Pharmacology - Drug treatment in pregnancy, breastfeeding and the neonate

Question 1

what happens to gastric emptying for oral preparations in pregnancy

a.delayed
b.accelerated

Answer 1

a.delayed

Question 2

what happens to concentrations of lipid and water soluble drugs in pregnancy

a.increase
b.decrease

Answer 2

b.decrease

total body water and fat increase so drug spread over a larger volume

Question 3

what happens to drug protein binding in pregnancy

a.increase
b.decrease

Answer 3

b.decrease

increased free (active) drug concentrations

Question 4

what happens to the clearance of drugs that depend on liver enzyme activity in pregnancy eg phenytoin and theophylline

a.increased clearance
b.decreased clearance

Answer 4

a.increased clearance

Question 5

increased renal plasma flow in pregnancy has what effect on the elimination of renally cleared drugs eg penicillins

a.increased elimination
b.decreased elimination

Answer 5

a.increased elimination (doubles)

Question 6

factors influencing placental transfer

Answer 6

lipid/water solubility
molecular size
protein binding
metabolism

Question 7

which type of molecule passes the placenta most easily

a.large,lipid soluble,unbound , non polar

b.small, lipid soluble, unbound, non polar

c.large, water soluble, bound , polar

d.small, water soluble, unbound , polar

Answer 7

b.small, lipid soluble, unbound, non polar

Question 8

which drugs effect blastocyst formation at 0-16 days

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

Answer 8

a.cytotoxic/ alcohol

Question 9

which drugs effect organogenesis day 17-60

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

Answer 9

b.teratogens

Question 10

which drugs effect cell and organ maturation day 60 days- term

a.cytotoxic/ alcohol

b.teratogens

c.alcohol, nicotine,radioactive iodine, corticosteroids

Answer 10

c.alcohol, nicotine,radioactive iodine, corticosteroids

Question 11

which drugs should be avoided in pregnancy

(7As and DMARDS)

Answer 11

ACEi / ARBS
Anticonvulsants - phenytoin, carbamazepine
Antibiotics - tetracyclines, trimethoprim, metronidazole
Antipsychotics - lithium
Antithyroid - carbimazole, propylthiouracil
Anticoagulant - warfarin, DOACS
Abuse - alcohol, opioids , cigarettes
DMARDS- methotrexate

Question 12

administration during which trimester has the greatest risk

a.first
b.second
c. third

Answer 12

a.first

Question 13

what was caused by taking thalidomide during pregnancy

a. phocomelia
b.dwarfism
c. trisomy 18

Answer 13

a. phocomelia

Question 14

prescribing during which trimester should be AVOIDED unless exceptional circumstances

a.first
b.second
c.third

Answer 14

a.first

Question 15

what should be used instead of ACEi in pregnancy

a.propanolol
b.timolol
c.sotalol
d.labetalol

Answer 15

d.labetalol

Question 16

what is given first line to treat nausea and vomiting in pregnancy

a.promethazine
b.labetalol
c.prednisolone
d.metoclopamide

Answer 16

a.promethazine

Question 17

what is given 2nd line to treat nausea and vomiting in pregnancy

a.promethazine
b. labetalol
c.prednisolone
d.metoclopamide

Answer 17

d.metoclopamide

if poor response to first line after 24 hr reassessment

Question 18

what should be given for asthma in pregnancy

a.inhalers
b. ACEi
c.promethazine

Answer 18

a.inhalers

prednisolone ok if needed

Question 19

which drug should be given for hypertension in pregnancy

a.metoclopamide
b.propanolol
c. warfarin
d.labetalol

Answer 19

d.labetalol

Question 20

which drug should be given for hypertension in pregnancy

a.metoclopamide
b.propanolol
c. warfarin
d.labetalol

Answer 20

d.labetalol

Question 21

first line antibiotic for UTIs in pregnancy

a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin

Answer 21

b.nitrofurantoin

Question 22

second line antibiotic for UTIs in pregnancy

a.trimethoprim
b.nitrofurantoin
c. amoxicillin
d.cefalexin

Answer 22

c. amoxicillin

or cefalexin

Question 23

which of these are relatively safe anticoagulants in pregnancy

a.heparin
b.warfarin
c.DOACs

Answer 23

a.heparin

AVOID other 2

Question 24

what is more of a risk in pregnancy and so referral to a specialist is required

a. anticonvulsants
b.seizures

Answer 24

b.seizures

both risky

Question 25

drugs which should be prescribed with caution in breastfeeding dont always like icecream on tasty cakes

Answer 25

diazepam alcohol lithium iodine opiods tetracyclines corticosteroids dont always like icecream on tasty cakes

Question 26

absorption of topical agents eg steroids is .. in neonates a.increased b.decreased

Answer 26

a.increased

Question 27

intramuscular absorption is........ in neonates a.increased b.decreased

Answer 27

b.decreased reduced muscle mass

Question 28

rectal absorption eg of diazepam , theophyllines in neonates is ... a.increased b.decreased c.efficient

Answer 28

c.efficient

Question 29

in older children body water % is greater so loading dose for aminoglycosides, digoxin , aminophylline is ........... (based on body weight) a.greater b.lower

Answer 29

a.greater

Question 30

in neonates albumin binding is .......................... increasing risk of drug billirubin interactions a.increased b.decreased

Answer 30

b.decreased

Question 31

impaired oxidation in neonates increases the concentration of which drugs a.metoclopamide and promethazine b. nitrofurantoin and cefalexin c.warfarin , diazepam and theophylline d.warfarin and DOACS

Answer 31

c.warfarin , diazepam and theophylline

Question 32

impairment of what process leads to increased risk of toxicity of drugs metabolised this way eg chloramphenicol a.oxidation b.reduction c.metabolism d.glucoronidation

Answer 32

d.glucoronidation

Question 33

a reduction in dose of renally cleared drugs based on body weight due to reduced GFR in neonates is applicable to which drugs a.aminoglycosides, aminophylline, digoxin b.promethazine, metoclopamide c.warfarin, diazepam , theothylline d.penicillins , digoxin , aminoglycosides

Answer 33

d.penicillins , digoxin , aminoglycosides

Question 34

grey baby syndrome is associated with increased serum levels of which drugs in neonates a.diazepam b.warfarin c.theophylline d.digoxin e.chloramenphicol

Answer 34

e.chloramenphicol

Question 35

at what point is renal function normal and so normal doses based on body weight can be used a.3 months b.4 months c.5 months d.6 months

Answer 35

d.6 months

Question 36

faster than normal oxidation leads to what effect a.exagerrated / toxic responses b.failure to respond to standard doses c.acute haemolysis following treatment with number of drugs d.prolonged apnoea

Answer 36

b.failure to respond to standard doses

Question 37

slower than normal oxidation leads to what effect a.exagerrated / toxic responses b.failure to respond to standard doses c.acute haemolysis following treatment with number of drugs d.prolonged apnoea

Answer 37

a.exagerrated / toxic responses

Question 38

glucose 6 phosphate dehydrogenase defficiency leads to what effect a.exagerrated / toxic responses b.failure to respond to standard doses c.acute haemolysis following treatment with number of drugs d.prolonged apnoea

Answer 38

c.acute haemolysis following treatment with number of drugs

Question 39

pseudocholinesterase leads to what effect a.exagerrated / toxic responses b.failure to respond to standard doses c.acute haemolysis following treatment with number of drugs d.prolonged apnoea

Answer 39

d.prolonged apnoea

Question 40

rules for prescribing in neonates

Answer 40

dose based on body SA paediatric formulary special adjustements especially if premature avoid new drugs all women 13-60 should be presumed pregnant until proven otherwise

Question 41

al