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PPT year 4 > Womens health: prescribing in pregnancy > Flashcards

Womens health: prescribing in pregnancy Flashcards

1
Q

normal length of pregnancy

A

37-42 weeks

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2
Q

cardiovascular increases x4

A

plasma volume
CO
stroke volume
HR

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3
Q

cardiovascular decreases x2

A

serum albumin

serum colloid oncotic pressure

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4
Q

changes in coagulation

A

increase in coagulation factors

increase in fibrinogen

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5
Q

what does fibrinogen do

A

converted enzymatically by thrombin to fibrin and then to a fibrin-based blood clot

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6
Q

what vein is affected in pregnancy

A

IVC compressed by the uterus

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7
Q

possible change to pulse

A

bounding

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8
Q

possible change to cardiac auscultation

A

third heart sound

systolic flow murmurs

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9
Q

potential ECG changes x4

A

left axis deviation
ectopic beats
ST depression and flattening/inverted T waves in inferior and lateral leads

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10
Q

changes in blood test x3

A

dilutional anaemia
leucocytosis
low albumin

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11
Q

leucocytosis

A

an increase in the number of white cells in the blood

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12
Q

2 physiological changes to the kidneys

A

Increase in renal blood flow and GFR

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13
Q

kidney changes affect on creatine and urea

A

increased excretion and reduced blood levels of urea and creatinine

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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

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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

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16
Q

bladder capacity change

A

increased

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17
Q

risk of UTI

A

increased

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18
Q

physiological change in the liver

A

Changes in oxidative liver enzymes e.g. CYP450

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19
Q

lungs physiological changes

A

Increase in tidal volume and minute ventilation

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20
Q

how much is tidal volume increased

A

30–50%

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21
Q

how does the RR change

A

it dosent psyche!

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22
Q

lung changes are caused by

A

increase in progesterone concentrations

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23
Q

anatomical change to the lungs

A

diaphragm is pushed 4–5 cm upward

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24
Q

anatomical change in lungs affect on drugs

A

inhaled drugs may be more readily absorbed e.g. steroids

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25
Q

summarise the respiratory ph thing

A

compensated respiratory alkalosis

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26
Q

describe compensated respiratory alkalosis

A

reduced pCO2, increased p02 and decreased bicarbonate

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27
Q

how are the lung changes benficial to the foetus

A

Lower maternal pCO2 facilitates oxygen/carbon dioxide transfer to/from the foetus.

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28
Q

GI physiological changes x2

A

Delayed gastric emptying

Prolonged small bowel transit time

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29
Q

GI complaints x2

A

GORD and N&V

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30
Q

Reduced gastric motility affect on bowel habit

A

constipation

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31
Q

Reduced gastric motility affect on nutrients

A

increased nutrient absorption

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32
Q

how does GORD come about

A

Progesterone causes relaxation of the lower esophageal sphincter and increased reflux,
pressure on the stomach from an enlarging uterus

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33
Q

Delayed gastric emptying and prolonged transit time affect on drug absorption

A

Prolonged time to reach peak concentration

Overall decrease in maximum concentration

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34
Q

Increased plasma volume affect on distribution

A

Increased volume of distribution of water-soluble drugs

Requires higher drug doses

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35
Q

Reduction in plasma protein levels affect on distribution

A

Decreased protein binding

Increased free fraction of the drug

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36
Q

CYP1A2 metabolises

A

caffine

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37
Q

what metabolises caffine

A

CYP1A2

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38
Q

CYP1A2 activity in pregnancy

A

reduced

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39
Q

caffine in pregnancy change

A

CYP1A2 activity is reduced causing caffeine plasma concentrations to double

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40
Q

Increased renal blood flow and GFR rate affect on elimination

A

Increased renal clearance

Shorter half-lives of renally cleared drugs

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41
Q

example of a drug affected by altered kidney elimination

A

lithium

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42
Q

lithium clearance in pregnancy

A

Clearance of lithium is doubled

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43
Q

when does lithum clearance change

A

in 3rd trimester

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44
Q

affect of lithium clearance in pregnancy on amount in the body

A

sub-therapeutic drug concentrations

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45
Q

which AED carries the same risk as background risk

A

lamotrigine

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46
Q

% of the general population will have a baby with a major malformation

A

2-3%

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47
Q

% who have epilepsy and don’t take AEDs will have a baby with a major malformation

A

3%

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48
Q

% who have epilepsy and do take an AED will have a baby with a major malformation

A

4-10%

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49
Q

3 AEDs with lower risks of malformations (2-5%)

A

Lamotrigine
Levetiracetam (Keppra)
Carbamazepine

50
Q

AED with higher risk of malformations (7-10%)

A

Sodium Valproate (Epilim)

51
Q

% of developmental problems when taking Na V

A

40% of children have developmental problems

52
Q

how much is the normal amount of folic acid

A

400 micrograms daily

53
Q

when to take folic acid

A

pre-conception to 12 weeks gestation

54
Q

why do women take folic acid

A

reduce NTD

55
Q

higher risk folic acid amount

A

5mg

56
Q

3 reasons to take 5mg

A

Anti-epileptic medication
Diabetes
Family history of NTD

57
Q

physical factors affecting drugs across the placenta x6

A 
Placenta surface area
Placental thickness
pH of maternal/foetal blood
Placental metabolism
Uteroplacental blood flow
Presence of drug transporters
58
Q

pharmacological factors affecting drugs across the placenta x6

A

Molecular weight of the drug
Lipid solubility
Protein binding
Concentration gradient

59
Q

which drugs cant cross placenta

A

molecular weight of >1kDa

60
Q

2 example of drugs over molecular weight of >1kDa

A

heparin and insulin

61
Q

drugs given to mum to promote foetal lung development

A

steroids

62
Q

when does nausea usually resolve

A

week 16-20

63
Q

meal recommendations for N and V

A

Small frequent meals high in protein and low in carbs and fat

64
Q

4 first line drugs for N and V

A

cyclizine
prochlorperazine
promethazine
chlorpromazine

65
Q

3 second line drugs for N and V

A

ondansetron
domperidone
metoclopramide

66
Q

Third line drug for N&V

A

hydrocortisone

67
Q

side effects of second line antiemetics for N and V

A

extra pyramidal side effects

68
Q

what to do if someone is dehydrated with N&V

A

IV fluid rehydration with potassium supplementation

69
Q

what to give if there is prolonged vomiting

A

Pabrinex/Thiamine

70
Q

severe N&V management

A

Enteral/parenteral feeding

Termination of pregnancy as last resort

71
Q

what is thalidomide

A

immunomodulator

72
Q

what was thalidomide originally used as

A

sedative

73
Q

what was thalidomide used for in pregnancy

A

nausea

74
Q

what teratogenic effects does thalidomide have

A

phocomelia

deformities of ears, heart and kidneys.

75
Q

phocomelia

A

hands or feet are attached close to the trunk

76
Q

what is thalidomide used for now

A

multiple myelome

77
Q

when is drug teratogenicity most likely to occur

A

1st trimester

78
Q

ACE inhibitors teratogenic effects x3

A

Renal abnormalities
patent ductus arteriosus (PDA)
oligohydramnios

79
Q

when not to take ace inhibitors

A

trimester 2/3

80
Q

antithyroid medication teratogenic effects

A

Neonatal hypothyroidism

81
Q

when not to take carbimazole

A

after week 10

82
Q

beta blocker teratogenic effects x3

A

IUGR
neonatal hypoglycaemia
bradycardya

83
Q

when not to take BB

A

throughout pregnancy

84
Q

lithium teratogenic effects

A

Cardiac defects (Ebsteins anomaly)

85
Q

when not to take lithium

A

1st trimester

86
Q

methotrexate teratogenic effects x4

A

Medical termination
craniofacial defects
ear/kidney/lung defects
cardiac abnormalities

87
Q

NSAIDs teratogenic effects

A

Premature closure of ductus arteriosus
oligohydramnios
PPHN

88
Q

when not to take NSAIDs

A

after week 30

89
Q

phenytoin teratogenic effects

A

Craniofacial abnormalities, growth/mental deficiency

90
Q

retinoids teratogenic effects

A

CNS abnormalities

renal/ear/eye/parathyroid abnormalities

91
Q

when not to take retinoids

A

4-10

92
Q

sodium valproate teratogenic effects

A

Neural tube defects

93
Q

when not to take NaV

A

1st trimester

94
Q

tetracyclines teratogenic effects

A

Tooth discolouration

95
Q

when not to take tetracyclines

A

2nd/3rd trimester

96
Q

thiazide teratogenic effects

A

Electrolyte abnormalities, growth retardation

97
Q

warfarin teratogenic effects

A

Fetal Warfarin Syndrome
CNS defects/eye abnormalities
Fetal/neonatal/placental haemorrhage

98
Q

when not to take

A

Weeks 6-12, 2nd/3rd trimester, Late 3rd trimester

99
Q

ebsteins anomaly

A

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
Q

what drug causes ebsteins anomaly

A

lithium

101
Q

whats foetal warfarin syndrome

A

Resulting abnormalities include low birth weight, slower growth, mental retardation, malformed bones, cartilage and joints, deafness and small head size

102
Q

Antimetabolite drugs affect on pregnancy

A

genetic abnormalities in the sperm = malformations in offspring

103
Q

examples of antimetabolites

A

methotrexate, azathioprine and mercaptopurine

104
Q

when to stop antimetabolites

A

6 months before conception

105
Q

amiodarone why should you avoid in breast feeding

A

Iodine content may cause neonatal hypothyroidism

106
Q

aspirin why should you avoid in breast feeding

A

Theoretical risk of Reye’s syndrome

107
Q

bisphosphonates why should you avoid in breast feeding

A

drowsy

108
Q

benzos why should you avoid in breast feeding

A

lethargy

109
Q

carbimazole why should you avoid in breast feeding

A

hypothyroid

110
Q

codein why should you avoid in breast feeding

A

Risk of opiate overdose

111
Q

COCP why should you avoid in breast feeding

A

May diminish milk supply and quantity

112
Q

cytotoxics why should you avoid in breast feeding

A

immunosuppression and neutropenia

113
Q

dopamine agonists why should you avoid in breast feeding

A

may suppress lactation

114
Q

epinephrine why should you avoid in breast feeding

A

irritability

115
Q

tetracyclines why should you avoid in breast feeding

A

tooth discolouration

116
Q

Renal abnormalities linked with

A

ACE inhibitor and Methotrexate use

117
Q

Parathyroid abnormalities associated with

A

retinoids

118
Q

Discoloured teeth linked to

A

tetracyclines

119
Q

Neural tube defects linked to

A

Sodium Valproate

120
Q

Persistent Pulmonary Hypertension of the Newborn associated with

A

NSAIDs

PPT year 4 (7 decks)

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