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SIU6 Special patient group > Pregnancy and breastfeeding > Flashcards

Pregnancy and breastfeeding Flashcards

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1
Q

ABSOLUTELY CONTRA-INDICATED DRUGS in pregnancy!

A

cytotoxic - methotrexate
vitamin A analogues - isotretinonin (acne)
cardiovascular - ACEI, spironolactone
endocrine - radioactive iodine, sex hormone
antibiotics - trimethoprim esp in 1st trimester (folate antag–> cofactor for NUD)
antifungal, anti-helminthics-parasite -
griseofulvin, mebendazole (toxicity in animal studies)

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2
Q

prescribing for pre-exisiting diabetic pregnant patients

What will happen to their BGL during pregnancy?

A

Glucose tolerance decreases due to ANTI-INSULIN effects of human placental lactogen, glucagon and cortisol. So BGL will rise during pregnancy.

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3
Q

What will you need to do according to the change in BGL during pregnancy?

A

Alter insulin doses almost daily. More frequent BGL monitoring. More frequent doses of insulin, or use metformin. >=4 insulin injections daily (2 basal +3 IR)/ insulin pump

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4
Q

What will be the result of having a baby whilst BGL is high?

A

OVERWEIGHT baby

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5
Q

what anti-epileptic meds are teratogenic?

A

Carbamazepine, valproate, phenytoin and phenobarbital are all teratogenic

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6
Q

which of the AE meds can cause NTD?

A

valproate and carbamazepine

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7
Q

which of the AE meds can cause cong cardiac defect?

A

valproate and phenytoin

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8
Q

phenytoin usage in preg can cause what conditions?

A

cardiac defect and orofacial clefts linked

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9
Q

what factor (in AE med usage) can increase the malformation risk in baby?

A

polypharmacy 6-7% for one drug, 15% for two and up to 50% for three

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10
Q

what amount of negative effects of AE drugs depends on?

A

dose, increased effect with increased dose

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11
Q

is lamotrigine safe to use in preg epileptic pt?

A

dose dependent effect on baby
only safe if <200mg BD
new drug, better than valproate and caba,

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12
Q

Evidence weak but we do advise all epileptic women esp. those on any of AE drugs to take what supplement?

A

5mg folic acid daily for at least 3 months pre-conception

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13
Q

how do we adjust the dose for thyroxine for preg pt who have hypothyrodism?

A

increase pre-pregnancy dose slightly during pregnancy

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14
Q

why do we need to increase thyroxine dosage in preg pt

A

Small amounts of thyroxine cross placenta and the foetus depends on maternal thyroxine until 12 weeks

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15
Q

what is pre-eclampsia

A

disease specific to pregnancy
high blood pressure and proteinuria
mother can have fits / strokes or die
baby severely growth restricted or die due to reduced blood supply

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16
Q

what can we do to minise the risk for baby in a pre-eclampsia mother

A

(c-cession, artificial early birth as baby stopped growing)

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17
Q

antihypertensives that can be used in preg pt?

A

Αlpha-methyl dopa
Nifedipine- give tds not bd due to increased vd =off label
Labetalol (orally and IV) rescue drugs
Hydralazine when BP is TOO HIGH rescue drugs

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18
Q

what type of antihypertensives are absolutely contraindicated?

A

ACE inhibitors, diuretics and ATII receptor blockers are contra-indicated

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19
Q

inappropriate medications use in each stage of preg can cause what type of prob for the baby?
- 1st trimester

A

congenital (anatomical) abnormalities.

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20
Q

inappropriate medications use in each stage of preg can cause what type of prob for the baby?
- 2/3 trimester

A

affect growth and functional development.

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21
Q

medications use in end of preg, in labour can have an effect on what?

A

Medications given at the end of pregnancy / in labour may affect the neonate.

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22
Q

3 rules in preg prescribing

A
  • use old med which are known to be safe (even tho lamo is new)
  • use smallest effective dose
  • ideally med should be stopped or changed pre-conceptally (before trying to have baby)
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23
Q

what are the three trimesters in preg?

A

1st trimester - 0-13w
2nd - 13-28w
3rd - 28- 40w

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24
Q

describe how is drug absorption affected by preg?

A

reduced absorption

  • morning sickness
  • progesterone reduce gastric emptying, slows the absorption, lowers the peak conc, a bigger prob in single use rather than long term
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25
describe how is drug distribution affected by preg?
increased body water volume decreased albumin production, increase preg steroid which displaces drugs from protein binding sites. increased 'free' fraction
26
describe how is drug metabolism affected by preg?
preg affects cyp450 enzymes- metab of other drugs eg induce enzymes that metabolise lamotrigine - higher dose needed
27
describe how is drug elinimation affected by preg?
higher cardiac output, increased 50% of GFR drugs that are renally excreted eg penecillin will be excreted faster amoxicillin- given 500mg tds instead of 250mg tds due to increased cl
28
what could be the reason for NUD in baby? (rmb: cong impairment is multifactorial)
sodium valproate and cofactor folate deficiency
29
how does mol cross placenta? what molecular factors are important in this?
simple diffusion | MW and conc grad
30
what does BUMPS stand for
best use of medicines in pregnancy
31
what does UKTIS stand for
uk technology information service (MI specialist service)
32
why is NSAID should be avoid in 3rd trimester?
In a fetus the ductus arteriosus allows blood to bypass it’s non-functioning lungs. NSAIDs given in third trimester can prematurely close this blood vessel which can lead to serious fetal and neonatal complications eg, pulmonary hypertension
33
Nitrofurantoin at term must be avoided due to
he risk of haemolytic anaemia in the newborn.
34
Drug pharmacokinetics change in the mother during pregnancy, when does it revert? what med might be an issue?
as soon as given birth (post-natal) lamotrigine metabolising enzymes induced in preg, higher doses needed. normalised level enzyme postpartum, so REDUCE the dose to avoid toxicity
35
what other meds doses might be increased in preg?
AE- lamotrigine AH- labetolol, nifidepine levothyroxine
36
how can we amend nifidepine dosage in post-partum?
TDS to BD due to reduced Vd
37
high BP is common in preg, how long does it take for BP to normalised post-partum?
after SIX weeks of giving birth
38
trimester exposure: | at the v beginning first x days
First 17 days = ‘all or nothing principle’
39
when is embryonic phase | an exposure will result in what
Day 18-55 (8w) (embryonic phase) congenital malformations can occur.
40
when is fetal phase? | an exposure will result in what
Day (8w) 56 onwards (fetal phase) medicines may affect the growth and functional development (e.g. hearing) of the fetus or have toxic effects on fetal tissues.
41
WHO recommends exclusive breastfeeding for the how many months of life
WHO recommends exclusive breastfeeding for the first six months of life
42
ADVANTAGES OF BF FOR BABY (1) Immune Function
- provide maternal igG - provide igA (cant be obtained from formula milk) only obtained after colostrum and breastfeed - provide igM in response to infections
43
Receiving IgA reduces incidence of:
- necrotising enterocolitis (IgA especially important to protect mucosal barriers) -Ear, gastrointestinal, respiratory and urinary tract infections
44
how does breast milk help reduce infections?
provide ig and hormones that stimulates their iMS
45
BF also reduces incidence of:
- diarrhoea - anaemias - risk of sudden infant death syndrome (SIDs) by 50%
46
how does BM (breast milk) reduce iron related anaemia?
Iron in breast milk more easily absorbed by baby than formula milk
47
Possible long-term health benefits of BM
reduced risk of adult obesity diabetes | osteoporosis
48
ADVANTAGES OF BF FOR MOTHER
reduce - BP - blood loss postpartum - anaemia - risk of osteoporosis - stress, improve mood - ovarian, breast cancer - bonding with baby - cheap, convinient
49
why is baby's age important in predicting if a drug will/will not pass through BM to reach inside them?
- during the first 48h of life, - large gap between alveolar cells - allow maternal ig, protein,wbc to pass through - easier for drugs to get through as well
50
who is metabolising the drugs? - in utero - BF
- in utero, drugs are metabolised by the mother | - drugs exposed in BM, baby have to metabolise them
51
4 drug properties that helps predict if a drug will pass through BM or not
to be passed through BM 1. MW <300 2. lipid solubility (high) 3. protein bound (low) 4. acid-base (more basic)
52
if BM acidic or basic?
slight acidic compare to blood
53
which type of meds will have a higher conc in BM adn why? weak acid or weak base?
BM is weakly acidic | weak base drugs will have a higher conc because it will get ioinsed in milk
54
which 2 drugs are high protein bound? what is the implication on BM passage?
sodium valpoate 94% warfarin 99% theoretically safe to use in BF but monitor s/e eg hepatic function, bleeding/bruise it is prob safer in full term baby
55
what type of liquid is BM? what is the implication on drug passage? what type of med will have high conc in bm?
fat in water emulsion high lipid solubility will dissolve in the fatty globules in milk all CNS penetrating medications will have a higher concentration in breast-milk.
56
lipid solubility is not a good predictor of drug accumulation in the milk. WHY?
Fat is small proportion of milk volume
57
what is the MW restriction on the passge in BM for durgs? | on what occasion does MW restriction not apply?
<300 allowed through >600 diff to pass mem, eg insulin, heparin during the first 48h of life, where alveolar gaps are large and more drugs will go through
58
why is lithium contraindicated?
- serious SEs (tremour/ involuntary movements) have been documented in BF babies, who can get about 56% of the maternal dose.
59
FACTORS PRODUCING POOR EXCRETION INTO BREAST MILK
High molecular weight- excep: first 48hrs Highly protein bound- bond to placenta blood Weak acid- acidic milk Short acting medication or preparation No active metabolites (fat doesnt count bc sm proportion)
60
when is the best time to take med whilst BF
- take dose STRAIGHT AFTER BF | - take at NIGHT (less BF at night)
61
which SSRI is better option for BF mum? why?
- paroxetine not fluoxetine - shorter half life - fluoxetine has longer half life and has active metabolites that last for 7-15 days
62
what are the alternative options for codeine use in BF?
dihyrocodeine or tramadol
63
can you give warfarin or dalteparin to a mum who is BF a pre-term baby?
YES- warfarin highly protein bound + delteparin high MW BUT - pre-term baby (not fully developed hepatic/renal metabolism- more at risk [also they will benefit more from BM]) - give oral vitK - monitor
64
can BF mum use nitrofuratoin?
low in BM but depends on baby's age- CI if <1m + C-6-PD deficiency (can't metab) due to potential haemolysis in infant if full term healthy: can use after 8 d of birth
65
DRUGS USED TO STIMULATE LACTATION (galactagogues) for pre-mature baby
dopamine D2 antagonist domperidone
66
DRUGS USE TO SUPPRESS LACTATION used if still birth late preg
dopamine receptor agonist carbigotine

SIU6 Special patient group (6 decks)

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