Prescribing in Pregnancy Flashcards
First pregnancy scan
12 weeks
What tragic wonder drug given to treat morning sickness in pregnant women in 1958-1961.
Thalidomide
—–now used to treat LEPROSY and MYELOMA
What are non-drug alternatives for anti-depressants and CBT?
- physiotherapy instead of NSAIDs
- CBT instead of antidepressants
When may you actually prescribe to pregnant women?
- when benefits OUTWEIGH the risk
What are the best drugs to give to pregnant ladies?
- olders drugs with BETTER safety records
- LOWEST effective dose for shortest period
- discuss risks and benefits and DOCUMENT this
What drugs cross the placenta?
- MOST cross it
- those with LOW molecular weight
- small, LIPID-soluble drugs (crosses faster)
How may ADME. be affected in Pregnancy?
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)
How may pharmacodynamic be affected in pregnancy?
- no real changes
- preg. women are just more SENSITIVE to some drugs
(hypotension with hypertensive drugs in 2ND trimester)
What supplement is advised in preg. women?
- 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
Highest risk of teratogenesis.
4th -11th week
What risks are there in 1st trimester?
- miscarriage risk
- time of organogenesis; sp avoid drugs if possible unless maternal benefit outweighs risk to fetus
Risks at 2nd and 3rd trimesters?
- growth of fetus is affected
- functional development (intellectual Impairment and behavioural abnormalities)
- toxic effects of fetal tissue
What effects do NSAIDS (use around labor) have on fetal circulation?
- premature closure of ductus arteriosus
What effects does Diethylstilbestrol have on babies?
- vaginal ADENOCARCINOMA in girls aged 15-20 years old
- urological malignancy in boys
WHy is there increased seizures in 10% of women?
- non compliance to anti-epileptic drugs ( therefore should stay on therapy)
- changes in plasma conc. (persistent vomitting and incr. clearance)
RIsk of mom having seizure during pregnancies on baby ?
with lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death
WHat is recommended for anti-epileptic prescription in pregnanct ladies?
- 20-30% of CONGENITAL malformations if on 4 drugs
- MONOTHERAPYY!!
- AVOID valproate and phenytoin
Poor control of sugar in preg. women results in….
- congenital malformations
- ## intra-uterine death
dIABETIC DRUGS not safe in preg. women?
- Sulfonylureaas
Safe diabetic drug in preg. women
INSULIN
Recommended rx for N.V ?
- Cyclizine
UTI recommended rx?
- Nitrofurantoin
- cefalexin
- 3rd trimester : Trimethoprim
Thromboprophylaxis?
with LMWH
RIsk Factors for TBE?
OBESITY, >35 Y.O SMOKING, PARA>3 PREVIOUS DVT C-SECTION
What drug to avoid fro TBE?
- warfarin in early (teratogen) and LATE pregnancy (risk of hemorrhage)
Drugs that can enter breast milk?
- small molecules
- fat soluble drugs
WIth longer feeds _______
- higher amounts of FAT soluble drugs will be found
Name drugs that make it to the breast milk and what effects do they it bring out ?
- Phenobarbitone: Sucklin problems
- Amiodarone- Neonatal hypothyroidism
- Cyotoxics: BM supression
- Bromocriptine: supresses lactation
- benzodiazepines: drowsiness
First line drug for hypertension in pregnancy>
- Labetalol
- Methyldopa
- —–first advise lifestyle changes
Permanent greyish staining of the teeth in early childhood/pregnancy
- tetracycline
What does valproate result in ?
- spina bifida and anencephaly
Name some self-medications that pregnant women may take…
- NSAIDs
- St. John’s Wort
- Other herbal preparations
What may androgens cause if consumed in 1st trimester?
Virilisation of Female Fetus
WHat defects do anti-epileptics and lithium bring about in 1st trimester?
- cardiac, limb, facial, NTD
- Lithium: Cardiovascular defects
WHat does methotrexate and warfarin bring about in 1st trimester?
- methotrexate: SKELETAL defects
- warfarin: limb and facial defects
What do ACE-Is/ ARBs and cytotoxics cause in 1st trimester exposure?
- renal Hypoplasia
- Multiple defects and abortion
WHat do retinoids cause in 1st trimester?
-ear, cardiovascular, skeletal defects
What happens with consumption of opiates around term?
- supression of fetal systems
- respiratory depression
What occurs with comsumption of warfarin around term?
- bleeding
What adverse effects may occur to a baby after delivery ?
- withdrawal syndrome with consumption of Opiates, SSRI
- Sedation
What are the effects on the baby if the mom experiences frequent seizures?
- lower verbal IQ
- Hypoxia
- bradycardia
- antenatal death
- maternal death
What is the risk of giving Labetalol for rx of Hypertension in late pregnancy?
- Beta blockers may inhibit fetal growth
- —still Labetalol is good for treating H/T
What is the leading cause of maternal Death?
- Venous Thromboembolism; pregnancy has a 10-fold incr. in VTE
What advise is given to pregnant mothers/ woemn in the puerperium/in labor to avoid VTE?
- women should be encouraged to MOBILIZE and stay hydrated
Which drug is the cause of a baby' face to look like this? - low nasal bridge - micrognathia - thin UPPER lip flat midface -epicanthal folds
Alcohol
Fetal Alcohol Syndrome
Which anti-epileptic drug results in a cleft-palate?
- cleft lip palate
