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DONE CLINICAL > Pregnancy and Breast Feeding > Flashcards

Pregnancy and Breast Feeding Flashcards

1
Q

Anaemia can be subdivided into 3 types which are…

A

Megaloblastic, microcytic and haemolytic

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2
Q

What is the most commonest form of microcytic anaemia?

A

Iron deficiency

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3
Q

Folate deficiency results in…

A

Macrocytic anaemia

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4
Q

How is folate deficiency treated?

A

With replacement therapy

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5
Q

Reduced absorption of vitamin B12 can lead to…

A

Macrocytic anaemia

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6
Q

Haemolytic anaemias include…

A

Sickle cell anaemia, thalassaemia and glucose-6-phosphate dehydrogenase deficiency

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7
Q

Anaemia can be defined as…

A

A reduction from normal of the quantity of haemoglobin in the blood

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8
Q

Megaloblastic anaemias include…

A

Folate deficiency and vit B12 deficiency

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9
Q

Microcyti anaemias include…

A

Iron deficiency anaemia, anaemia of chronic disease and sideroblastic anaemia

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10
Q

List some of the non specific signs and symptoms of anaemia…

A 
Tiredness
Pallor
Fainting 
Tachycardia 
Palpitations
Worsening angina
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11
Q

During pregnancy there is an ___ in red cell mass and an increase in plasma volume which can result in a physiological dilution anaemia.

A

Increase

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12
Q

To meet the demand of metal red cell production the gut increases its ability to absorb iron during pregnancy. Some of this demand is met by the stopping of ______

A

Menstruation

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13
Q

How should you treat iron deficient anaemia?

A

Give iron sulphate tablets 200mg bd to tds until a normal range is reached + 3 months to improve symptoms

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14
Q

How long does it take for haemoglobin levels to rise 1g/dL?

A

Around 2 weeks - if this rise does not happen then the treatment is incorrect

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15
Q

Raised MCV is…

A

Macrocytic anaemia - megaloblastic (Red cells are larger than normal)

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16
Q

How much prophylactic folic acid should be given to pregnant women. (Can be given before conception and during first 12 weeks of pregnancy)

A

400mcg/day

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17
Q

How much folic acid should be given to a pregnant women with history of neural tube defects?

A

5mg/day

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18
Q

What is used to treat VitB12 deficiency?

A

Cyancobalamin oral 50-150mcg od

OR Hydroxcobalamin 1mg x 6 doses over 2 weeks (prophylaxis)

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19
Q

For a pregnant woman with folate-deficient megaloblastic anaemia how much folic acid should be given?

A

5mg daily until term

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20
Q

ACE inhibitors should NOT be given during the __ and __ trimesters

A

2nd and 3rd

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21
Q

ACE inhibitor use can result in fetal…

A

Renal dysfunction

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22
Q

NSAIDs should be avoided during the __ trimester specifically

A

3rd

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23
Q

NSAIDs can cause premature closing of the fetal ____ arteriousus

A

Ductus

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24
Q

The capacity of neonates to eliminate drugs is ____

A

reduced - this can lead to toxicity

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25
Q

Gastric and intestinal emptying time increases by __ to __ % in the second and third trimester

A

30 and 40%

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26
Q

Delayed gastric and intestinal emptying in pregnancy can lead to…

A

Delayed absorption and onset of action of some drugs

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27
Q

Vol of dis of drugs may be altered due to…

A
  • Inc in blood plama vol
  • Inc in CO
  • Inc in renal blood flow (3rd tri)
  • Inc 8L body water
28
Q

Patients taking drugs with enhanced clearance in pregnancy should be closely monitored. Give some examples of these drugs…

A

Carbamazepine, Phenytoin, Lithium and Digoxin

29
Q

What drug is recommended for use in hypertension in pregnancy and why?

A

Methyldopa - long history of safe use

30
Q

Which is preferred in pregnancy: Monotherapy or Polytherapy?

A

Monotherapy

31
Q

Which vitamin should be avoided in pregnancy?

A

Vitamin A

32
Q

Exclusive breastfeeding should take place for the first ____ months of a babies life

A

6 months

33
Q

Do highly protein bound drugs tend to pass into breast milk?

A

No they tend to remain in the maternal plasma

34
Q

Do lipophilic drugs have the ability to pass into breast milk?

A

Yes - the alveolar epithelium of the breast is a lipid barrier. CNS active drugs usually have characteristics needed to pass into milk

35
Q

Do drugs with LOW or HIGH MW tend to pass readily into milk?

A

LOW MW - as they can pass through the small pores easier

36
Q

Do more ACIDIC or BASIC drugs pass into breast milk more easily?

A

BASIC - higher pKa values - pass into breast milk more easily

37
Q

Drug clearance by the infant does not reach adult values until - months

A

6 to 7

38
Q

Name a drug used in suppressing milk production…

A

Cabergoline and bromocriptine (dopamine agonist)

39
Q

Name a drug used in stimulating lactation…

A

Domperidone (dopamine D2 antagonists)

40
Q

What information is needed to answer a question about a drug in pregnancy? 8 THINGS

A
  • Stage of pregnancy (Trimesters)
  • Medication involved
  • Dose, Frequency, Route
  • Indication
  • Other options tried
  • Preg history
  • Who is asking?
41
Q

What is the name of a good online resource to see drug usage in pregnancy?

A

TOXBASE, UKTIS (UK teratology info service)

42
Q

Lamotrogine doses must be ____ postpartum to ____ ____

A

REDUCED to AVOID TOXICITY

43
Q

Full term baby = ____ weeks

A

40

44
Q

Babies receive the antibody _____ if they receive colostrum (first milk after birth)

A

IgA - reduces risk of ear, GI, resp and urinary tract infections

45
Q

List some advantages of BF…

A 
Mother:
Less risk some cancers
Less risk osteoporosis 
Bonding with baby 
Cost effective

Baby:
Reduced incidence diarrhoea
Reduced risk iron related anaemia
Protects against sudden infant death syndrome
Long term = Lower obesity risk, reduced high BP risk

46
Q

What is the name of the drug and lactation database?

A

Lactmed

47
Q

Penicillin is a weak acid. Is it more or less likely to pass into breast milk than Isoniazid (weak base)

A

Less likely - Weak BASES become ionised in milk

48
Q

Warfarin is 99% protein bound. Will it therefore have high risk of passing into mothers breast milk?

A

No - only 1% is estimated to pass into mothers breast milk but should still observe for bleeding/bruising

49
Q

Heparin and insulin have high molecular weights.
Lithium and Alcohol have low molecular weights.

Which are most likely to pass into breast milk?

A

Lithium and Alcohol as they can cross the membrane

50
Q

What is a teratogen?

Give an example…

A
  • Agent that results in structural or functional abnormalities in the foetus or in the child after birth after maternal exposure during pregnancy
  • e.g Thalidomide
51
Q

What are the following drugs classed as…

  • ACE inhibitors
  • Carbamazepine
  • Carbimazole
  • Lithium
  • Ethanol
  • Phenytoin
  • Valproic acid
  • Vitamin A
  • Warfarin
A

Teratogens

52
Q

What does the term antenatal mean?

A
  • During pregnancy
53
Q

At what stage (time period) does the ‘all or nothing’ principle apply?
- Explain this principle

A
  • First 17 days (week 0-2 post conception)

- Teratogenic exposure lead to either death of the embryo or full recovery

54
Q

Vitamin A derivative such as Isotretonin (used to treat acne/psoriosis) has a ___ half life

A

LONG

55
Q

What drug can be administered to mothers to resolve foetal tachycardia in foetus?

A
  • Flecainide
56
Q

Why does hypoalbuminaemia occur in pregnancy?

A
  • Plasma volume increases at a greater rate than the increase in albumin
  • Results in low levels of albumin
57
Q

What is a consequence of hypoalbuminaemia?

A
  • Less drug binding to protein
  • More free drug
  • Higher concentration of drug
58
Q

In the first few weeks of pre, the glomerular filtration rate (GFR) increases by approx 50%
- Drugs excreted primarily unchanged by kidneys show enhanced slim and lower CSS concs.

Give some examples of these drugs…

A
  • Lithium
  • Digoxin
  • Penicillin
59
Q

Why do doses of lamotrigene need to be increased during pregnancy to exert the same effect?

A
  • Because the enzyme that metabolises Lamotrigene is induced by pregnancy
  • Therefore, more metabolism of the drug takes place during pregnancy
  • So a higher dose is needed for get same effect
60
Q

What happens to blood glucose levels in pregnancy?

A
  • Increase

- Anti insulin effects are a result of pregnancy

61
Q

What do diabetics need to do during pregnancy?

A
  • Ensure they take BS levels more frequently
  • Take 5mg folic acid
  • May need more freq doses of insulin/metformin
62
Q

What is pre-eclampsia?

A
  • Increase in blood pressure during pregnancy

- Increase in protein in the urine

63
Q

Which antihypertensives are contraindicated in pregnancy?

A
  • ACEI
  • ATIIreceptor blockers
  • Diuretics
64
Q

Name 3 medicines absolutely contraindicated in breastfeeding…

A
  • Amiodarone
  • Lithium
  • Iodides
65
Q

Name some ways in which a breastfeeding mother can minimise risk to baby if taking medication…

A
  • Take dose straight after feeding
  • Take dose at night if possible
  • Avoid poly pharmacy
  • Express milk before taking dose? ASK
66
Q

Name 4 screening tests that may be carried out to determine any problems with pregnancy…

A

1) Ultrasound
2) Amminocentesis (downs)
3) Blood screening (Hereditary disease)
4) Alpha feta protein - Neural tube defects e.g spina bifida

DONE CLINICAL (10 decks)

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