Prescribing in Pregnancy Flashcards
which drug given extensively in the 60’s as an antiemetic resulted in the deaths of new borns and >10,000 children born with deformities?
thalidomide
what is important to remember about medications given in pregnancy?
self medications: NSAID’s, St Jonhs wort, herbal remedies
how is liver metabolism affected in pregnancy?
increased metabolism of some drugs i.e. phenytoin
is clearance of drugs by the kidneys affected during pregnancy?
can be cleared a lot more quickly due to inc in GFR
anti-hypertensives are particularly dangerous during which trimester?
2nd due to physiological drop in BP
what is done preconception regarding medications?
counselling re chronic conditions i.e. hypertension, diabetes
optimise therapy before pregnancy (safest drug possible)
when is folic acid given during pregnancy?
daily for 3 months prior and first 3 months of pregnancy
what should you ask women before starting a new drug treatment if they are of child bearing age?
ask about pregnancy/ palns to become pregnant
during which weeks is there the greatest teratogenic risk?
4-11 weeks
drugs can affect which areas of development during the 2nd and 3rd trimesters?
growth of foetus
functional devleopment- intellectual impairment, behaviorual abnormalities
describe teratogenicity of ACE/ARBs?
renal hypoplasia
is methotrexate contraindicated in pregnancy?
yes- teratogenic causing skeletal defects
opiates can cause what in newborns?
respiratory depression
if mother has been taking opiates, SSRI durign pregnancy what can occur in baby?
withdrawal syndrome
what percentage of woman discontinue their antiepileptic medications during pregnancy?
20%
incidence of congenital malformations is higher in women who aren’t treated for epilepsy than those who are?
those who aren’t treated
Seizures more dangerous than drug itself
monotherapy or several anti epileptic drugs are preferred durign pregnancy?
monotherapy
(if on 4 drugs risk of malformation increases)
which two anti epileptic drugs should be avoided in pregnancy?
valproate
phenytoin
what supplement shoul dbe given durign pregnancy in addition to anti-epileptic medication?
folic acid 5mg daily
what is the best treatment of diabetes in pregnancy?
insulin therapy
are sulphonylureas safe during pregnancy?
NO- convert to insulin therapy
is metformin safe to take durign pregnancy?
yes- also in breastfeeding
what should be used to treat hypertension?
labetalol
methyldopa
which anti-hypertensive medications are contraindicated in pregnancy?
ACE/ARB
Beta blockers may inhibit foetal growth in late pregnancy
