Drugs in Pregnancy Flashcards
(32 cards)
What pregnancy chances occur?
- Increased total body water
- Increased liver metabolism
- Inreased renal BF
- Increased plasma protein conc
What are teratogens?
Administration of a drug that can cause structural or functional abnormalities in the foetus or child after birth
What to consider when prescribing in pregnancy?
- Only prescribe if medication benefit outweighs the risk
- Use drugs with extensive use rather than new
- Use lowest effective dose
What drugs should not be used in pregnancy?
Valproate
What methods of contraception should be used?
- Long-acting reversible contraception (LARC)
- Copper intra-uterine device
- Progesterone-only implant
How to advise when preparing for pregnancy?
- Healthy eating, ideal weight, supplements (folic acid), smoking cessation, alcohol consumption, drug misuse, existing medical conditions, vaccinations, cervical & STI screening
What should be avoided in pregnancy?
- Vitamin A supplements and food high in vitamin A
- Unpasteurised milk and cheese
- Ripened soft cheese
- Raw/partially cooked eggs
- Caffeine
- Certain seafood
What should the aim for BMI be?
Between 18.5 and 24.9 (overweight BMI > 25, obese >30)
No dieting in pregnancy
What dose of folic acid should be taken?
Folic acid 400mcg daily, 5mg if high risk
Vitamin D (10mcg)
What should be prescribed if smoking cessation required?
NRT
DO NOT prescribe bupropion/varenicline
What is the difference for alcohol consumption accoring to NICE and DoH?
NICE: do not drink at all in the first 3 months, increased risk of miscarriage
DoH: Avoid alcohol
Can methadone be taken during pregnancy?
Yes, neonatal withdrawal syndrome after
What vaccinations are required for pregnancy?
- Ensure up to date with rubella
- Tdap (between 27-36 weeks)
- Influenza
- COVID-19
- Others: travel vaccines, Hep A, Hep B, meningococcal
What dose of folic acid should diabetic patients take?
5mg
What type of drugs are used to treat diabetes in pregnancy?
- Metformin, glibenclamide
- Insulin (rapid-acting or isophane NPH insulin)
- Insufficient evidence for long-acting
What is the target BP for HPT in pregnancy?
<135/85mmHg
What are the drug options for HPT in pregnancy?
Labetalol, nifedipine, methyldopa
What is the target BP for postnatal care?
<140/90mmHg
What are the risk factors for gestational diabetes?
- BMI > 30kg/m2
- Previous gestational diabetes
- Family history of diabetes (1st degree relative)
- Family origin
How is gestational diabetes diagnosed?
Routine screening
Risk assessment done at first midwife appt and if 1 or more risk factors glucose tolerance test offered between 24-28 weeks (women need to fast 8-10 hours before), given 75g of glucose drink, bloods checked 2 hours after
What are the signs/symptoms of gestational diabetes?
- Increased thirst, urinary frequency, dry mouth & tiredness (some women have none)
What are the complications of gestational diabetes?
- Larger than usual baby
- Premature birth (<37 weeks)
- Pre-eclampsia
- Complications with the baby
- Still birth
How long after birth are bloods checked?
6-13 weeks
What is the stages of gestational HPT?
- Hypertension (140/90-159/109mmHg) > labetalol to treat (aim for 135/85mmHg, measure BP once-twice/week)
- Severe (>160/100mmHg) > admit to hosp, aim for 135/85 measure every 15-30 mins till less than this
