9 Preg

Question 0

Li, some beta lactams require higher or lower doses?

Answer 0

High, becuase renally excreted

Question 1

How does GFR change?

Answer 1

Increased becuase increase fluid volume

Question 2

Hepatic metabolism is increased or decrease do

Answer 2

Increased (possible due to enzyme induction from endogenous progesterone)

Question 3

Methadone and phenytoin clearance?

Answer 3

Metabolism increases in the third trimester

Question 4

Theophylline metabolism

Answer 4

Decreases

Question 5

When to increase loading dose due to increased weight gain.?

Answer 5

When rapid effect is required
If magnitude of effect is proportional to peak plasma concentration

(Because vol distribution is effected)

Question 6

Main binding agent

Answer 6

Albumin (acids) and AAG (bases)

Question 7

Medicines with potential to cause Withdrawl I. The neonate

Answer 7

Antidepressants and antipsychotics

Question 8

First line in gestational hypotension and preeclampsia

Answer 8

Labetalol

Question 9

For chronic hypertension

Answer 9

Consider the risks of what is already being taken

Question 10

Insulin doses in pregnancy

Answer 10

May change rapidly

Question 11

What oral hypoglycemic agents cba be taken in preg?

Answer 11

Only Metformin

Question 12

First choice insulin in preg

Answer 12

Isophane

Question 13

Is warfarin safe in breastfeeding?

Answer 13

Yes first line

Question 14

Properties of drugs that easily cross the placenta

Answer 14

Unionised and lipophilic

Question 15

Milk has a higher or lower pH than plasma

Answer 15

Lower

Question 16

Milk has a higher or lower protein binding capacity

Answer 16

Lower

Question 17

Milk has a higher or lower lipid con

Answer 17

Higher

Question 18

Properties of agents that partition into the milk

Answer 18

Highly lipophilic

Not highly protein bound

Question 19

First few days of breast feeding produces

Answer 19

Colostrum

More proteins and fewer lipids

Question 20

What is a teratogen

Answer 20

Agents that cross the placenta and cause congenital malformations

Question 21

Abnormal tissue formation is called

Answer 21

Dysmorphogenisis

Question 22

Examples of congential abnormalities

Answer 22

Downs, NTD, heart defect

Question 23

HG

Answer 23

Hyperemesis gravedarum

Intractable nausea vomiting and dehydration

Question 24

Possible treatment for HG

Answer 24

Metoclopramide IV fluid replacement Nutritional support Supplementation of thiamine to prevent wernikes

Question 25

In HG avoid

Answer 25

Dextrose containing fluid (precipitate wernikes)

Question 26

Three pregnancy screens

Answer 26

Ultrasound Bloods Amniocentesis

Question 27

Amniocentesis allows us to detect ...

Answer 27

Chromosomal disorders. 14-16 weeks. Looks at shed cells in amniotic fluid. I aside, risk of miscarriage.

Question 28

Untrasound are when?

Answer 28

10-13weeks 6 days: see gestational age | 18-20weeks 6 days: heart/general health

Question 29

Mucosal translucency scan

Answer 29

Shows thickness at back of babies next that indicates down's | Non evasive

Question 30

Blood test eg.

Answer 30

Markers for downs Triple alpha fetal protien Quadrupal - identify likelyhood of a problem

Question 31

Tx asthma

Answer 31

As normal. Leukotrine antagonists only of continued be benifits. Steroids should not be withheld.

Question 32

Tx depression

Answer 32

SSRI - fluoxetine TCA -amitryptiline MAOI - avoid Li - abnormalities not clearly defined, come off if pos

Question 33

Tx gestational diabetes

Answer 33

Insulin or glibencamide (only safe sulfonylurea)

Question 34

Diabetes, remember 3

Answer 34

High dose folic acid | Come off statins and ACEi

Question 35

Antiepileptics that are safest

Answer 35

Gabapentin and lamotrigine

Question 36

Antiepileptics to avoid if at all possible

Answer 36

Valproate

Question 37

Considerations for epilepsy

Answer 37

Mono therapy if possible TDM as vol distribution/ metabolism changes Vitamin k given at birth

Question 38

BP target if pregnancy

Answer 38

150/100

Question 39

Risk of preeclampsia should have

Answer 39

Low dose aspirin from week 12 to term

Question 40

Risk factors for preeclampsia

Answer 40

``` Diabetes CDK Over 40 BMI over 35 on first bist Chronic hypertension ```