Pregnancy in Practice - Chronic Conditions Flashcards
(30 cards)
What do you need to consider when prescribing/choosing medications?
- How to minimise potential s/e
- Previous responses to drugs
- Risks of discontinuation symptoms
- Patient preference
- Drug Safety
- Non-pharmacological alternatives
- Pregnancy stage
- Benefits vs. Risks
- Use lowest effective dose in shortest duration of time.
Give examples of mental health issues.
- Depression
- Schizophrenia
- Parkinson’s Disease
- Dementia
- Epilepsy etc.
Give examples of interventions for Depression
- CBT
- TCAs
- SSRI’s
- Venlafaxine
Give examples of interventions for Depression.
- CBT
- TCAs
- SSRI’s
- Venlafaxine
Give examples of interventions for Schizophrenia
- Antipsychotics
- Raised prolactin levels * Clozapine
- Olanzapine
- Lithium
- Valproate
Give examples of interventions for BPAD.
- Anti-depressants e.g. TCAs, SSRI etc.
Explain the general relationship between pregnancy and epilepsy.
- Approx. 3000-5000 babies are born to epileptic women.
- 10% of those have congenital malformations
- Increased risk of Neural Tube Defects (NTD)
Explain how treatment is introduced for epileptic women.
Folic Acid 5mg daily to reduce risk of NTD.
What does the MHRA state about using Valproate and prescribing drugs for epilepsy in pregnant women?
- Avoid multiple agents.
- Monotherapy with most effective medication taken at lowest effective dose.
- Avoid use of Sodium Valproate - known teratogenic.
What is the pregnancy prevention programme (PPP)?
- Includes evaluating individual circumstances in every case.
- Use ‘highly effective’ methods of contraception:
– Long-acting reversible contraception (LARC)
– Copper intra-uterine device
– Progesterone-only implant
What does pharmacy regulation state about prescribing valproate?
- Must not be used in pregnancy.
- Only used in girls & women when there’s no alternative & a pregnancy prevention programme in place.
Go to this website for further details:
https://www.gov.uk/guidance/valproate-use-by-women-and-girls#history
What are the requirements to ensure Valproate prescribing?
Refer to the checklist in Slide 10 of the Drug Use in Pregnancy lecture.
What are the requirements to ensure compliance in the pregnancy prevention programme?
What counselling points do you need to give to patients taking Valproate?
Refer to Slide 11 - Patient Card for Sodium Valproate.
What action should be done if the pregnant woman is suffering from Hypothyroidism?
– Ideally - optimal control prior to pregnancy
– Dose adjustments likely to be required
– Monitoring
What action should be done if the pregnant woman is suffering from Hyperthyroidism?
– Monitoring
– Propylthiouracil
– Carbimazole
What is the possible complication of pregnant women diagnosed with Diabetes Mellitus?
Increased risk of developing NTD. Give Folic Acid 5mg daily.
Which type of Diabetes is common is pregnancy?
Gestational Diabetes
What supplement is recommended to take during pregnancy?
- Folic Acid 5mg daily
What supplement is recommended to take during pregnancy?
- Folic Acid
What is the risk of Diabetes Mellitus to the mother and developing foetus?
- Miscarriage
- Pre-eclampsia (hypertension)
- Pre-term labour (Premature birth)
What advice is given if diabetes is established?
Adjunct or Alternative to Insulin: Metformin
What type of Insulin is safe for use in pregnancy?
- Rapid acting
- Isophane (NPH) insulin
What other medications do you need to consider for Diabetes especially in pregnancy?
ACEi’s + ARBs:
- Hypertension
- Gradual progression of nephropathy.
- Discontinue before pregnancy or ASAP after confirmation.
Statins:
- Discontinue before pregnancy or ASAP after confirmation.
