Drugs in Pregnancy and the Newborn

Question 1

In normal / young / fit and healthy mothers, what is the background risk of congenital malformations?

Answer 1

2-3%

Question 2

Define “teratogen”

Answer 2

An agent administered to a mother which directly or indirectly causes structural / functional abnormalities in the foetus or child after birth

Question 3

Give an example of a drug which causes Transplacental carcinogenicity

Answer 3

Diethylstilboestrol

Question 4

Give examples of facial phenotypic features observed in Foetal Alcohol Syndrome

Answer 4

• Microcephaly
• Indistinct philtrum
• Flat midface
• Low set ears, minor ear abnormalities
• Thin upper lip
• Low nasal bridge
• Small chin

Question 5

What is the recommendation of drinking alcohol during pregnancy?

Answer 5

No clear recommendation, should avoid alcohol altogether (atleast for first 3 months)

Question 6

What are the two major types of Inheritance?

Answer 6

Mendelian

Multifactorial / Polygenic

Question 7

Spina bifida is caused by a failure in the fusion of?

Answer 7

The caudal neural tube

Question 8

How can Spina bifida be prevented in 70% of cases?

Answer 8

Folic acid supplementation during pregnancy

Question 9

What factors may influence what dose of a drug you prescribe to a pregnant woman?

Answer 9

• Transfer of drug (passive + facilitate diffusion, active transport)
• Molecular weight
• Lipid solubility
• Ionisation
• Protein binding
• Chemical structure
• Pharmacokinetic changes (blood flow)

Question 10

Drugs of what size can freely pass through the Placenta?

Answer 10

< 600 Daltons

Question 11

What kinds of drugs do not cross the placenta at all? Give 2 examples

Answer 11

Large molecular weight drugs > 1000 Daltons, i.e. Insulin and Heparin

Question 12

Lithium when taken by pregnant women increases the risk of what in a foetus?

Answer 12

Ebstein’s anomaly

Question 13

Assuming the first day of the pregnancy is the first day of the LMP, when does ovulation occur?

Answer 13

Week 2 after LMP

Question 14

The period of maximal susceptibility to teratogenic effects is usually when?

Answer 14

First 10 weeks post conception

Question 15

An embryo is defined as an embryo from what weeks?

What about a foetus?

Answer 15

Embryo: Week 2 - 9
Foetus: Week 9 - 38

Question 16

Androgens taken by the mother can have what effect on the foetus during the first trimester?

Answer 16

Masculinisation of the female foetus

Question 17

Oestorgens taken by the mother can have what effect on the foetus during the first trimester?

Answer 17

Feminisation of the male foetus

Question 18

Warfarin taken by the mother can have what effect on the foetus during the first trimester?

Answer 18

Craniofacial / cardiovascular / CNS defects

Question 19

Antiepileptics taken by the mother can have what effect on the foetus during the first trimester?

Answer 19

Facial defects / mental retardation / neural tube defects

Question 20

Antiepileptics taken by the mother can have what effect on the foetus after the first trimester?

Answer 20

Possible mental retardation, autism, aspergers

Question 21

Narcotics taken by the mother can have what effect on the foetus after the first trimester?

Answer 21

Neonatal respiratory depression

Question 22

Warfarin taken by the mother can have what effect on the foetus after the first trimester?

Answer 22

Foetal harmorrhage, CNS abnormalities

Question 23

Benzodiazepines taken by the mother can have what effect on the foetus after the first trimester?

Answer 23

Floppy infant syndrome, neonatal respiratory depression, withdrawal symptoms

Question 24

ACE Inhibitors taken by the mother can have what effect on the foetus after the first trimester?

Answer 24

Oligohydramnios (too little amniotic fluid)

Question 25

Following the Thalidomide tragedy, what Post-Marketing surveillance was introduced?

Answer 25

- Yellow Card - Congenital malformation registries - UK Teratology Information Service - UK Epilepsy & Pregnancy Register

Question 26

What is the Black Triangle which may appear after a drug name?

Answer 26

Pharmacovigiliance, indicates medication is new to the market, or that existing medicine is being used for a new reason or by a new route of administration

Question 27

Describe the steps of the Pain Ladder for a pregnant woman

Answer 27

``` - Phase I Non-Pharmacological Paracetamol Codeiene NSAID Paracetamol + Codeiene NSAID + Codeine ``` - Phase II Tramadol - Phase III Amitriptyline - Phase IIII Opiates

Question 28

When should NSAIDs not be given during a pregnancy?

Answer 28

Not be given after 28/40 weeks

Question 29

NSAID use after 28 weeks can lead to..?

Answer 29

Premature closure of the Ductus Arteriosus

Question 30

Describe the Stepwise management for Nausea and Vomiting in Pregnant women

Answer 30

1. Non-pharmacological 2. Pharmacological First choice: Cyclizine / Promethazine Second choice: Prochlorperazine / Metoclopramide

Question 31

Describe the Stepwise management for Constipation

Answer 31

1. Non-pharmacological management | 2. Laxatives, Lactulose, Senna, Glycerine suppositories

Question 32

Severe nausea, vomiting and weight loss in pregnancy refers to..?

Answer 32

Hyperemesis Gravidarum

Question 33

Describe the first two steps in the Stepwise use of Antibiotics

Answer 33

1. Penicillins and Cepalosporins | 2. Erythromycin and Clindamycin

Question 34

Tetracyclines should be avoided at what stage of pregnancy?

Answer 34

After 15 weeks gestation