Prescribing in Pregnancy

Question 1

randomised clinical trials are the mainstay of testing drugs in pregnancy T or F

Answer 1

F, very unethical

presents risk to some mums and babies

Question 2

what should be considered as an alternative to drugs in pregnancy?

Answer 2

physio

CBT > antidepressants

Question 3

recommendations for dosage and choice of drug in pregnancy?

Answer 3

use older drugs with better safety records

lowest effective dose for shortest period

Question 4

what painkiller medications are prohibited in pregnancy

Answer 4

NSAIDs

Question 5

what kind of molecules do not pass the placenta

Answer 5

large molecular weight molecules eg heparin

Question 6

what kind of molecules pass through the placenta more quickly?

Answer 6

small, lipid soluble drugs

Question 7

why does Vd increase in pregnancy?

Answer 7

increased PV and fat stores

Question 8

what happens if the drug doesnt bind to proteins as well in pregnancy?

Answer 8

there is more free drug in the circulation

Question 9

why does GFR increase in pregnancy?

Answer 9

elimination of renally excreted drugs increases

Question 10

at what trimester are women at risk of hypotension if theyre on antihypertensives?

Answer 10

2nd trimester

Question 11

what should you check in any woman of childbearing age who presents?

Answer 11

are they pregnant?

are they planning to get pregnant?

Question 12

when is folic acid given in pregnancy? what dose?

Answer 12

400mcg daily for 3 months pre-conception and 3 months post-conception

Question 13

period of greatest teratogenic risk?

Answer 13

4th-11th week

Question 14

drug taking rules for 1st trimester

Answer 14

avoid unless risk outweighs benefit

Question 15

what drugs can cause renal hypoplasia

Answer 15

ACEi

ARB

Question 16

what can antiepileptics cause?

Answer 16

cardiac, facial, limb, neural tube defects

Question 17

what defects does lithium cause?

Answer 17

cardio defects

Question 18

what defects does methotrexate cause?

Answer 18

skeletal defects

Question 19

what defects does warfarin cause?

Answer 19

limb/facial defects

Question 20

when does most intellectual

and behavioural development of the fetus occur?

Answer 20

2nd and 3rd trimester

Question 21

what are the main changes to the fetus in 2T and 3T?

Answer 21

growth
functional development
fetal tissue develops

Question 22

main effect of opiates on baby and when?

Answer 22

resp depression at birth

Question 23

anti-epileptics of choice in pregnancy

Answer 23

levotiracetam

lamotrigine sometimes

Question 24

why do seizures increase in compliant pregnant women with epilepsy?

Answer 24

persistent vomiting can cause increased clearance

Question 25

a dose of ___ should be given to pregnant women with epilepsy

Answer 25

5mg

Question 26

what diabetic drugs are not safe in pregnancy?

Answer 26

SURs

Question 27

insulin is thought to be safe in pregnancy T or F

Answer 27

T

Question 28

Tx of HTN in pregnancy?

Answer 28

labetalol

methyldopa

Question 29

B blockers are safe in pregnancy T or F

Answer 29

F, may inhibit fetal growth in late pregnancy

Question 30

complication of methyldopa?

Answer 30

depression

Question 31

best drug for N+V in pregnancy

Answer 31

cyclizine

Question 32

best drug for UTI in pregnancy

Answer 32

nitrofurantoin
cefalexin
trimethoprim (3rd trimester only)

Question 33

antacids are safe in pregnancy T or F

Answer 33

T

Question 34

risk factors for prophylaxis for VTE? when should you give prophylaxis

Answer 34

give prophylaxis if >2 of:
obesity
age >35
smoking
para 3
previous DVT
previous CS

Question 35

when is VTE prophylaxis given?

Answer 35

pregnancy
at delivery
up to 7 days postpartum

Question 36

what drug compositions enter breats milk?

Answer 36

small, lipophilic drugs

Question 37

foremilk is rich in protein/fat

Answer 37

protein

Question 38

hindmilk is rich in protein/fat

Answer 38

fat

Question 39

amiodarone has what effect on baby and when?

Answer 39

breastfeeding phase

neonatal hypothyroidism

Question 40

what antibiotic stains bones and teeth?

Answer 40

tetracycline

Question 41

what drug can cause vaginal adenocarcinomas?

Answer 41

desplex