Z-F Chronic conditions -

Question 1

if mum has hypothyroidism during pregnancy, why does her levothyroxine dose have to be increased?

Answer 1

T4 crosses the placenta, increase by 30-50%

Question 2

is mum has hypertension, what medications are used to treat this?

Answer 2

labetlol (b blocker)
nifedifine (c blocker)
doxazosin (a blocker)

Question 3

what are the safe anti-epileptic meds to use in pregnancy?

Answer 3

levetiracetam, lamotrigine and carbemazepine

Question 4

which fetal abnormality does phenyoin cause?

Answer 4

cleft lip and palate

Question 5

which fetal abnormalities does sodium valproate cause?

Answer 5

developmental delay and neural tube defects

Question 6

if mum has RA, what meds can she take?

Answer 6

hydroxychloroquine or sulfalazine (methotrexate is teratogenic)

Question 7

why are NSAIDs generally avoided in pregnancy?

Answer 7

they work by blocking prostaglandins (important in maintaining ductus arterosus in the fetus and neonate, they also soften the cervix and stimulate uterine contractions at the time of delivery)

Question 8

why are ACEi and ARBS contraindicated in pregnancy?

Answer 8

they can cross the placenta affecting the kidneys and reducing the production of urine (and therefore amniotic fluid)

Question 9

what is hypocalvaria and which medications cause it?

Answer 9

incomplete formation of the skull bones

ACEi and ARBs

Question 10

what is the effect of using opiates during pregnancy?

Answer 10

can cause withdrawal symptoms in the neonate = called neonatal abstinence syndrome (NAS) + presents between 3-72 hours after birth with irritability, tachynopea, high temp and poor feeding

Question 11

when is lithium avoided and why?

Answer 11

in the first trimester as it is linked with congenital cardiac abnormalities eg ebsteins anomaly (where the tricuspid valve is set lower on the right side of the heart towards the apex, causing a bigger right atrium and a smaller right ventricle)

Question 12

is lithium safe for breastfeeding?

Answer 12

no

Question 13

what are the most common antidepressants in prgnancy?

Answer 13

SSRIS - but they are linked to congenital heart defects

avoid paroxetine

Question 14

is isotretinoin (roaccutane) safe in pregnancy?

Answer 14

no
causes miscarriage and congenital defects
women require reliable contraception before, during and for one month after taking isotretinoin

Question 15

when should women be given MMR vaccine?

Answer 15

before or after pregnancy as it is a live vaccine

Question 16

how to treat pregnant women with chickenpox?

Answer 16

oral aciclovir if they present within 24 hours of rash staring and are more than 20 weeks gestation

Question 17

what is listeria?

Answer 17

gram positive bacteria that causes listeriosis

Question 18

which foods contain listeria?

Answer 18

unpasteurised dairy products, processed meats and contaminated foods
avoid foods eg blue cheese

Question 19

what is the triad of congenital toxoplasmosis?

Answer 19

intracranial calcification
hydrocephalus
chorioretinitis (inflammation of the choroid and retina in the eye)

Question 20

what is fetal anaemia caused by?

Answer 20

parovirus infeciton of the erythroid progenitor cells in the fetal bone marrow and liver
these cells produce RBCs adn the infection causes they to produce faulty RBCs that have a short life span = anaemia