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Repro and Sexual Health > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

1
Q

What percentage of women will take drugs in pregnancy?

A

> 90%

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2
Q

What drugs are taken most frequently in pregnancy?

A

Painkillers
Antibiotics
Antacids

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3
Q

Will drugs cross the placenta?

A

Yes; except large molecular weight such as heparin

Small, lipid soluble drugs pass quicker

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4
Q

How is absorption of drugs affected in pregnancy?

A

May be affected by things like morning sickness

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5
Q

How distribution of drugs affected in pregnancy?

A

Increased plasma volume and fat stores
Volume of distribution increases
Decreased protein binding and therefore increased free drug

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6
Q

How is the metabolism of drugs affected in pregnancy?

A

Increased liver metabolism e.g. phenytoin

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7
Q

How is elimination of drugs affected in pregnancy?

A

Increased GFR

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8
Q

Are pharmacodynamics affected in pregnancy?

A

No significant changes

Pregnant women may be more sensitive to some drugs

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9
Q

What needs to be considered when women are preconception?

A 
Are they pregnant?
Are they planning a pregnancy?
Could they become pregnant?
Counselling re chronic conditions; epilepsy, diabetes, hypertx
Optimise therapy to choose safest drug
Review whether drug therapy necessary
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10
Q

How much folic acid should be taken pre and post conception?

A

400 mcg 3 months prior and first 3 months of pregnancy

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11
Q

What are the risks of prescribing in 1st trimester?

A

Risk of early miscarriage
Organogenesis
Avoid drugs if at all possible unless maternal benefit outweighs risk to foetus

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12
Q

What is the period of greater teratogenic risk?

A

4-11 week

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13
Q

List of teratogenic drugs

A 
ACEi
Androgens
Antiepileptics
cytotoxics
Lithium
Methotrexate
Retinoids
Warfarin
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14
Q

What is the abnormality assoc with ACEi in pregnancy?

A

Renal hypoplasia

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15
Q

What is the abnormality assoc with androgens in pregnancy?

A

Virilisation of female foetus

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16
Q

What is the abnormality assoc with antiepileptics in pregnancy?

A

Cardiac, facial, limb and neural tube defects

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17
Q

What is the abnormality assoc with cytotoxics in pregnancy?

A

Multiple defects

Abortion

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18
Q

What is the abnormality assoc with lithium?

A

CV defects

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19
Q

What is the abnormality assoc with methotrexate?

A

Skeletal defects

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20
Q

What is the abnormality assoc with retinoids?

A

Ear, cv, skeletal defects

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21
Q

What is the abnormality assoc with warfarin?

A

Limb and facial defects

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22
Q

What are the risks in the 2nd and 3rd trimester in terms of prescribing?

A

Growth of foetus
Functional development; intellectual, behavioural
Toxic effects on foetal tissue

23
Q

What effects can prescribing have around term?

A

Adverse effects on labour; progres of labour, adaptation of foetal circulation (premature closure of ductus with NSAIDs)
Suppression of foetal systems (opiates)
Bleeding (Warfarin = catastrophic)

24
Q

What adverse effects can prescribing have on the baby after delivery?

A

Withdrawal syndrome; Opiates, SSRI

Sedation

25
Q

What effects did diethylstilbestrol have on children?

A

Vaginal adenocarcinomas in girls aged 15-20

Urological malignancy in boys

26
Q

What can lead to the 10% increased in seizures seen in epileptic women whilst pregnant?

A

Non-compliance

Changes in plasma conc of drug; persistent vomiting, increased clearance

27
Q

What are frequent seizures in pregnancy associated with?

A 
Lower verbal IQ
Hypoxia
Bradycardia
Antenatal death
Maternal death
28
Q

Which antiepileptics should be avoided in pregnancy?

A

Valproate

Phenytoin

29
Q

How much folic acid should be given to epileptic women whilst pregnant?

A

5mg daily

30
Q

What % of babies born to women taking epileptics have a major congenital malformation?

A

4%

96% do not

31
Q

Is insulin safe in pregnancy?

A

Yes

32
Q

What is the risk associated with poor diabetic control in pregnancy?

A

Increases risk of congenital malformation and intrauterine death

33
Q

Are sulfonylureas safe in pregnancy?

A

No; convert to insulin

34
Q

What can be used to treat hypertension in pregnancy?

A

Labetalol
Methyldopa; assoc with depression
Nifedipine
AVOID ACEI

35
Q

What risk is assoc with beta blockers in pregnancy?

A

Can inhibit foetal growth in late pregnancy

36
Q

How is N+V tx in pregnancy?

A

Cyclizine

37
Q

How are UTIs tx in pregnancy?

A

Nitrofurantoin in 1st and 2nd trimester

Trimethoprim in 3rd trim

38
Q

How is pain tx in pregnancy?

A

Paracetamol

39
Q

How is heartburn tx in pregnancy?

A

Antacids

40
Q

What is the risk of VTE in pregnancy?

A

10 fold increase

Leading cause of maternal death in pregnancy

41
Q

What advice is given to all pregnant women to prevent VTE?

A

Mobilise

Adequate hydration

42
Q

Who should receive LMWH prophylaxis for VTE in pregnancy?

A

2 or more risk factors; age >35, obesity, smoking, para >3, previous DVT, C-section

43
Q

When should high risk mothers receive LMWH?

A

Delivery

7 days post-partum

44
Q

How is VTE tx in pregnancy?

A

Therapeutic dose of LMWH
AVOID WARFARIN:
1st trim; teratogenic
3rd trim; hemorrhage in delivery

45
Q

Do drugs enter the breast milk?

A

Most but especially small and lipophilic molecules

Tend to enter in small quantities

46
Q

How can feeding patterns affect drug distribution in breast feeding?

A

Foremilk; protein rich
Hindmilk; higher fat content
Longer feeds, higher amounts of fat soluble drugs in milk

47
Q

What will amiodarone in breast milk result in?

A

Neonatal hypothyroidism

48
Q

What will cytotoxics in breast milk result in?

A

Bone marrow suppression

49
Q

What will BZD in breast milk result in?

A

Drowsiness

50
Q

What will bromocriptine in breast milk result in?

A

Suppresses lactation

51
Q

Which antibiotic given in pregnancy or early childhood results in brown teeth staining?

A

Tetracycline

52
Q

Which drug taken in excess can cause; short palpebral fissure, flat midface, short nose, thin upper lip?

A

FAS

53
Q

Which antiepileptic is assoc with a cleft lip and palate?

A

Phenytoin

54
Q

Which antiepileptic is assoc with spina bifida and anencephaly?

A

Valproate

Repro and Sexual Health (77 decks)

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