Prescribing in Pregnancy

Question 1

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?

Answer 1

thalidomide

Question 2

what is important to remember about medications given in pregnancy?

Answer 2

self medications: NSAID’s, St Jonhs wort, herbal remedies

Question 3

how is liver metabolism affected in pregnancy?

Answer 3

increased metabolism of some drugs i.e. phenytoin

Question 4

is clearance of drugs by the kidneys affected during pregnancy?

Answer 4

can be cleared a lot more quickly due to inc in GFR

Question 5

anti-hypertensives are particularly dangerous during which trimester?

Answer 5

2nd due to physiological drop in BP

Question 6

what is done preconception regarding medications?

Answer 6

counselling re chronic conditions i.e. hypertension, diabetes

optimise therapy before pregnancy (safest drug possible)

Question 7

when is folic acid given during pregnancy?

Answer 7

daily for 3 months prior and first 3 months of pregnancy

Question 8

what should you ask women before starting a new drug treatment if they are of child bearing age?

Answer 8

ask about pregnancy/ palns to become pregnant

Question 9

during which weeks is there the greatest teratogenic risk?

Answer 9

4-11 weeks

Question 10

drugs can affect which areas of development during the 2nd and 3rd trimesters?

Answer 10

growth of foetus

functional devleopment- intellectual impairment, behaviorual abnormalities

Question 11

describe teratogenicity of ACE/ARBs?

Answer 11

renal hypoplasia

Question 12

is methotrexate contraindicated in pregnancy?

Answer 12

yes- teratogenic causing skeletal defects

Question 13

opiates can cause what in newborns?

Answer 13

respiratory depression

Question 14

if mother has been taking opiates, SSRI durign pregnancy what can occur in baby?

Answer 14

withdrawal syndrome

Question 15

what percentage of woman discontinue their antiepileptic medications during pregnancy?

Answer 15

20%

Question 16

incidence of congenital malformations is higher in women who aren’t treated for epilepsy than those who are?

Answer 16

those who aren’t treated

Seizures more dangerous than drug itself

Question 17

monotherapy or several anti epileptic drugs are preferred durign pregnancy?

Answer 17

monotherapy

(if on 4 drugs risk of malformation increases)

Question 18

which two anti epileptic drugs should be avoided in pregnancy?

Answer 18

valproate

phenytoin

Question 19

what supplement shoul dbe given durign pregnancy in addition to anti-epileptic medication?

Answer 19

folic acid 5mg daily

Question 20

what is the best treatment of diabetes in pregnancy?

Answer 20

insulin therapy

Question 21

are sulphonylureas safe during pregnancy?

Answer 21

NO- convert to insulin therapy

Question 22

is metformin safe to take durign pregnancy?

Answer 22

yes- also in breastfeeding

Question 23

what should be used to treat hypertension?

Answer 23

labetalol

methyldopa

Question 24

which anti-hypertensive medications are contraindicated in pregnancy?

Answer 24

ACE/ARB

Beta blockers may inhibit foetal growth in late pregnancy

Question 25

how to treat N&V in pregnancy?

Answer 25

cyclizine

Question 26

treament of a UTI in pregnancy?

Answer 26

nitrofurantoin in 1st and 2n trimester only

trimethoprim in 3rd trimester only

Question 27

by how much is risk of VTE increased in pregnancy?

Answer 27

10 fold increase

Question 28

what are all pregnant women/those in labour/ puerperium encouraged to do regardless of risk factors for VTE?

Answer 28

keep hydrated and and mobiliise

Question 29

those with significant risk factors for VTE should be treated prohphyactically with what?

Answer 29

LMWH

Question 30

what are risk factors for VTE in pregnant women?

Answer 30

obesity

smoking

para >3

previous DVT

C-section

Question 31

most molecules will ente r breast milk but even more so if they are?

Answer 31

smaller molecules

fat soluble (lipophilic)

Question 32

what drug suppresses lactation?

Answer 32

bromocriptine

sometimes deliberately given if women wants to stop breast feeding due to pain/tenderness

Question 33

if epilepsy what dose of folic acid prescribed?

Answer 33

5mg

(standard 400mcg)