Prescribing in Pregnancy Flashcards
randomised clinical trials are the mainstay of testing drugs in pregnancy T or F
F, very unethical
presents risk to some mums and babies
what should be considered as an alternative to drugs in pregnancy?
physio
CBT > antidepressants
recommendations for dosage and choice of drug in pregnancy?
use older drugs with better safety records
lowest effective dose for shortest period
what painkiller medications are prohibited in pregnancy
NSAIDs
what kind of molecules do not pass the placenta
large molecular weight molecules eg heparin
what kind of molecules pass through the placenta more quickly?
small, lipid soluble drugs
why does Vd increase in pregnancy?
increased PV and fat stores
what happens if the drug doesnt bind to proteins as well in pregnancy?
there is more free drug in the circulation
why does GFR increase in pregnancy?
elimination of renally excreted drugs increases
at what trimester are women at risk of hypotension if theyre on antihypertensives?
2nd trimester
what should you check in any woman of childbearing age who presents?
are they pregnant?
are they planning to get pregnant?
when is folic acid given in pregnancy? what dose?
400mcg daily for 3 months pre-conception and 3 months post-conception
period of greatest teratogenic risk?
4th-11th week
drug taking rules for 1st trimester
avoid unless risk outweighs benefit
what drugs can cause renal hypoplasia
ACEi
ARB
what can antiepileptics cause?
cardiac, facial, limb, neural tube defects
what defects does lithium cause?
cardio defects
what defects does methotrexate cause?
skeletal defects
what defects does warfarin cause?
limb/facial defects
when does most intellectual
and behavioural development of the fetus occur?
2nd and 3rd trimester
what are the main changes to the fetus in 2T and 3T?
growth
functional development
fetal tissue develops
main effect of opiates on baby and when?
resp depression at birth
anti-epileptics of choice in pregnancy
levotiracetam
lamotrigine sometimes
why do seizures increase in compliant pregnant women with epilepsy?
persistent vomiting can cause increased clearance
a dose of ___ should be given to pregnant women with epilepsy
5mg
what diabetic drugs are not safe in pregnancy?
SURs
insulin is thought to be safe in pregnancy T or F
T
Tx of HTN in pregnancy?
labetalol
methyldopa
B blockers are safe in pregnancy T or F
F, may inhibit fetal growth in late pregnancy
complication of methyldopa?
depression
best drug for N+V in pregnancy
cyclizine
best drug for UTI in pregnancy
nitrofurantoin
cefalexin
trimethoprim (3rd trimester only)
antacids are safe in pregnancy T or F
T
risk factors for prophylaxis for VTE? when should you give prophylaxis
give prophylaxis if >2 of: obesity age >35 smoking para 3 previous DVT previous CS
when is VTE prophylaxis given?
pregnancy
at delivery
up to 7 days postpartum
what drug compositions enter breats milk?
small, lipophilic drugs
foremilk is rich in protein/fat
protein
hindmilk is rich in protein/fat
fat
amiodarone has what effect on baby and when?
breastfeeding phase
neonatal hypothyroidism
what antibiotic stains bones and teeth?
tetracycline
what drug can cause vaginal adenocarcinomas?
desplex
