Psychiatry and Drugs in Pregnancy

Question 1

what can valproate cause

Answer 1

NTD, craniofacial defects, CV abnormality, IUGR, reduced IQ, cleft, genitourinary abnormalities

Question 2

what can carbamazepine cause

Answer 2

vit K deficiency-haemorrhagic disease of the newborn, facial dysmorphism, cardiac anomalies, fingernail hypoplasia, NTD

Question 3

what can lamotrigine cause

Answer 3

cleft, SJS to baby f breast fed

Question 4

if on anticonvulsants can you breast feed

Answer 4

yes there is only rare side effects

Question 5

what can lithium cause

Answer 5

neonatal hypotonia, hypothyroidism, hypoglycaemia

Question 6

is lithium contraindicated in breast feeding

Answer 6

yes

Question 7

if on lithium and find out you are preganant what is recommended

Answer 7

stop lithium gradually ?Switch to SSRI

Question 8

do schizophrenia patients require maintenance meds throughout pregnancy

Answer 8

yes

Question 9

what appear safer in pregnancy typical or atypical antipsychotics

Answer 9

typical antipsychotics-haloperidol, chlorpromazine

Question 10

what can atypical antipsychotics cause

Answer 10

gestational diabete, IUGR

Question 11

what can antipsychotics cause and therefore what should babies be monitored for

Answer 11

observed for lethargy, sedation and appropriate developmental milestones as they are sedating with very long half lives

Question 12

why is clozapine contraindicated in breast-fed babies

Answer 12

liability of inducing potential life threatening events in the infant

Question 13

what is olanzapine associated with an increased risk of

Answer 13

extrapyramidal reactions

Question 14

can anticholinergic drugs be used in pregnancy

Answer 14

no

Question 15

what can bulimia nervosa cause in pregnancy

Answer 15

IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis, miscarriage, premature delivery

Question 16

if depressed should you keep them on their medications

Answer 16

if mild consider stopping but some meds safe in pregnancy

Question 17

which SSRIs have high levels in breast milk

Answer 17

citalopram and fluoxetine

Question 18

which SSRI can you breast feed on

Answer 18

sertraline

Question 19

which TCAs are safe in pregnancy and okay for breast feeding

Answer 19

amitriptyline, nortryptilline

Question 20

what do antidepressants carry risk of

Answer 20

withdrawal or toxicity in neonates

Question 21

when does postnatal depression tend to present

Answer 21

2-6 weeks postnatally-lasts weeks to months

Question 22

if get postnatal depression what is lifetime risk of depression

Answer 22

70%

Question 23

what is baby blues

Answer 23

brief period of emotional instability
tearful, irritable, anxiety and poor sleep
day 3-10 self limiting
support and reassurance

Question 24

what are the early symptoms of puerperal psychosis

Answer 24

sleep disturbance, confusion, irrational ideas

mania, delusions, hallucinations and confusion

Question 25

what are the risk factors for puerperal psychosis

Answer 25

bipolar, puerperal psychosis, 1st degree relative with history

Question 26

how is puerperal psychosis treated

Answer 26

it is an emergency
needs admission to specialised mother-baby unit
antidepressant, antipsychotics, mood stabilisers and ECT