Medication use in Pregnancy

Question 1

What is a teratogen?

Answer 1

Agent which causes developmental abnormality in an embryo or foetus

Question 2

What is an example of a serious teratogen?

Answer 2

Sodium valproate

Question 3

What is the lowest risk of epilepsy medications?

Answer 3

Gabapentin
Levetiracetam
Clonazepam
Lamotrigine

Question 4

How is epilepsy managed in pregnancy?

Answer 4

Specialist referral required
Dose adjustments = switch from sodium valproate
= dose reduction/withdrawal if seizures well controlled

Question 5

What effect does drugs have in the 1st trimester?

Answer 5

Drugs produce congenital malformations

Question 6

What effect does drugs have during 2nd + 3rd trimester?

Answer 6

Affect growth/functional developmental of foetus
Have toxic effect on foetal tissues

Question 7

What should pregnant women be vaccinated for?

Answer 7

Rubella
Varicella
Hepatitis B if at risk of contracting it

Question 8

What are examples of drugs that affect the foetus?

Answer 8

ACEi
Antimetabolites
Benzodiazepines
Carbamazepine
Warfarin
Lithium
Penicillamine
Phenobarbital
Phenytoin
Tetracycline
Thalidomide
Valproic acid

Question 9

What is 1st line for morning sickness?

Answer 9

Lifestyle changes - sleep hygiene, regular meals, avoid fatty foods, plenty of fluids

Question 10

What is 2nd line for morning sickness?

Answer 10

Antihistamines
eg. cyclizine, promethazine

Question 11

What is problem with Ondansetron?

Answer 11

Can cause cleft lip if used in 1st trimester

Question 12

Why should women be advised to take folic acid?

Answer 12

Reduce likelihood of baby having neural tube defect

Question 13

What are the NICE guidelines for folic acid?

Answer 13

400mcg OD before pregnancy + throughout 1st 12 weeks

Question 14

Why does GP prescribe 5mg of folic acid?

Answer 14

If family history of NTD
Have diabetes, sickle cell anaemia or thalassaemia
Women taking anti-epileptic medication
Woman obese (BMI>30kg)

Question 15

What else should women be advised to take?

Answer 15

VitD 10mcg throughout pregnancy + after if they are breastfeeding

Question 16

What is the advice on weight?

Answer 16

Overweight or obese to lose weight before becoming pregnant

Question 17

What risks are there being associated with being obese?

Answer 17

Neural tube defects
Heart defects
Cleft palate/cleft lip
Limb reduction abnormalities

Question 18

What is the advice on smoking?

Answer 18

Stop smoking prior
= increased risk of miscarriage
AVOID NRT

Question 19

What is the advice about alcohol?

Answer 19

Avoid drinking alcohol due to risk of foetal alcohol spectrum disorder

Question 20

What advice about OTC?

Answer 20

Advised to speak to pharmacist before taking any OT products

Question 21

Should you take herbal remedies?

Answer 21

NO

Question 22

What can VitA cause?

Answer 22

Congenital defects

Question 23

Should Fe be supplied?

Answer 23

No = unpleasant maternal side effects

Question 24

When calculating anti-coagulant dose what weight do you use?

Answer 24

Pre-pregnancy weight

Question 25

What Tinzaparin sodium should be used in pregnancy?

Answer 25

Formulations without benzyl alcohol (syringes)

Question 26

What do you need to try and do in 1st trimester with medications?

Answer 26

Avoid all drugs = balance risk of disease = consider non-drug treatment first = lowest effective dose

Question 27

How is asthma managed?

Answer 27

Take medication as prescribed in order to keep asthma well controlled Requires little modification

Question 28

How is diabetes managed?

Answer 28

Oral hypoglycaemic drugs carry risk of teratogenesis + prolong neonatal hypoglycaemia Switched to insulin

Question 29

How is RA managed?

Answer 29

Refer to rheumatologist Especially if taking NSAIDs + DMARDs

Question 30

How is gastro-oesophageal reflux managed?

Answer 30

Some OTC antacid licensed for pregnancy Avoid antacids with high Na+ OTC H2 antagonists not licensed

Question 31

What is the non-pharmacological management of gastro-oesophageal reflux?

Answer 31

Not eat late in the day Use extra pillows at night to sleep Avoid chocolate + coffee

Question 32

How is constipation + haemorrhoids managed?

Answer 32

Increase fluid + fibre intake Bulk-forming laxatives + lactulose

Question 33

How are coughs + colds managed?

Answer 33

Non-medicated pastilles + simple linctus Avoid products containing sympathomimetic decongestants

Question 34

How is vaginal discharge managed?

Answer 34

Common in pregnancy Refer if itch, sore, offensive smell, pain on passing urine

Question 35

How is thrush managed?

Answer 35

One week course of topical imidazole Oral treatment AVOIDED

Question 36

What is gestational hypertension?

Answer 36

BP >140/90 after 20 weeks of gestation without presence of proteinuria

Question 37

What are the symptoms of gestational hypertension?

Answer 37

Oedema Blurred vision Upper abdominal pain Nausea + vomiting

Question 38

What is the definition of pre-eclampsia?

Answer 38

BP >140/90 after 20 weeks gestation with either = proteinuria = kidney/liver dysfunction

Question 39

If increased risk of pre-eclampsia what is given?

Answer 39

75mg aspirin OD

Question 40

What can gestational hypertension do?

Answer 40

Reduce blood flow to placenta = foetus receives less oxygen + nutrients

Question 41

What are the drugs choices for gestational hypertension?

Answer 41

1st line = beta blocker Labetalol

Question 42

What drugs do you avoid with gestational hypertension?

Answer 42

Diuretics Atenolol ACEi AT II receptors

Question 42

What is gestational diabetes?

Answer 42

Fasting plasma glucose level of 5.6mmol/L or above OR 2-hour plasma glucose level of 7.8mmol/L or above

Question 43

What is 1st line treatment for gestational diabetes?

Answer 43

Changes in diet Regular exercise (walking 30mins after meal)

Question 44

What is the only anti-diabetic drug that can be used in pregnancy?

Answer 44

Metformin

Question 45

What is foetal alcohol syndrome?

Answer 45

Inadequate growth, facial defects, small head + mental retardation

Question 46

What can alcohol lead to?

Answer 46

Foetal alcohol syndrome Miscarriage Low birth weight

Question 47

What medications MUST be avoided?

Answer 47

Statins (stopped 3 months before conception) Warfarin (swap to tinzaparin) Isotretinoin (teratogenic) Lithium