Drugs In Pregnancy

Question 1

What is a teratogen?

Answer 1

Something which causes an abnormality within the baby following foetal exposure during pregnancy

Question 2

When are teratogens most dangerous?

Answer 2

At the start of pregnancy - during embryogenesis and organogenesis.
This is when it is most likely to produce a defect.

Question 3

What affects can smoking have on a baby?

Answer 3

Low birth weight.
Pre-term birth.
Cerebral Palsy.
Learning difficulties.

Question 4

What condition can be caused by alcohol in pregnancy?

Answer 4

Foetal alcohol syndrome.

Question 5

What are the common characteristics of foetal alcohol syndrome?

Answer 5

Facial: smith philtrum, thin vermillion border, small palpebral fissures.
Brain: Microcephaly, seizures, intellectual disability.
Other: Low weight, small height, Limb dislocation, heart defects.

Question 6

What common symptoms do elicit drugs cause?

Answer 6

Low birth weight.
Withdrawal symptoms.
Learning and behavioural problems.

Question 7

What is pharmacokinetics?

Answer 7

What the body does to a drug, including absorption, distribution, metabolism and excretion.

Question 8

What is pharmacodynamics?

Answer 8

What the drug does to the body.

Question 9

What condition does the consumption of thalidomide during pregnancy cause?

Answer 9

Phocomelia (shortening of the limbs)

Question 10

What medications are prescribed for nausea and vomiting?

Answer 10

First Line:
Cyclizine (antihistamine)
Prochloroperazine (phenothiazine)
Doxylamine/pyridoxine combination

Second Line:
Ondansetron
Metoclopramide

Question 11

What medications can be used to treat hypertension in pregnancy?

Answer 11

Start daily aspirin from week 12

Labetelol (beta blocker)
Nifedipine (calcium channel blocker)
Methyldopa (antihypertensive)
Hydralazine (vasodilator)

Question 12

Which hypertensive medications should be stopped in pregnancy?

Answer 12

ACE inhibitors (end in pril)
Angiotensin receptor blockers (end in sartan)

these should be stopped/swapped as soon as pregnancy is confirmed.

Question 13

Why is folic acid given to mothers during pregnancy?

Answer 13

For neural tube development: to prevent spina bifida and anencephaly.

Question 14

Which birth defects are increased slightly when taking AED’s (anti epileptic drugs)?

Answer 14

Spina bifida/neural tube defects (sodium valproate) 
Cleft lip (sodium valproate)
Heart abnormalities (phenobarbitone)
Brain - reduced memory, attention and speech development.

Question 15

What amount of folic acid should be given to mothers during pregnancy?

Answer 15

The normal amount is 400mcg daily from 12 weeks.

Question 16

Who should receive high dose folic acid in pregnancy?

Answer 16

Those with an increased risk of having neural tube defects.
Epilepsy
previous children with NTD
Diabetes
Obesity
Malabsorption disorders

Question 17

Which drugs should be used in a diabetic who is pregnant?

Answer 17

All oral anti diabetic drugs should be stopped (except METFORMIN) and substituted with insulin therapy.

Question 18

Which diabetic drug can be resumed after pregnancy and during breast feeding?

Answer 18

Glibenclamide.

Question 19

Which drugs should be given to pregnant women with an increase of thromboembolism?

Answer 19

Low molecular weight heparin

WARFARIN IS TERATOGENIC

Question 20

Which thromboembolic drugs are contraindicated in pregnancy?

Answer 20

Warfarin

DOACs (end in aban)

Question 21

What are common abnormalities seen if warfarin is used during pregnancy?

Answer 21

Nasal hypoplasia
Skeletal abnormalities - short limbs and digits
Stippled epiphyses

WARFARIN CAN BE USED DURING BREAST FEEDING.

Question 22

Which medication can be used to treat asthma in pregnancy?

Answer 22

Beta 2 agonist - albuterol, salbutamol
Inhaled corticosteroid - budesonide
systemic corticosteroid - severe asthma
Theophyline (can cause potential toxicity)

Question 23

What medications can be used to treat headaches and migraines?

Answer 23

Parcetamol
Ibuprofen - AVOID In 3rd trimester
Sumatriptan - acute migraine
Propanolol

Question 24

What are the potential complications of antidepressants and antipsychotics?

Answer 24

Lithium - cardiac anomaly
Diazepam - cleft lip, floppy infant syndrome
Quetiapine - large baby, poor neonatal adaptation syndrome

Question 25

Which antibiotics are safe in pregnancy?

Answer 25

Penicilin
Erythromycin
Azithromycin
Cephalospirons

Question 26

Which antibiotics are contraindicated in pregnancy?

Answer 26

Tetracycline - effects skeletal development
Sulphonamides - teratogenic (avoid in 1st semester)
Aminoglycosides (streptomycin) - auditory or vestibular nerve damage

Question 27

What cancer treatments can be used in pregnancy?

Answer 27

Should be avoided if possible - most cytotoxic drugs are teratogenic.