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Reproduction > Week 5- Prescribing in pregnancy > Flashcards

Week 5- Prescribing in pregnancy Flashcards

1
Q

NOTE

A

No drug is completely safe in pregnancy. So how do you know which drugs you can use. First consider non-pharmalogical methods

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2
Q

When would you prescribe drug therapy in a pregnant women?

A

When the benefits outweigh the risks.

NOTE- most drugs aren’t licensed in pregnancy- prescribe outwit license.

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3
Q

Which drugs aren’t likely to cross the placenta?

A

Large molecular weight drugs.

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4
Q

Which drugs cross the placenta quickly?

A

Small, lipid soluble drugs.

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5
Q

In pregnancy, what might affect the absorption of a drug?

A

Morning sickness may reduce absorption of a drug.

Also the increased plasma volume and fat stores means the volume of distribution increases

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6
Q

In pregnancy, what might affect the distribution of a drug?

A

Decreased protein binding means more free drug.

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7
Q

In pregnancy, what might affect the metabolism of drugs?

A

Increased liver metabolism of some drugs.

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8
Q

What may affect the elimination of drugs in a pregnant women?

A

Increased renal excretion due to increased GFR.

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9
Q

Does anything change in pregnant women with regards to pharmacodynamics?

A

No significant changes- pregnant women may become more sensitive to certain drugs.

Example- hypotension with antihypertensives in 2nd trimester.

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10
Q

What should you give a women with suspected pregnancy, or who is planning a pregnancy?

A

400mcg of folic acid 3 months prior to pregnancy and in the first three months of pregnancy.

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11
Q

When is the period of greatest teratogenic risk? in this period how should you handle drug therapy?

A

4th-11th week.

Avoid drugs if possible, unless the benefits outweigh the risk to the foetus.

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12
Q

what do ACE inhibitors/ARBs do in pregnancy?

A

They are teratogenic and cause renal hypoplasia.

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13
Q

What do androgens do in pregnancy?

A

Teratogenic- cause virilisation of the female fetus.

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14
Q

What do anti epileptics do in pregnancy?

A

Teratogenic- cardiac, facial, limb, and neural tube defects.

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15
Q

What do cytotoxics do in pregnancy?

A

Teratogenic- cause multiple defects, abortion.

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16
Q

What does lithium do in pregnancy?

A

Teratogenic- causes cardiovascular defects.

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17
Q

What does methotrexate do in pregnancy?

A

Teratogenic- causes skeletal defects.

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18
Q

What do retinoids do in pregnancy?

A

Teratogenic- cause ear, cardiovascular or skeletal defects.

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19
Q

What does warfarin do in pregnancy?

A

Teratogenic- causes limb and facial defects.

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20
Q

What drug can cause respiratory depression?

A

Opiates.

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21
Q

What drug can cause bleeding in labour?

A

Warfarin

22
Q

What drugs can cause withdrawal symptoms?

A

Opiates

SSRI’s.

23
Q

NOTE

A

In epilepsy- the incidence of congenital malformations is higher in untreated epilepsy than in women without epilepsy.
There are increased seizures in 10% of women.

24
Q

Why are there increased seizures in 10% of women in pregnancy?

A

Non-compliance

Decreased plasma concentration of drug- persistent vomiting, increased clearance

25
Q

Are there any consequences with increased seizures in pregnancy?

A

Associated with lower IQ, hypoxia, bradycardia, antenatal death, maternal death.

26
Q

What should the approach to treating epilepsy during pregnancy be?

A

The risk increases by 20-30% if you are on 4 therapies so try mono therapy.

27
Q

Which epileptic drugs should be avoided?

A

Sodium valproate

Phenytoin

28
Q

Is insulin thought to be safe in pregnancy?

A

Yes.

29
Q

Do you need to change doses of insulin during pregnancy?

A

Requirements of insulin change.

30
Q

What diabetic drug is not safe in pregnancy? What should you change them to?

A

Sulfonylureas

Change to insulin.

31
Q

Which antihypertensive drugs are used in pregnancy?

A

Labetalol
Methyldopla
Nifedine

32
Q

What anti-hypertensive medication should you avoid during pregnancy?

A

ACE inhibitors and ARBs

33
Q

Why antihypertensive may inhibit foetal growth in late pregnancy?

A

Beta blockers.

34
Q

What drug would you give for nausea and vomiting?

A

Cyclizine

35
Q

What drug would you give for a UTI?

A

Follow the local guidelines

Nitrofurantoin, cefalexin,

36
Q

What drug should you give for pain in pregnancy?

A

Paracetamol

37
Q

What drug should you give for heartburn in pregnancy?

A

Antacids.

38
Q

NOTE

A

All pregnant women are at a 10 fold increase of VTE in pregnancy. All women should have their VTE risk assessed in pregnancy.

39
Q

What should women with significant VTE risk factors be given?

A

Low molecular weight heparin.

40
Q

How would you treat a DVT or PE in pregnancy?

What drug should you avoid?

A

Low molecular weight heparin.

Avoid warfarin- teratogenic.

41
Q

Which types of drugs are more likely to enter breast milk?

A

Small molecules

Fat soluble drugs

42
Q

What is fore milk rich in?

A

Protein

43
Q

What is hind milk rich in?

A

Higher fat content

44
Q

NOTE

A

Some drugs are concentrated in breast milk.

45
Q

What can amiodarone cause if transferred through breast milk?

A

Neonatal hypothyroidism.

46
Q

What can cytotoxic drugs cause if transferred through breast milk?

A

Bone marrow suppression

47
Q

What can benzodiazepines cause if transferred through breast milk?

A

Drowsiness.

48
Q

What can bromocriptine cause if transferred through breast milk?

A

Suppress lactation.

49
Q

Which antibiotic, not safe for use in pregnancy, can stain teeth?

A

tetracycline.

50
Q

Which anti epileptic drug is mostly associated with cleft palate?

A

phenytoin.

Reproduction (34 decks)

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