Prescribing in pregnancy

Question 1

When should you prescribe in pregnancy?

Answer 1

If benefits of drug outweigh risks

Question 2

Most drugs do not cross the placenta. true or false?

Answer 2

False

- most drugs DO cross the placenta

Question 3

Warfarin crosses the placenta true or false?

Answer 3

True

Question 4

Heparin crosses the placenta true or false ?

Answer 4

False

Question 5

In what way might absorption of a drug be affected during pregnancy?

Answer 5

Morning sickness

Question 6

During pregnancy, there is increased/decreased volume of distribution?

Answer 6

Increased

Question 7

Who should get folic acid? and what dose should they get?

Answer 7

Everyone should be offered folic acid 400mcg daily for 3 months pre-conception and for first 3 months of pregnancy

Question 8

Why is folic acid offered in pregnancy?

Answer 8

To prevent neural tube defects

Question 9

Which trimester of pregnancy has the greatest teratogenic risk?

Answer 9

First trimester

Question 10

Name 2 anti-hypertensives which should be avoided during pregnancy (and why)

Answer 10

ACE inhibitors
ARBs
(cause renal hypoplasia in foetus)

Question 11

Name 2 anti-epileptics which should be avoided in pregnancy

Answer 11

Sodium valproate

Phenytoin

Question 12

Why should sodium valproate be avoided in pregnancy?

Answer 12

Neural tube defects

Question 13

Why should phenytoin be avoided in pregnancy?

Answer 13

Cleft lip and palate

Cardiac malformations

Question 14

Lithium should be avoided in pregnancy. True or false?

Answer 14

True

- it causes CVS defects

Question 15

Warfarin can be safely used in pregnancy. True or false?

Answer 15

False

• causes limb and facial defects
• can cause haemorrhage during delivery

Question 16

NSAIDs are safe to use during pregnancy. true or false?

Answer 16

False

they should be avoided where possible

Question 17

Name 3 drugs which have an adverse effect on labour

Answer 17

Warfarin - bleeding
NSAIDs - adaptation of foetal circulation
Opiates - resp depression

Question 18

What adaptation of the foetal circulation is caused by NSAIDs

Answer 18

Premature closing of the ductus arteriosus

Question 19

Which drug, given to prevent miscarriages, caused vaginal adenocarcinoma in girls aged 15-20 whose mothers were exposed to the drug?

Answer 19

Diethylstilbestrol

Question 20

Which anti-emetic was given to thousands of pregnant women for morning sickness but had serious side effects?

Answer 20

Thalidomide

Question 21

Are most anti-depressants safe to use in pregnancy?

Answer 21

Yes

Question 22

First line anti-depressant in pregnancy

Answer 22

Sertaline

Question 23

Are benzodiazepines safe to use in pregnancy?

Answer 23

No

Question 24

Which antipsychotic should not be used in pregnancy?

Answer 24

Clozapine

Question 25

Can lithium be used in pregnancy?

Answer 25

Yes, but try to avoid

Avoid sudden discontinuation

Question 26

Sodium valproate in pregnancy - at what trimester is the risk of neural tube defects highest?

Answer 26

First trimester

Question 27

There is no need to stop a drug that was used during pregnancy when it comes to breastfeeding. True or false?

Answer 27

True

Question 28

Benzodiazepines are safe to use when breastfeeding. true or false?

Answer 28

False

Question 29

Why should you avoid lithium in breast feeding?

Answer 29

There are high quantities of lithium in breast milk

Question 30

Can sodium valproate be used in breastfeeding?

Answer 30

Yes