pre-conception counselling and drugs in pregnancy (W1)

Question 1

pre-pregnancy counselling advice?

Answer 1

take folic acid
stop smoking, drinking, drugs
healthy weight
vaccines?
vitamin D
disease optimization
screen for sickle cell and thalassaemia

Question 2

disease optimization examples?

Answer 2

shouldn’t get pregnant if you have poorly managed diabetes - will harm the baby and mother
shouldn’t get pregnant if you have very high blood pressure

Question 3

folic acid is required for what?

Answer 3

purine and pyrimidine synthesis amino acid conversions

Question 4

what is folic acid important for during foetal development? what else is a risk factor for this?

Answer 4

closing the neural tube
family history

Question 5

what should pregnant women start taking as soon as they are aware that they are pregnant

Answer 5

folic acid

Question 6

what does significant exposure to alcohol during pregnancy result in

Answer 6

foetal alcohol syndrome

Question 7

alcohol screening questions?

Answer 7

tolerance - how many to get drunk
annoyed by people asking you to cut down
ever felt the need to cut down?
eye-opener-drink first thing in the morn

Question 8

what is the leading preventable cause of birth defects

Answer 8

alcohol

Question 9

what is common in foetal alcohol spectrum disorder

Answer 9

facial dysmorphism - low nasal bridge, thin upper lip, smooth philtrum, small palpebral fissures

Question 10

dihydrofolate reductase action?

Answer 10

converts dihydrofolate to tetrahydrofolate (involved in purine and pyrimidine synthesis)

Question 11

what drug commonly used to treat RA is a competitive inhibitor of dihydrofolate reductase?

Answer 11

methotrexate

Question 12

methotrexate effect?

Answer 12

reduces cell division
reduced amino acid synthesis
antagonises action of folic acid

Question 13

what can methotrexate cause

Answer 13

congenital defects, eg:
cranial face anomalies
congenital heart disease
limb defects

Question 14

how long should you be off methotrexate before conception

Answer 14

3 months

Question 15

safe drugs for RA during pregnancy?

Answer 15

hydroxychloroquine
sulfasalazine
(both types of DMARDs)

Question 16

epilepsy treatment relevant to pregnancy?

Answer 16

sodium valproate

Question 17

what is a seizure?

Answer 17

sudden change in behaviour caused by electrical hyper synchronization of neuronal networks in the cerebral cortex

Question 18

what is epilepsy

Answer 18

recurrent seizures

Question 19

with sodium valproate, what percentage of foetuses get neural tube defects?

Answer 19

1-2% (20x risk of general population)

Question 20

what is sodium valproate associated with?

Answer 20

mainly neural tube like defects
also cardiac, oral, urogenital malformations

Question 21

should sodium valproate be used in those of child bearing age? what is an exception to this?

Answer 21

NO!!!!!!!!!!!!!!!!!!!!!
can be used if they are in a pregnancy prevention programme

Question 22

what is a pregnancy prevention programme

Answer 22

given counselling and information leaflet
ensure highly effective contraception (often 2 forms)

Question 23

commonly used drug for hypertension, heart failure, renal disease?

Answer 23

angiotensin converting enzyme inhibitors (ACEi)

angiotensin receptor blockers (ARBs) have similar uses

Question 24

what do angiotensin converting enzymes do

Answer 24

convert angiotensin 1 into angiotensin 2

Question 25

ACEi/ARB in second and third trimester

Answer 25

oligohydramnios (reduced amniotic fluid) renal failure high blood pressure pulmonary hypoplasia respiratory distress syndrome

Question 26

foetal circulation features

Answer 26

low pressure system

Question 27

ACEi/ARB in first trimester?

Answer 27

uncertain, there is a risk

Question 28

when during pregnancy should you avoid NSAIDs

Answer 28

3rd trimester

Question 29

what in the foetal circulation enables oxygenated blood to pass from the pulmonary artery to the aorta (bypassing the lung)

Answer 29

ductus arteriosus

Question 30

what keeps the ductus arteriosus open during pregnancy

Answer 30

prostaglandin E (PGE)

Question 31

what is prostaglandin E produced by

Answer 31

placenta

Question 32

what allows the ductus arteriosus to close

Answer 32

drop in prostaglandin E levels

Question 33

NSAIDs mechanism of action? what does this result in?

Answer 33

inhibits cyclooxygenase results in inhibition of prostaglandin production

Question 34

what can occur when you take NSAIDs during pregnancy? (especially during the 3rd trimester)

Answer 34

premature closure of ductus arteriosus

Question 35

what does premature closure of ductus arteriosus cause

Answer 35

pulmonary hypertension leading to cardiac failure (high output cardiac failure as pumping blood through wrong part of body) leads to foetal hydrops (fluid accumulation in tissues and organs)