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REPRO > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

1
Q

First pregnancy scan

A

12 weeks

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2
Q

What tragic wonder drug given to treat morning sickness in pregnant women in 1958-1961.

A

Thalidomide

—–now used to treat LEPROSY and MYELOMA

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3
Q

What are non-drug alternatives for anti-depressants and CBT?

A
  • physiotherapy instead of NSAIDs

- CBT instead of antidepressants

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4
Q

When may you actually prescribe to pregnant women?

A
  • when benefits OUTWEIGH the risk
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5
Q

What are the best drugs to give to pregnant ladies?

A
  • olders drugs with BETTER safety records
  • LOWEST effective dose for shortest period
  • discuss risks and benefits and DOCUMENT this
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6
Q

What drugs cross the placenta?

A
  • MOST cross it
  • those with LOW molecular weight
  • small, LIPID-soluble drugs (crosses faster)
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7
Q

How may ADME. be affected in Pregnancy?

A

Absorp: - by morning sickness
Distrib.: - volume of distribution of durg is INCREASED IN BODY (INCREASED plasma volume and fat stores)
Metabol.- increased free drug d/t decr. protein binding
- incr. liver metabolism
Excret.- incr. renal excretion (incr. GFR)

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8
Q

How may pharmacodynamic be affected in pregnancy?

A
  • no real changes
  • preg. women are just more SENSITIVE to some drugs
    (hypotension with hypertensive drugs in 2ND trimester)
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9
Q

What supplement is advised in preg. women?

A
  • intake of Folic Acid -400mcg for 3 months prior and 1st 3 months of preg.
  • couselling re-chronic condition (epilepsy, DM, h/t)
  • review if drug therapy is necessary
  • choose safest drugs
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10
Q

Highest risk of teratogenesis.

A

4th -11th week

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11
Q

What risks are there in 1st trimester?

A
  • miscarriage risk

- time of organogenesis; sp avoid drugs if possible unless maternal benefit outweighs risk to fetus

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12
Q

Risks at 2nd and 3rd trimesters?

A
  • growth of fetus is affected
  • functional development (intellectual Impairment and behavioural abnormalities)
  • toxic effects of fetal tissue
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13
Q

What effects do NSAIDS (use around labor) have on fetal circulation?

A
  • premature closure of ductus arteriosus
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14
Q

What effects does Diethylstilbestrol have on babies?

A
  • vaginal ADENOCARCINOMA in girls aged 15-20 years old

- urological malignancy in boys

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15
Q

WHy is there increased seizures in 10% of women?

A
  • non compliance to anti-epileptic drugs ( therefore should stay on therapy)
  • changes in plasma conc. (persistent vomitting and incr. clearance)
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16
Q

RIsk of mom having seizure during pregnancies on baby ?

A

with lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death

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17
Q

WHat is recommended for anti-epileptic prescription in pregnanct ladies?

A
  • 20-30% of CONGENITAL malformations if on 4 drugs
  • MONOTHERAPYY!!
  • AVOID valproate and phenytoin
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18
Q

Poor control of sugar in preg. women results in….

A
  • congenital malformations
  • ## intra-uterine death
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19
Q

dIABETIC DRUGS not safe in preg. women?

A
  • Sulfonylureaas
20
Q

Safe diabetic drug in preg. women

A

INSULIN

21
Q

Recommended rx for N.V ?

A
  • Cyclizine
22
Q

UTI recommended rx?

A
  • Nitrofurantoin
  • cefalexin
  • 3rd trimester : Trimethoprim
23
Q

Thromboprophylaxis?

A

with LMWH

24
Q

RIsk Factors for TBE?

A 
OBESITY,
>35 Y.O 
SMOKING,
PARA>3
PREVIOUS DVT 
C-SECTION
25
Q

What drug to avoid fro TBE?

A
  • warfarin in early (teratogen) and LATE pregnancy (risk of hemorrhage)
26
Q

Drugs that can enter breast milk?

A
  • small molecules

- fat soluble drugs

27
Q

WIth longer feeds _______

A
  • higher amounts of FAT soluble drugs will be found
28
Q

Name drugs that make it to the breast milk and what effects do they it bring out ?

A
  • Phenobarbitone: Sucklin problems
  • Amiodarone- Neonatal hypothyroidism
  • Cyotoxics: BM supression
  • Bromocriptine: supresses lactation
  • benzodiazepines: drowsiness
29
Q

First line drug for hypertension in pregnancy>

A
  • Labetalol
  • Methyldopa
  • —–first advise lifestyle changes
30
Q

Permanent greyish staining of the teeth in early childhood/pregnancy

A
  • tetracycline
31
Q

What does valproate result in ?

A
  • spina bifida and anencephaly
32
Q

Name some self-medications that pregnant women may take…

A
  1. NSAIDs
  2. St. John’s Wort
  3. Other herbal preparations
33
Q

What may androgens cause if consumed in 1st trimester?

A

Virilisation of Female Fetus

34
Q

WHat defects do anti-epileptics and lithium bring about in 1st trimester?

A
  • cardiac, limb, facial, NTD

- Lithium: Cardiovascular defects

35
Q

WHat does methotrexate and warfarin bring about in 1st trimester?

A
  • methotrexate: SKELETAL defects

- warfarin: limb and facial defects

36
Q

What do ACE-Is/ ARBs and cytotoxics cause in 1st trimester exposure?

A
  • renal Hypoplasia

- Multiple defects and abortion

37
Q

WHat do retinoids cause in 1st trimester?

A

-ear, cardiovascular, skeletal defects

38
Q

What happens with consumption of opiates around term?

A
  • supression of fetal systems

- respiratory depression

39
Q

What occurs with comsumption of warfarin around term?

A
  • bleeding
40
Q

What adverse effects may occur to a baby after delivery ?

A
  • withdrawal syndrome with consumption of Opiates, SSRI

- Sedation

41
Q

What are the effects on the baby if the mom experiences frequent seizures?

A
  • lower verbal IQ
  • Hypoxia
  • bradycardia
  • antenatal death
  • maternal death
42
Q

What is the risk of giving Labetalol for rx of Hypertension in late pregnancy?

A
  • Beta blockers may inhibit fetal growth

- —still Labetalol is good for treating H/T

43
Q

What is the leading cause of maternal Death?

A
  • Venous Thromboembolism; pregnancy has a 10-fold incr. in VTE
44
Q

What advise is given to pregnant mothers/ woemn in the puerperium/in labor to avoid VTE?

A
  • women should be encouraged to MOBILIZE and stay hydrated
45
Q 
Which drug is the cause of a baby' face to look like this?
- low nasal bridge
- micrognathia 
- thin UPPER lip 
flat midface 
-epicanthal folds
A

Alcohol

Fetal Alcohol Syndrome

46
Q

Which anti-epileptic drug results in a cleft-palate?

A
  • cleft lip palate

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