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Prescribing in Pregnancy Flashcards

1
Q

what was the drug used for morning sickness that caused lots of death and deformities in babies

A

thalidomide

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2
Q

what drugs cross the placenta

A

most
except large molecular weight heparin

small, lipid soluble cross more quickly

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3
Q

how can pharmacokinetics be affected in pregnancy

A

Absorption may be affected by morning sickness

Increased plasma volume and fat stores
(Volume of distribution increases)

Decreased protein binding
(Increased free drug)

Increased liver metabolism of some drugs
(Phenytoin)

Elimination of renally excreted drugs increases
Increased GFR

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4
Q

what drugs should you monitor doses during pregnancy and after delivery

A

lithium, digoxin

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5
Q

name a drug pregnant women are more sensitive to

A

can get hypotension with antihypertensives in 2nd trimester

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6
Q

what drug should be taken pre conception

A

Folic acid 400mcg daily for 3 months prior and first 3 months of pregnancy

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7
Q

what else needs to be done preconception

A

review drugs of chronic conditions, choose safest options/ decide if treatment necessary

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8
Q

what is the period of greatest teratongenic risk

A

4-11th week in 1st trimester:

risk of miscarriage, organogenesis

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9
Q

what is the general rule for prescribing in 1st trimester

A

Avoid drugs if at all possible unless maternal benefit outweighs risk to foetus

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10
Q

name 8 teratogenic drugs

A 
ACE inhibitors/ARB		
Androgens			
Antiepileptics			
Cytotoxics			 
Lithium				 
Methotrexate			 
Retinoids			 
Warfarin
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11
Q

what can ACEis/ ARBs cause

A

Renal hypoplasia

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12
Q

what can androgens cause

A

Virilisation of female foetus

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13
Q

what can antieplieptics cause

A

Cardiac, facial, limb, neural tube defects

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14
Q

what can cytotoxics cause

A

Multiple defects, abortion

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15
Q

what can lithium cause

A

Cardiovascular defects

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16
Q

what can methotrexate cause

A

Skeletal defects

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17
Q

what can retinoids cause

A

Ear, cardiovascular, skeletal defects

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18
Q

what can warfarin cause

A

Limb and facial defects

19
Q

what is at risk in 2nd and 3rd trimester

A 
Growth of foetus
Functional development
-Intellectual impairment
-Behavioural abnormalities
Toxic effects on foetal tissue
20
Q

name a drug that causes developmental disorders due to affecting foetus in 2nd and 3rd trimester

A

sodium valproate

21
Q

what drug can suppress the foetal resp system during labour

A

opiates

22
Q

what drugs can cause withdrawal effect on foeuts after birth

A

opiates, SSRI

23
Q

what does diethylstilbestrol cause

A

vaginal adenocarcioma in F and urological malignancy in M in patients whose mothers were exposed (delayed effect of the drug)

24
Q

what should be done to prevent VTE in pregnancy

A

all should be encouraged to stay mobilised and hydrated

those with significant risk factors should receive thromboprophylaxis with LMWH at delivery and up to 7 days post partum

25
Q

what constitutes significant risk of VTE

A

2 or more risk factors eg obesity, age>35yrs, smoking, para >3, previous DVT, Caesarean delivery

26
Q

how do you treat suspected DVT or PE

A

theraputic dose LMWH

27
Q

why should you avoid warfarin in pregnancy

A

teratogenic in early pregnancy

risk of haemorrhage during delivery if given during late pregnancy

28
Q

what drugs enter breast milk

A

most especially small molecule and fat soluble (lipophilic) drugs

29
Q

how can breast feeding patterns affect amount of drugs in milk

A

foremilk- protein rich
hind milk- higher fat content
longer feeds, higher amounts of fat soluble drugs in milk

30
Q

why might drugs in breast milk accumulate in infant

A

immature metabolism

31
Q

name a drug that is actively concentrated in breast milk

A

phenobarbitone (causes suckling difficulties)

32
Q

what can amiodarone in breast milk cause

A

neonatal hypothyroidism

33
Q

what can cytotoxics in breastmilk cause

A

bone marrow suppression

34
Q

what can benzodiazepines in breastmilk cause

A

drowsiness

35
Q

what can bromocriptine in pregnancy

A

can suppress lactation

36
Q

should pregnant women take herbal remedies e.g. st john wort

A

should avoid - consider why she wants to take them, undiagnosed illness?

37
Q

what hypertension drugs are considered safe in pregnancy

A

Labetalol or methyldopa

38
Q

what are the golden rules to prescribing in pregnancy

A

Balance risk vs benefits
Treat if necessary
Safest drug, lowest effective dose, shortest possible time

39
Q

what antibiotics given in pregnancy can cause staining of teeth and bones

A

tetracycline- also avoid in children under 12

40
Q

what are the facial features of fetal alcohol syndrome

A 
short palpebral fissures 
flat midface 
short nose 
indisctinct philtrum 
thin upper lip
41
Q

when drug is associated with cleft lip and palate

A

phenytoin

42
Q

what drug when taken in pregnancy causes vaginal adenocarcinoma in female offspring

A

stilbestrol

43
Q

name 2 neural tube defects caused by valproate

A

spina bifida and anecephaly

Reproduction (51 decks)

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