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Prescribing in Pregnancy Flashcards

1
Q

How common is medication use during pregnancy?

A

> 90% of women take drugs during pregnancy = painkillers (12%), antibiotics (11%), antacids (8%), folic acid and iron

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2
Q

What are some common self-medicated drugs taken during pregnancy?

A

NSAIDs, St John’s wart, herbal preparations

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3
Q

What drugs won’t cross the placenta?

A

Drugs with large molecular weight

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4
Q

What actions encompass pharmacokinetics?

A

Absorption, distribution, metabolism and elimination

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5
Q

How may pregnancy affect absorption of drugs?

A

Morning sickness may affect absorption

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6
Q

How can pregnancy affect pharmacokinetics?

A

Decreased protein binding = increased free drug
Increased liver metabolism of some drugs
Elimination of renally excreted drugs increases

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7
Q

How does pregnancy increase volume of distribution?

A

Increases plasma volume and fat stores

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8
Q

Does pregnancy alter pharmacodynamics?

A

No = no significant change

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9
Q

How is prescribing managed pre-pregnancy?

A

Folic acid = 400mcg daily for 3 months before conception and for 1st three months of pregnancy
Counselling for chronic conditions
Optimise therapy to choose safest drug

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10
Q

What does the first trimester carry risk of?

A

Risk of early miscarriage and period of greatest teratogenic risk = avoid drugs if possible

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11
Q

When is the period of greatest teratogenic risk?

A

4th - 11th weeks gestation

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12
Q

What are some common drugs that are teratogenic?

A

ACE inhibitors = renal hypoplasia
Androgens = virilisation of female foetus
Anti-epileptics = cardiac/facial/limb/neural tube defects
Cytotoxics = multiple defects, abortion
Lithium = CV defects Methotrexate = skeletal defects
Warfarin = limb and facial defects

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13
Q

What normally occurs in the second and third trimesters?

A

Growth of foetus and functional development

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14
Q

What effects can drugs have on the foetus in the second and third trimesters?

A

Intellectual impairment and behavioural abnormalities

Toxic effects on foetal tissue

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15
Q

How can drugs have an adverse effect on labour?

A

Progress of labour, respiratory depression, bleeding

Adaption of foetal circulation = premature closure of ductus arteriosus

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16
Q

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

A

Withdrawal syndrome or sedation

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17
Q

What were the negative effects of diethlystilbestrol?

A

Urological malignancies in boys

Vaginal adenocarcinomas in girls aged 15-20

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18
Q

What does untreated epilepsy carry a risk of?

A

Untreated epilepsy has higher incidence of congenital malformations than in women with treated epilepsy

19
Q

How may pregnancy impact epilepsy?

A

May increase seizures (10%) = changes in plasma concentration of drugs (persistent vomiting, increased clearance)

20
Q

What are frequent seizures during pregnancy associated with?

A

Lower verbal IQ, hypoxia, bradycardia, antenatal death and maternal death

21
Q

What do anti-epileptic drugs increase the risk of?

A

Congenital malformations = 20-30% risk if on 4 drugs, monotherapy is preferred as lower risk

22
Q

What anti-epileptics should be stopped during pregnancy?

A

Valproate and phenytoin

23
Q

How much folic acid should be prescribed to women with epilepsy during pregnancy?

A

5mg daily

24
Q

Is insulin safe to take during pregnancy?

A

Yes = may need to change dose

25
Q

What does poor diabetic control during pregnancy increase the risk of?

A

Congenital malformations and intra-uterine death

26
Q

What diabetic medication must be stopped during pregnancy?

A

Sulfonylureas = switch to insulin

27
Q

What happens to blood pressure during the second trimester?

A

It falls

28
Q

What drugs should be used to treat hypertension during pregnancy?

A

Labetalol, methyldopa or nifedipine MR

29
Q

What anti-hypertensives should be avoided during pregnancy?

A

Avoid ACE inhibitors and ARBs

Beta blockers may inhibit foetal growth in late pregnancy

30
Q

What are some common acute problems that occur during pregnancy and their preferred treatment?

A

Nausea and vomiting = cyclizine safest
Pain = paracetamol Heartburn = antacids
UTI = nitrofurantoin, cefalexin, trimethoprim if 3rd trimester

31
Q

What is the leading cause of maternal death during pregnancy?

A

VTE = pregnancy increases risk of VTE by 10%

32
Q

What are all women encouraged to do during pregnancy to reduce risk of VTE?

A

Mobilise and stay adequately hydrated

33
Q

What should women at high risk of VTE be prescribed?

A

Thromboprophylaxis with LMWH = give at delivery and up to 7 days post partum

34
Q

What are the risk factors for VTE?

A

Obesity, age >35, smoking, parity >3, previous DVT, C-section = considered high risk of 2 or more risk factors

35
Q

How should DVT or PE during pregnancy be treated?

A

Using therapeutic dose of LMWH

36
Q

Why should warfarin be avoided during pregnancy?

A

Teratogenic in early pregnancy

Carries risk of haemorrhage during delivery

37
Q

Do drugs tend to enter breastmilk?

A

Yes = most drugs enter breastmilk, especially small molecules and lipophilic drugs

38
Q

What can affect the amount of drug a baby receives through breastmilk?

A

Feeding pattern = longer feeds have higher amounts of fat soluble drugs in milk

39
Q

Why may drugs accumulate in a baby?

A

They have immature metabolisms

40
Q

What is an example of a drug that is actively concentrated in breastmilk?

A

Phenobarbitone = causes suckling difficulties

41
Q

What are some drugs that can cause problems when they are transferred via breastmilk?

A 
Amiodarone = neonatal hypothyroidism
Cytotoxics = bone marrow suppression
Benzodiazepines = drowsiness
Bromocriptine = supresses lactation
42
Q

What are some effects of drugs on babies?

A 
Tetracycline = staining of bones and teeth
Phenytoin = cleft lip and palate 
Valproate = neural tube defects (spina bifida, anencephaly)
43
Q

What are the facial features caused by foetal alcohol syndrome?

A

Short palpebral fissures, flat midface, short nose, indistinct philtrum, thin upper lip, epicanthal folds, low nasal bridge

Reproduction (62 decks)

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