
25
Q

Do antiepileptics increase the risk of congenital malformations?

A

Yes- 20/30% risk if on 4 drugs, monotherapy preferred
Avoid valproate, phenytoin
(96% won’t have major malformations)

26
Q

Are insulin and sulfonylureas safe during pregnancy?

A

Insulin yes, sulfonylureas no- switch to insulin

27
Q

What does poor diabetic control increase the risk of?

A

Congenital malformations

IUD

28
Q

Do diabetic requirements change during pregnancy?

A

Yes

29
Q

What can beta blockers do in late pregnancy?

A

Inhibit fetal growth

30
Q

How should N & V be treated in pregnancy?

A

Cyclizine

31
Q

How should UTI be treated in pregnancy?

A

Nitrofurantoin, cephalexin (3T trimethoprim)

32
Q

How should mild pain be treated in pregnancy?

A

Paracetamol

33
Q

How should heartburn be treated in pregnancy?

A

Antacids

34
Q

By how much does pregnancy increase the risk of VTE?

A

10x

35
Q

What thromboprophylaxis for VTE should be used in pregnancy and by who?

A

LMWH at delivery and up to 7 days post partum if:

2 or more RFs e.g. obesity, >35yo, smoking, para >3, previous DVT, Caesarean delivery

36
Q

How should suspected or established DVT or PE be treated?

A

Therapeutic dose of LMWH

Avoid warfarin in early pregnancy (teratogenic) and late pregnancy (risk of haemorrhage during delivery)

37
Q

What drugs enter breast milk?

A

Most, especially small or fat soluble drugs

38
Q

How can feeding patterns affect amounts of drugs in breastfeeding?

A

Foremik- protein rick
Hindmilk- higher fat content
Longer feeds, higher amounts of fat soluble drugs in milk

39
Q

What drug is actively concentrated in breast milk?

A

Phenobarbitone- suckling difficulties

40
Q

What can amiodarone cause when passed through breast milk?

A

Neonatal hypothyroidism

41
Q

What can cytotoxics cause when passed through breast milk?

A

Bone marrow suppression

42
Q

What can benzodiazepines cause when passed through breast milk?

A

Drowsiness

43
Q

What can bromocriptine cause when passed through breast milk?

A

Suppresses lactation

44
Q

Which antibiotic given during pregnancy or in early childhood can cause staining of bones and teeth?

A

Tetracycline- avoid in children up to 8yo

45
Q

Which antiepileptic drug is particularly associated with cleft lip and palate?

A

Phenytoin

46
Q

Which antiepileptic drug is particularly associated with neural tube defects such as spina bifida and anencephaly?

A

Valproate

Reproduction (40 decks)

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