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Reproductive Health Block > Prescribing In Pregnancy > Flashcards

Prescribing In Pregnancy Flashcards

1
Q

What drugs are proven to have benefit in pregnancy?

A
  • Folic acid (500 micrograms or 4mg OD) for prevention of neural tube defects
  • Acyclovir for prevention of vertical herpes infection transmission
  • Iron supplementation
  • Anaesthetic agents in labour
  • Zidovudine for prevention of vertical transmission of HIV
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2
Q

What foods and household products might a woman worry about eating/using during pregnancy?

A
  • Caffeine
  • Hairspray
  • Cigarette smoke
  • Alcohol
  • Illicit drugs
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3
Q

Is caffeine teratogenic?

A

No, and there is only a very weak association with miscarriage.

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4
Q

Is hairspray teratogenic?

A

Nope

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5
Q

What common and basic drugs might a pregnant woman be worried about taking during pregnancy?

Are these teratogenic?

A
  • Antiemetics
  • Aspirin
  • Paracetamol
  • Antihistamines
  • Oral contraceptives

None of these are considered teratogenic.

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6
Q

Which classes of drugs are teratogenic?

A
  • Anti-epileptics
  • Androgens
  • Retinoids
  • ACE Inhibitors
  • Anti-thyroid drugs
  • Warfarin
  • Folic acid antagonists
  • Some antibiotics
  • Cyclophosphomide
  • Vitamin A
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7
Q

Which antibiotics have a teratogenic effect?

A
  • Tetracyclines
  • Streptomycin
  • Trimethoprim
  • Aminoglycosides
  • Quinolones
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8
Q

Other than during pregnancy, when is pregnancy important to consider in prescribing?

A

In a woman of childbearing age, especially one who wishes to conceive.
In men trying to father a child.

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9
Q

Which period of pregnancy is most at risk of congenital malformations?

A

The first trimester (up to end of week eleven)

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10
Q

Which period of pregnancy is most at risk of growth restriction or functional development issues?

A

Second and third trimesters.

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11
Q

What principles should be used when prescribing in pregnancy?

A
  • Only use if benefit to mother outweighs risk to foetus
  • Avoid all in first trimester
  • Use drugs with evidence of no effect in pregnancy where possible
  • Smallest effective doe used
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12
Q

If a potentially teratogenic drug is prescribed for a woman of child-bearing age, what should be prescribed alongside it?

A

Contraception as well as written advice about effects on pregnancy.

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13
Q

If a pt with pre-eclampsia also has asthma, what do we prescribe instead of labetalol?

A

Nifedipine

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14
Q

Which drug has in recent history caused lots of problems when prescribed in pregnancy?

A

Thalidomide

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15
Q

Which drugs cross the placenta?

A

All o them pretty much, apart from those with a high molecular weight e.g. insulin and heparin.

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16
Q

Why do drugs with a narrow therapeutic index need monitoring and adjusting in pregnancy?

A

Volume of distribution changes during pregnancy

17
Q

Will a drug that has caused harm in one pregnancy cause the same effect in a subsequent pregnancy?

A

No, not necessarily.

18
Q

Why might an OCP become less effective when the pt is carbamazepine?

A

Carbemazepine is an enzyme-inducer which causes oestrogens and progestogens from contraceptives to be metabolised faster and reduce efficacy of OCP.

19
Q

If a woman is on an enzyme-inducer e.g. carbamazepine, what contraceptives should be used for best efficacy?

A

-Progestogen-only impant

If tablet is preferred:
-OCP containing at least 50 micrograms of ethinylestradiol (continuous or tri-cycling regimen).

20
Q

What does the teratogenicity of a drug depend upon?

A
  • Dose
  • Polypharmacy
  • Stage of pregnancy/timing of exposure
21
Q

What are the 2 main outcomes from drug exposure during the embryonic phase of pregnancy i.e. first 17 days?

A

Cellular damage leading to either:

  1. Spontaneous abortion
  2. Replacement of damaged cells -> normal pregnancy
22
Q

How does gut motility change in pregnancy?

A

It decreases

23
Q

How does lung function change in pregnancy?

A

It increases

24
Q

How do plasma volume and body water change in pregnancy?

A

They both increase

25
Q

How does glomerular filtration change in pregnancy?

A

It increases

26
Q

How does plasma protein levels change in pregnancy?

A

They decrease.

27
Q

Where can information about prescribing in pregnancy be found?

A
  • BNF
  • Local /Regional NHS medicines information centre
  • UK teratology Information Service
  • Manufacturer
  • Electronic Medicines Compendium
28
Q

What kind of paracetamol use is safe in pregnancy?

A

Occasional use and short courses.

29
Q

How does the folic acid dose change for n/low risk mothers compared to high risk mothers?

A

500 micrograms for low risk
4 mg for high risk
Take throughout first trimester for both.

30
Q

Do enzyme inducing drugs such as carbamazepine have an effect on hormonal emergency contraception?

A

Yes

31
Q

What should a woman on an enzyme inducer such as carbamazepine take for emergency contraception?

A
  • Preferably non-hormonal i.e. copper coil

- If this is not an option, a double dose of levonorgestrel (i.e 3mg) should be given.

32
Q

A woman is on the following drugs. Which should be discontinued during pregnancy?

Gliclazide
Metformin
Ramipril
Simvastatin
Lithium
A 
Gliclazide - discontinue
Metformin - continue
Ramipril - discontinue
Simvastatin - discontinue
Lithium - ideally discontinue but practically the risk to the mother will often outweigh benefits of stopping.
33
Q

What drug is used forgestational hypertension?

A

Labetalol

34
Q

If labetalol and nifedipine are both contraindicated, what drug can be used to treat hypertension in pregnancy?

What is the caveat to this?

A

Methyldopa BUT MUST STOP within 2 days of birth as the side effects include postnatal depression and sedation.

35
Q

How do thyroxine requirements change in early pregnancy?

A

They increase by 30-50% in early pregnancy!

36
Q

Why do thyroxine requirements increase in pregnancy?

A

The placental enzymes increase metabolism of thyroxine, plasma volume increases, and maternal thyroid hormone is transferred to the developing foetus.

37
Q

How should euthyroidism be maintained in pregnancy?

A
  • Check TFTs as soon as pregnancy confirmed
  • Maintain trimester specific TSH and free T4 levels.
  • Endocrinologist involvement for dosing and monitoring requirements
  • Review again after birth and once breastfeeding as stopped.

Reproductive Health Block (10 decks)

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