Prescribing in Pregnancy, Breastfeeding and Children Flashcards
What drugs are teratogenic (birth abnormalities)
- Methotrexate, Trimethoprim
- Statins
- ACE Inhibitors / ARBs
- Lithium
- Sodium Valproate
What drugs cause dental hypoplasia and teeth staining in babies
Tetracyclines
What drugs can cause a miscarriage
Prostoglandin Analogues
e.g Misoprostol
What drug can cause congenital malformations and foetal haemorrhage
Warfarin
What drug can causes grey baby syndrome
Chloramphenicol
What is grey baby syndrome
- grey skin
- haemodynamic collapse
What drugs can cause early closure of ductus arterious in babies
- Aspirin
- NSAIDs
What drug causes a cleft plate in babies
Topiramate
What is cleft plate in babies
opening in roof of mouth
What drug can cause the feminisation of a male foetus
Finasteride
What drug can cause arthropathy in babies
Quinolones
What is arthopathy and what can it be associated with
It is a joint disease and it is associated with Lyme disease
What is Lyme Disease
a form of arthritis caused by bacteria that are transmitted by ticks.
What drugs cause auditory and vestibular damage in the 2nd and 3rd trimester
Amino glycosides
What medications stay in high amounts in breast milk
- Ethosuximide
- Lamotrigine
- Fluvastatin
What drug inhibits infant’s suckling reflex
Phenobarbital
What drug inhibits lactation (breast milk production)
Bromocriptine
What is a pre-term neonate
baby born <37 weeks
What is a term neonate
baby born between 37 and 42 weeks
What is a post-term neonate
> =42 weeks
What is a neonate
0 to 28 days old
What is an infant
28 days to 24 months
What is a child
2 years till 12 years
Children and hepatic impairment
- children have a large reserve of hepatic metabolism
- don’t need dose adjustments usually
At which age are liver enzymes still immature
- preterm neonate
to - Infant
How to calculate neonate eGFR
serum creatinine
How to calculate child over 1 year eGFR
serum creatinine
Why should you avoid intramuscular injections in children
it is painful
What can benzyl alcohol do in neonates
fata toxic syndrome
Why should you avoid lactose in medication
if severe lactose intolerance
What can polyoxyl castor oil do in children
cause anaphylaxis
If propylene glycerol is not eliminated from the body correctly, it can cause what
adverse effects
What should you stick with when prescribing biosimilar medication
- prescribe by brand name
- do not switch brand
How should multiple injections be administered
- separate sites
- not mixed
Except when using syringe drivers in palliative care
What type of injection is more painful
one mixed with water for injection (isotonic)
What drugs have injection site reactions together
- prochlorperazine
- chlorpromazine
- diazepam
The risk of what increases when giving more than one drug with saline solution or NaCl 0.9% solution
increases risk of precipitation
When does IV Cyclizine precipitate when mixed with diamorphine
- At a concentration >10mg/ml
- When conc of diamorphine to cyclizine increases
How quickly are mixtures of diamorphine and cyclizine precipitate
after 24 hours
How quickly are mixtures of diamorphine and Haloperidol precipitate and at which concentration of haloperidol
- after 24 hours
- at a haloperidol concentration of >2mg/ml
What medications can be mixed with diamorphine
- cyclizine
- haloperidol
- dexamethasone
- hyoscine
- levomepromazine
- metoclopramide
- midazolam
Problems with intravenous infusions
- microbial contamination
- Incompatibility
(increases toxicity and side effects)
What is incompatibility in IV fusions
- wrong pH
- concentration change
- ‘salt out’ (where addition of salts causes crystallisation or precipitation)
Why is precipitation in IV fusions bad
- no control over dose
- can initiate or exacerbate adverse effects
Specifically what drugs and why should you avoid IV precipitations
- Diazepam
- Cytotoxics
you should avoid it as these drugs cause thrombophlebitis
(inflammation of vein wall)
Which substances are commonly incompatible as IV fusions
- Amino Acids
- Mannitol
- Sodium Bicarbonate
Why should you not inject into blood
because it can cause irreversible crenation of red blood cells
Why should you change the infusion administering set after giving the infusion
- avoid contamination
- avoid blood clot
(clotting factors from previous injection can cause a clot to form in the set.
-increases chance of microbial growth
- increase chance of embolisms)
Why should you not add antibiotics or electrolytes to infusion sets
- precipitation
- break down of emulsion, causing a separation of phases. increases likely hood of embolism.
Why should extemporaneous formulations should be made immediately
- minimise microbial contamination
- prevents degradation
What does degraded ampicillin injection form if newly made and left.
- forms polymers
- which can cause sensitivity reactions
Intravenous infusions things to make sure are done
- use infusion fluid of correct pH with some drugs
- mix drug additions well
- ensure it is a quick process from adding mixing the infusion and administering
- protect some injections from light
Give an example of a drug that requires a specific pH when given in infusions
furosemide
Why do you need to protect some infusions from the light
to prevent oxidation
How is a continuous infusion diluted and set
- diluted in large volume
- infused over long time
How is a intermintant infusion diluted and set
- diluted in small volume
- infused over short time
How would you minimise extravasation with cytotoxic drugs in infusion
- infuse via the drip tubing
