Prescribing in pregnancy Flashcards
1
Q
period of greatest teratogenic risk?
A
4th-11th week
avoid drugs if possible
2
Q
Name the more common teratogenic drugs? (8)
A
ACE inhibitors/ARBs- Renal hypoplasia Androgens- Virilisation of female foetus Antiepileptics- Cardiac, facial, limb, neural tube defects Cytotoxics- Multiple defects, abortion Lithium- Cardiovascular defects Methotrexate- Skeletal defects Retinoids- Ear, cardiovascular, skeletal defects Warfarin- Limb and facial defects
3
Q
Epilepsy
- effect on disease?
- why? ^^ (2)
- effect on foetus?
- risk of medication?
- what should be avoided?
- protective meds?
A
- increased seizures
- non-compliance and change in plasma Conc of drug due to vomiting and inc clearance
- freduent seizures are associated with: lower verbal IQ, hypoxia, bradycardia, antenatal death, maternal death
-inc risk of congenital malformations by 20-30% if on 4 drugs
96% of babies born to women taking anti epileptics will NOT have major congenital malformations
- valproate, phenytoin
- folic acid
4
Q
Diabetes
- safe meds?
- unsafe meds?
- poor control increases risk of what?
A
- insulin
- sulfonylureas
- congenital malformation & intrauterine death
5
Q
Hypertension
- use what meds? (3)
- Avoid? (3)
A
-labetolol
Methyldopa
Nifedipine
-ACE, ARB
beta blockers in late preg
6
Q
What can be given for the following common problems?
- nausea & vomiting
- UTI
- pain
- heartburn
A
- cyclizine
- Nitrofurantoin, cefalexin (3rd trimester trimethoprim)
- paracetamol
- antacids
7
Q
prevention of DVT
- in all pregnancy women?
- in high risk groups?
- treatment of DVT? what should be avoided?
A
- mobilisation and hydration
- LMHW
-therapeutic dose of LMWH
avoid warfarin in early and late preg
8
Q
What drugs cannot be used with breast feeding?
A
Phenobarbitone Amioderone- hypothyroidism Cytotoxics- BM suppression Benzos- Drowsiness Bromocriptine- suppressses lactation
