prescribing in pregnancy Flashcards
what drug does not cross placenta
low molecular weight heparin
what may affect absorption of drugs in pregnancy
morning sickness
why is distribution of drugs affected in pregnancy
increased plasma volume and fat stores
decreased protein binding - increased free drug
how is metabolism of drugs affected in pregnancy
increased liver metabolism (eg phenytoin)
how is elimination of drugs affected in pregnancy
elimination of renally excreted drugs increases (increased GFR)
what medication is recommended for 3 months prior to conception and for how long should it be continued
folic acid 400mcg/day
start 3 months before conception and continue for first 3 months of pregnancy
what does folic acid reduce risk of
neural tube defects
what drugs are teratogenic
ACE inhibitors/ARBs androgens antiepileptics cytotoxic llithium methotrexate retinoids warfarin
what do ACE/ARBs cause
renal hypoplasia
what do androgens cause
virilisation of female foetus
what do antiepileptics cause
cardiac, facial, limb, neural tube defects
what does lithium cause
CV defects
what does methotrexate cause
skeletal defects
what do retinoids cause
ear, CV and skeletal defects
what does warfarin cause
limb and facial defects
what can opiates given during labour cause
respiratory depression
what can SSRIs and opiates given throughout pregnancy cause
withdrawal symptoms
sedation
complications of frequent maternal seizures
lower IQ hypoxia bradycardia antenatal death maternal death
what anti-convulsants should be avoided in pregnancy
valproate
phenytoin
what diabetic drug is not safe in pregnancy
sulfonylurea (convert these patients to insulin)
what anti-emetic should be given in pregnancy
cyclizine
what antibiotics should be used in pregnancy for UTI
nirofuratoin (1st and 2nd trimester)
trimethoprim (3rd trimester)
what should be given for pain during pregnancy
paracetamol
what should be given for heart burn during pregnancy
antacids
criteria for prophylactic treatment of VTE during and after labour
2 or more of: age >35 obesity smoking parity >3 previous DVT C section
what treatment is given prophylactically during labour and how long after birth should it be continued
LMWH
up to 7 days post partum
what treatment is used if DVT/PE in pregnancy
LMWH
what drugs are contraindicated in breastfeeding
amiodarone
cytotoxics
benzodiazepines
bromocriptine
