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7006PHM Prof Pharm II > Pre-existing conditions in preg > Flashcards

Pre-existing conditions in preg Flashcards

1
Q

Discuss importance of asthma management in preg

A

Preg women greater risk of uncontrolled asthma = risk of foetal hypoxia

review asthma every 4-6 wks

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2
Q

What is used to treat asthma in preg?

A

SABA
LABA

ICS preventer = beclomethasone, budesonide, fluticasone –> not C/I in preg

Oral corticosteroids = dose for asthma –> no risk of mother or baby

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3
Q

Discuss the importance of treating epilepsy in pregnancy

A

Preg women = more freq seizures, may remain same, or dec in freq

Uncontrolled = dangerous, potentially life threatening to both mother and foetus

Consider inc failure of anti-convulsant therapy due to dec [serum] and altered pharmacokinetics

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4
Q

Outline of epilepsy management prior to preg

A

Consider w/drawl if seizure free for at least 2 yrs

stabilise on monotherapy if possible, w/ lowest dose

Folic acid 5mg/day, 1 month before conception

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5
Q

Discuss the treatment of epilepsy in pregnancy

A

Balance risk of anti-eps vs Mother/baby ADRs
All anti-epileptics are teratogenic (valproate is the worst), no drug of choice

Monotherapy if possible

Vit K supplement = some anti-eps deplete vit K in foetus (inc bleeding risk)

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6
Q

Outline the monitoring of epileptic mothers in preg

A

Plasma drug levels monitored throughout and 3 months post-partum

Better than 90% chance that baby will be normal

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7
Q

What med hx should be considered in women presenting w/ prei-natal depression?

A

Past mental health disorders = inc chance of depression occurring and bipolar occurrence in preg

Family hx of psychosis postnatally –> inc risk of mental health disorders

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8
Q

What women are at inc risk of peri-natal depression?

A

Women who experience multiple preg

Those who conceive through IVF

Those w/ PCOS

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9
Q

What are some potential harms to foetus w/ psychotropic use in preg?

A

Miscarriage, foetal death in utero, still birth

pre-term birth, congenital abnormality

growth restriction, poor neonatal adaptation

long term neurodevelopmental effects

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10
Q

Outline the psychotropics used in pregnancy for depression

A

Paroxetine not good, TCAs, SSRI safe w/ lowest dose

TCAs = may cause premature delivery and congenital malformation (seizure, altered muscle) –> AVOID doxepin (neonate resp depress)

SSRIs = may cause immature delivery, persistent pulmonary HTN, withdrawal, no risk of malformations except w/ peroxetine,

Antidepressants post natally = monitor babu feeding, neurological and resp difficulties

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11
Q

What antipsychotics should not be stopped/started in pregnancy?

A

Do not prescribe sodium valproate in preg

Do not stop antipsychotics

Do not initiate clozapine

Do not start peroxetine

Avoid doxepin

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12
Q

Discuss hypothyroidism in preg

A

Effect foetal brain development due to inc need for maternal thyroxine

hCG have inversely proportional relationship to TSH

Use levothyroxine therapy (inc dose 30-50%), monitor thyroid function each trimester

reassess maintenance dose 6-8 wks post partum

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13
Q

Discuss hyperthyroidism in preg

A

Common due to graves’ disease and gestational thyrotoxicosis

PTU preferred before conception + 1st tri

Switch to carbimazole in 2nd tri

Block-replace regimen = C/I

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14
Q

Discuss post-partum thyroid dysfunction

A

Common, result in hypo/hyperthyroidism = auto-immune conditions at risk

Must be differentiated from new onset/relapsed graves

Initial phase of hyperthyroidism due to thyroiditis followed by temporary hypothyroidism, eventual normal

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15
Q

What is the counselling for diabetes in women of reproductive age?

A

Need for excellent BG control and how to achieve

Nutrition advice

Folate supplementation to reduce risk of neural tube defect

Not smoking

Potential change in antihypertensive therapy during preg (ACEi can cause foetal damage in tri 2 and 3)

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16
Q

What is the treatment of Type 1 diabetes in preg?

A

multidose regimen = v/short acting insulin, intermediate insulin at bed time

17
Q

What is the risk of pre-existing diabetes in pregnancy

A

Maternal mortality inc if pre-existing CHD

Potential progression to microvascular complications

Inc risk of pre-eclampsia and peri-partum intervention

Malformations rate correlated w/ poor control

18
Q

What is the treatment of Type 2 diabetes in preg?

A

Management by diet is not usually sufficient

If diet cannot maintain glycaemic control = insulin therapy should be initiated

No absolute C/I for metformin

19
Q

What is the monitoring for pre-existing diabetes in pregnancy?

A

Intensive BG monitoring = pre-req

BG lvls should be routine preprandially and bed time, periodic check between 2am and 4am for unchecked hypoglycaemia

HbA1c dec due to haemodilution of preg

20
Q

Outline the insulin requirements throughout pregnancy

A

1st tri = insulin sensitivity inc, dec in insulin dose (nausea common, reduce carbs), altered symptoms

wks 22-32 = insulin req rise, fall slightly after 36 wks gestation

Postpartum = insulin req reduce by 20%, hypos anticipated/avoided, carbs should be close by, resume oral insulin once BF is stopped

T2DM = should continue on diet or insulin therapy while BF

21
Q

What are predisposing factors to gestational diabetes?

A

Aboriginal, Torres Strait Islander women

Maternal age >30 yrs

Fam Hx DM

Obesity BMI >30kg/m2

Inc incidence 2nd and 3rd tri

22
Q

Discuss (generally) gestational diabetes

A

Glucose intolerance in preg, management returns to normal PP

Inc risk of future T2DM

Check BG 4x/day (fasting and postprandial), if lvls exceed 10% –> insulin therapy

Council about likelihood of developing T2DM later in life after GD

23
Q

When is GD screened for in pregnancy?

A

26 weeks gestation via per oral glucose tolerance test (POGTT)

Again, 6-12 wks PP glucose tolerance test

24
Q

What is the treatment for gestational diabetes melilites?

A

Insulin = for those who don’t obtain optimal BGL w/ lifestyle mods

Metformin (XR or SR) is an option of treatment, no teratogenic problems but may need supplemental insulin

25
Q

Is VTE prophylaxis required in all pregnancies?

A

Only those w/ risk factors require prophylaxis = hx VTE and identified thrombophilia

Other risk = obesity, active cancer, delivery by emergency caesarean

26
Q

What are some signs and symptoms of pulmonary embolism?

A

Dyspnoea
Palpitations
Chest pain
Haemoptysis
Hypoxia/cyanosis
Tachycardia/Tachypnoea
Hypotension, collapse

27
Q

What are some signs and symptoms of DVT?

A

DVT in preg is prox, may not present w/ usual features

Unilateral leg pain, swelling in extremity

Inc in calf/thigh circumference

Inc temp

Prominent superficial vein, pitting oedema

28
Q

How are VTEs prevented/treated in pregnancy?

A

Treatments
- Graduated compression stockings
- Low molecular weight heparins (enoxaparin)

Treatment throughout preg and 6wks PP

LMWH should be discontinued at earliest onset of labour, minimise bleeding complications

29
Q

What are varicose veins?
(treatments, aetiology)

A

Pooling of blood in surface veins due to insufficient valves (calves, inside legs, vulva)

Usually appear in 1st tri, influenced by:
- fam hx
- elevated BP
- hormones

Symptom relief by elevating feet, avoid long periods of standing

30
Q

Describe the symptoms of vaginal thrush

A

Thick, white discharge

Non-offensive odour, vulval itch or soreness
Superficial dyspareunia, external dysuria

31
Q

How is vaginal thrush treated in pregnancy?

A

Topical vaginal antifungals = pessary preferred, applicator used w/ care (not rec)

Oral fluconazole = inc risk of miscarriage

32
Q

What skin rashes occur in preg? Why?

A

Melasma or chloasma faciei = due to high circulating oestrogen

Physiological changes to skin
- inc pigmentation, hair growth
- vascular instability and striae (stretch marks)

33
Q

What is striae gravidarum? When occur?

A

During last trimester, 60-90% women (abdomen, breast, thigh, hips, lower back, buttock)

Initially erythematous = fade and become skin coloured or hypopigmented atrophic

34
Q

Discuss pruritus in pregnancy (treatments, what it is, when to refer)

A

Mild itching due to skin stretch

Topical treatment (emollients)
- wet dressing, tepid shower to cool skin
- calamine lotion: avoid on dry skin, dries skin more
- menthol/camphor lotion chilling sensation

Refer = itching is severe —> obstetric cholestasis or intrahepatic cholestasis of preg

35
Q

Discuss intrahepatic cholestasis in preg (what is, treatment, associations)

A

Causes unexplained pruritus during the 2nd 3rd = raised blood lvl of bile acids and/or liver enz

Intrahepatic cholestasis associated w/:
- inc risk of preterm delivery
- stillbirth
- risk of later hepatobiliary cancer, thyorid disease, diabetes, psoriasis, crohn disease, CVD

Treatment = ursodeoxycholic acid + aqueous cream w/ menthol

7006PHM Prof Pharm II (24 decks)

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