Prescribing in Pregnancy Flashcards

1
Q

State the overall guidance for prescribing in pregnancy

A

Lowest effective dose for shortest period using safest drug if maternal benefit > foetal risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most drugs cross the placenta. True/False? What is the exception to this?

A

True

Except LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How might pharmacokinetics be affected by pregnancy?

A

Less absorption (morning sickness)
Increased distribuition (> plasma volume and fat)
Increased metabolism
Decreased binding (> free drug)
Increased elimination in renal-excreted drugs (>GFR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should a female take 3 months prior to and in the first 3 months of pregnancy?

A

400 mcg folic acid

5mg folic acid in epileptics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In which trimester is a baby at most risk from teratogenicity?

A

1st trimester (4th - 11th week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What teratogenic effect do ACEI/ARBs have?

A

Renal hypoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What teratogenic effect do antiepileptics have?

A

Cardiac defects
Facial and limb defects
Neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What teratogenic effect does lithium have?

A

Cardiac defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What teratogenic effect does methotrexate have?

A

Skeletal defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What teratogenic effect does warfarin have?

A

Limb and facial defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List adverse effects of medications on labour

A

Progress of labour
Adaptation of foetal ciculation
Suppression of foetal systems e.g. resp depression
Bleeding e.g. warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are frequent seizures in pregnancy associated with in the child?

A

Lower IQ
Hypoxia
Bradycardia
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which antiepileptics should be avoided in pregnancy?

A

Valproate

Phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which class of diabetic drugs is not safe in pregnancy?

A

Sulfonylureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When does BP fall during pregnancy?

A

2nd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which antihypertensives should be avoided in pregnancy?

A

ACEI/ARB

17
Q

List alternative antihypertensives that can be used in pregnancy

A

Labetalol
Methyldopa
Nifedipine MR

18
Q

Which medications are safest for use in nausea and vomiting?

A

Cyclizine

19
Q

Which medications are safest for use in UTI?

A

Nitrofurantoin
Cefalexin
Trimethoprim in 3rd trimester

20
Q

Which medications are safest for use in pain?

A

Paracetamol

21
Q

Which medications are safest for use in heartburn?

A

Antacids

22
Q

Which drug is used to treat and prevent VTE in pregnancy?

A

LMW Heparin

23
Q

Why is warfarin contraindicated in early and late pregnancy respectively?

A

Teratogenic

Risk of haemorrhage during delivery

24
Q

Most drugs enter breast milk. True/ False?

A

True

Especially small molecules, lipophillic drugs

25
Q

List some common drugs that can concentrate in breastmilk and their effect

A
Phenobarbitone (suckling difficulty)
Amiodarone (hypothyroidism)
Cytotoxics (bone marrow suppression)
BZDs (drowsiness)
Bromocriptine (suppresses lactation)
26
Q

Which antibiotic given in pregnancy or early childhood can cause blue staining of teeth?

A

Tetracycline

27
Q

List facial features of foetal alcoholic syndrome

A
Short palpable fissures
Flat midface
Epicanthal folds
Short nose, low bridge
Indistinct philtrum
Thin upper lip
28
Q

Which antiepileptic can cause cleft lip/palate?

A

Phenytoin

29
Q

Which antiepileptic is associated with neural tube defects?

A

Valproate