Prescribing in Pregnancy Flashcards
State the overall guidance for prescribing in pregnancy
Lowest effective dose for shortest period using safest drug if maternal benefit > foetal risk
Most drugs cross the placenta. True/False? What is the exception to this?
True
Except LMWH
How might pharmacokinetics be affected by pregnancy?
Less absorption (morning sickness)
Increased distribuition (> plasma volume and fat)
Increased metabolism
Decreased binding (> free drug)
Increased elimination in renal-excreted drugs (>GFR)
What should a female take 3 months prior to and in the first 3 months of pregnancy?
400 mcg folic acid
5mg folic acid in epileptics
In which trimester is a baby at most risk from teratogenicity?
1st trimester (4th - 11th week)
What teratogenic effect do ACEI/ARBs have?
Renal hypoplasia
What teratogenic effect do antiepileptics have?
Cardiac defects
Facial and limb defects
Neural tube defects
What teratogenic effect does lithium have?
Cardiac defects
What teratogenic effect does methotrexate have?
Skeletal defects
What teratogenic effect does warfarin have?
Limb and facial defects
List adverse effects of medications on labour
Progress of labour
Adaptation of foetal ciculation
Suppression of foetal systems e.g. resp depression
Bleeding e.g. warfarin
What are frequent seizures in pregnancy associated with in the child?
Lower IQ
Hypoxia
Bradycardia
Death
Which antiepileptics should be avoided in pregnancy?
Valproate
Phenytoin
Which class of diabetic drugs is not safe in pregnancy?
Sulfonylureas
When does BP fall during pregnancy?
2nd trimester
Which antihypertensives should be avoided in pregnancy?
ACEI/ARB
List alternative antihypertensives that can be used in pregnancy
Labetalol
Methyldopa
Nifedipine MR
Which medications are safest for use in nausea and vomiting?
Cyclizine
Which medications are safest for use in UTI?
Nitrofurantoin
Cefalexin
Trimethoprim in 3rd trimester
Which medications are safest for use in pain?
Paracetamol
Which medications are safest for use in heartburn?
Antacids
Which drug is used to treat and prevent VTE in pregnancy?
LMW Heparin
Why is warfarin contraindicated in early and late pregnancy respectively?
Teratogenic
Risk of haemorrhage during delivery
Most drugs enter breast milk. True/ False?
True
Especially small molecules, lipophillic drugs
List some common drugs that can concentrate in breastmilk and their effect
Phenobarbitone (suckling difficulty) Amiodarone (hypothyroidism) Cytotoxics (bone marrow suppression) BZDs (drowsiness) Bromocriptine (suppresses lactation)
Which antibiotic given in pregnancy or early childhood can cause blue staining of teeth?
Tetracycline
List facial features of foetal alcoholic syndrome
Short palpable fissures Flat midface Epicanthal folds Short nose, low bridge Indistinct philtrum Thin upper lip
Which antiepileptic can cause cleft lip/palate?
Phenytoin
Which antiepileptic is associated with neural tube defects?
Valproate
