Womens health: prescribing in pregnancy Flashcards
1
Q
normal length of pregnancy
A
37-42 weeks
2
Q
cardiovascular increases x4
A
plasma volume
CO
stroke volume
HR
3
Q
cardiovascular decreases x2
A
serum albumin
serum colloid oncotic pressure
4
Q
changes in coagulation
A
increase in coagulation factors
increase in fibrinogen
5
Q
what does fibrinogen do
A
converted enzymatically by thrombin to fibrin and then to a fibrin-based blood clot
6
Q
what vein is affected in pregnancy
A
IVC compressed by the uterus
7
Q
possible change to pulse
A
bounding
8
Q
possible change to cardiac auscultation
A
third heart sound
systolic flow murmurs
9
Q
potential ECG changes x4
A
left axis deviation
ectopic beats
ST depression and flattening/inverted T waves in inferior and lateral leads
10
Q
changes in blood test x3
A
dilutional anaemia
leucocytosis
low albumin
11
Q
leucocytosis
A
an increase in the number of white cells in the blood
12
Q
2 physiological changes to the kidneys
A
Increase in renal blood flow and GFR
13
Q
kidney changes affect on creatine and urea
A
increased excretion and reduced blood levels of urea and creatinine
14
Q
possible affect of increased GFR
A
Mild glycosuria and/or proteinuria could occur due to increased GFR exceeding the ability of the renal tubules to reabsorb glucose/protein
15
Q
anatomical changes in the kidneys x3
A
relaxation/dilation of renal pelvis/ureters, increased length of kidneys and relaxation of bladder smooth muscle
16
Q
bladder capacity change
A
increased
17
Q
risk of UTI
A
increased
18
Q
physiological change in the liver
A
Changes in oxidative liver enzymes e.g. CYP450
19
Q
lungs physiological changes
A
Increase in tidal volume and minute ventilation
20
Q
how much is tidal volume increased
A
30–50%
21
Q
how does the RR change
A
it dosent psyche!
22
Q
lung changes are caused by
A
increase in progesterone concentrations
23
Q
anatomical change to the lungs
A
diaphragm is pushed 4–5 cm upward
24
Q
anatomical change in lungs affect on drugs
A
inhaled drugs may be more readily absorbed e.g. steroids
25
summarise the respiratory ph thing
compensated respiratory alkalosis
26
describe compensated respiratory alkalosis
reduced pCO2, increased p02 and decreased bicarbonate
27
how are the lung changes benficial to the foetus
Lower maternal pCO2 facilitates oxygen/carbon dioxide transfer to/from the foetus.
28
GI physiological changes x2
Delayed gastric emptying
| Prolonged small bowel transit time
29
GI complaints x2
GORD and N&V
30
Reduced gastric motility affect on bowel habit
constipation
31
Reduced gastric motility affect on nutrients
increased nutrient absorption
32
how does GORD come about
Progesterone causes relaxation of the lower esophageal sphincter and increased reflux,
pressure on the stomach from an enlarging uterus
33
Delayed gastric emptying and prolonged transit time affect on drug absorption
Prolonged time to reach peak concentration
| Overall decrease in maximum concentration
34
Increased plasma volume affect on distribution
Increased volume of distribution of water-soluble drugs
| Requires higher drug doses
35
Reduction in plasma protein levels affect on distribution
Decreased protein binding
| Increased free fraction of the drug
36
CYP1A2 metabolises
caffine
37
what metabolises caffine
CYP1A2
38
CYP1A2 activity in pregnancy
reduced
39
caffine in pregnancy change
CYP1A2 activity is reduced causing caffeine plasma concentrations to double
40
Increased renal blood flow and GFR rate affect on elimination
Increased renal clearance
| Shorter half-lives of renally cleared drugs
41
example of a drug affected by altered kidney elimination
lithium
42
lithium clearance in pregnancy
Clearance of lithium is doubled
43
when does lithum clearance change
in 3rd trimester
44
affect of lithium clearance in pregnancy on amount in the body
sub-therapeutic drug concentrations
45
which AED carries the same risk as background risk
lamotrigine
46
% of the general population will have a baby with a major malformation
2-3%
47
% who have epilepsy and don’t take AEDs will have a baby with a major malformation
3%
48
% who have epilepsy and do take an AED will have a baby with a major malformation
4-10%
49
3 AEDs with lower risks of malformations (2-5%)
Lamotrigine
Levetiracetam (Keppra)
Carbamazepine
50
AED with higher risk of malformations (7-10%)
Sodium Valproate (Epilim)
51
% of developmental problems when taking Na V
40% of children have developmental problems
52
how much is the normal amount of folic acid
400 micrograms daily
53
when to take folic acid
pre-conception to 12 weeks gestation
54
why do women take folic acid
reduce NTD
55
higher risk folic acid amount
5mg
56
3 reasons to take 5mg
Anti-epileptic medication
Diabetes
Family history of NTD
57
physical factors affecting drugs across the placenta x6
```
Placenta surface area
Placental thickness
pH of maternal/foetal blood
Placental metabolism
Uteroplacental blood flow
Presence of drug transporters
```
58
pharmacological factors affecting drugs across the placenta x6
Molecular weight of the drug
Lipid solubility
Protein binding
Concentration gradient
59
which drugs cant cross placenta
molecular weight of >1kDa
60
2 example of drugs over molecular weight of >1kDa
heparin and insulin
61
drugs given to mum to promote foetal lung development
steroids
62
when does nausea usually resolve
week 16-20
63
meal recommendations for N and V
Small frequent meals high in protein and low in carbs and fat
64
4 first line drugs for N and V
cyclizine
prochlorperazine
promethazine
chlorpromazine
65
3 second line drugs for N and V
ondansetron
domperidone
metoclopramide
66
Third line drug for N&V
hydrocortisone
67
side effects of second line antiemetics for N and V
extra pyramidal side effects
68
what to do if someone is dehydrated with N&V
IV fluid rehydration with potassium supplementation
69
what to give if there is prolonged vomiting
Pabrinex/Thiamine
70
severe N&V management
Enteral/parenteral feeding
| Termination of pregnancy as last resort
71
what is thalidomide
immunomodulator
72
what was thalidomide originally used as
sedative
73
what was thalidomide used for in pregnancy
nausea
74
what teratogenic effects does thalidomide have
phocomelia
| deformities of ears, heart and kidneys.
75
phocomelia
hands or feet are attached close to the trunk
76
what is thalidomide used for now
multiple myelome
77
when is drug teratogenicity most likely to occur
1st trimester
78
ACE inhibitors teratogenic effects x3
Renal abnormalities
patent ductus arteriosus (PDA)
oligohydramnios
79
when not to take ace inhibitors
trimester 2/3
80
antithyroid medication teratogenic effects
Neonatal hypothyroidism
81
when not to take carbimazole
after week 10
82
beta blocker teratogenic effects x3
IUGR
neonatal hypoglycaemia
bradycardya
83
when not to take BB
throughout pregnancy
84
lithium teratogenic effects
Cardiac defects (Ebsteins anomaly)
85
when not to take lithium
1st trimester
86
methotrexate teratogenic effects x4
Medical termination
craniofacial defects
ear/kidney/lung defects
cardiac abnormalities
87
NSAIDs teratogenic effects
Premature closure of ductus arteriosus
oligohydramnios
PPHN
88
when not to take NSAIDs
after week 30
89
phenytoin teratogenic effects
Craniofacial abnormalities, growth/mental deficiency
90
retinoids teratogenic effects
CNS abnormalities
| renal/ear/eye/parathyroid abnormalities
91
when not to take retinoids
4-10
92
sodium valproate teratogenic effects
Neural tube defects
93
when not to take NaV
1st trimester
94
tetracyclines teratogenic effects
Tooth discolouration
95
when not to take tetracyclines
2nd/3rd trimester
96
thiazide teratogenic effects
Electrolyte abnormalities, growth retardation
97
warfarin teratogenic effects
Fetal Warfarin Syndrome
CNS defects/eye abnormalities
Fetal/neonatal/placental haemorrhage
98
when not to take
Weeks 6-12, 2nd/3rd trimester, Late 3rd trimester
99
ebsteins anomaly
congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart
100
what drug causes ebsteins anomaly
lithium
101
whats foetal warfarin syndrome
Resulting abnormalities include low birth weight, slower growth, mental retardation, malformed bones, cartilage and joints, deafness and small head size
102
Antimetabolite drugs affect on pregnancy
genetic abnormalities in the sperm = malformations in offspring
103
examples of antimetabolites
methotrexate, azathioprine and mercaptopurine
104
when to stop antimetabolites
6 months before conception
105
amiodarone why should you avoid in breast feeding
Iodine content may cause neonatal hypothyroidism
106
aspirin why should you avoid in breast feeding
Theoretical risk of Reye’s syndrome
107
bisphosphonates why should you avoid in breast feeding
drowsy
108
benzos why should you avoid in breast feeding
lethargy
109
carbimazole why should you avoid in breast feeding
hypothyroid
110
codein why should you avoid in breast feeding
Risk of opiate overdose
111
COCP why should you avoid in breast feeding
May diminish milk supply and quantity
112
cytotoxics why should you avoid in breast feeding
immunosuppression and neutropenia
113
dopamine agonists why should you avoid in breast feeding
may suppress lactation
114
epinephrine why should you avoid in breast feeding
irritability
115
tetracyclines why should you avoid in breast feeding
tooth discolouration
116
Renal abnormalities linked with
ACE inhibitor and Methotrexate use
117
Parathyroid abnormalities associated with
retinoids
118
Discoloured teeth linked to
tetracyclines
119
Neural tube defects linked to
Sodium Valproate
120
Persistent Pulmonary Hypertension of the Newborn associated with
NSAIDs
