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Obs and Gynae > prescribing in pregnancy > Flashcards

prescribing in pregnancy Flashcards

(49 cards)

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1
Q

what anti emetic was prescribes to thousands of women caused lots of babies to be born deformed?

A

thalidomide

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2
Q

what drugs dont pass the placenta?

A

Most drugs cross
-except large molecular weight drugs such as heparin

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3
Q

what drugs cross the placenta more quickly

A

small, lipid soluble drugs

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4
Q

what is affected when taking meds with morning sickness:
A- absorption
B- distribution
C- metabolism
D- elimination

A

A- Absorption

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5
Q

what occurs to plasma volume in pregnancy?

A

increases

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6
Q

what occurs to protein binding in pregnancy and what affect does this have?

A

Decreased protein binding
-this leads to increased free drug

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7
Q

what occurs to liver metabolism of certain drugs such as phenytoin in pregnancy?

A

increased liver metabolism of certain drugs

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8
Q

what occurs to elimination of renally excreted drugs in pregnancy and what affect does this have on GFR?

A

increase elimination of renally excreted drugs
-increased GFR in pregnancy

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9
Q

what occurs to BP in second trimester of pregnancy?

A

it drops and goes back up in 3rd trimester

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10
Q

what should be given to women for 3 months prior and first 3 months of pregnancy?

A

they should take folic acid 400mcg

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11
Q

why are pregnant women given folic acid?

A

to prevent neural tube defects and microcephaly in foetus

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12
Q

what time is the period of greatest teratogenic risk?

A

1st trimester especially between 4th and 11th week of pregnancy

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13
Q

what can occur if drug exposure in 2nd + 3rd trimester of pregnancy

A

-foetal intellectual impairment and behavioural abnormalities

-Growth of foetus may be affected

-Toxic effects on foetal tissue

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14
Q

what affect does taking opiates during pregnancy have on the foetus?

A

-can cause respiratory depression
-can cause neonatal abstincence syndrome (NAS) which is basically withdrawal

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15
Q

what affect does taking warfarin during pregnancy have on foetus and mother?

A

fetus= limb and facial defects

mother= risk of haemorrhage during labour

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16
Q

risks of taking SSRIs during pregnancy?

A

first trimester= congenital heart defects, congenital malformations (especially when taking paroxetine)

third trimester= persistent pulmonary hypertension in neonates

also may experience withdrawals

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17
Q

what changes are made to medication for epileptics who are pregnant

A

avoid valproate and phenytoin
higher dose of folic acid

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18
Q

what diabetic meds arent safe in pregnancy

A

sulfynurea
so convert this to insulin

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19
Q

what hypertensive meds should be used in pregnancy?

A

-labetalol
-methyldopa

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20
Q

what hypertension meds should be avoided in pregnancy?

21
Q

1st line med for N+V in pregnancy?

22
Q

1st line med UTI in pregnancy

Study These Flashcards
A

Nitrofurantoin, cefalexin

in third trimester- trimethoprim

23
Q

1st line med for pain in pregnancy

24
Q

1st line med for heartburn in pregnancy

25
does pregnancy increase risk of VTE?
yes by about 10x
26
what meds should pregnant women with significant 2 or more VTE risk receive?
LMWH (up to 7 days post partum as well) 2 or more of: obesity >35 years smoking >3 pregnancies ceserean delivery previous DVT
27
what are risks for VTE?
LMWH (up to 7 days post partum as well) 2 or more of: obesity >35 years smoking >3 pregnancies ceserean delivery previous DVT
28
treatment for venous thromboembolism in pregnancy?
LMWH -avoid warfarin as this risks haemorrhage during delivery
29
difference between foremilk and hindmilk?
foremilk- protein rich hindmilk- fat rich
30
what can amiodarone cause if passed through breast milk?
neonatal hypothyroidism
31
what can cytotoxics cause if passed through breast milk?
bone marrow suppression
32
what can benzodiazepines cause if passed through breast milk?
drowsiness
33
what can bromocriptine cause if passed through breast milk?
suppress lactation
34
treatment?
35
give LMWH -ideally teach her how to inject herself each day
36
tetracycline -can give staining of bones and teeth (avoid in pregnancy and children up to 12 years)
37
alcohol -this is fetal alcohol syndrome
38
phenytoin -cleft lip and palate
39
(vaginal adenocarcinoma)
stillbestrol
40
Valproate -causes neural tube defects (spina bifida on left)
41
what med should be taken for RA in pregnancy?
stop methotrexate -start hydroxychloroquine
42
what changes are there to the mum in pregnancy?
-Increased plasma volume + fat stores -increased liver metabolism for some drugs -decreased protein binding (due to lower albumin levels)
43
what does increased plasma volume and fat stores lead to?
increases the volume of distribution around body (higher dose of drug is required to achieve a given plasma concentration)
44
what does increased liver metabolism to certain drugs do?
puts more stress onto liver
45
why are there decreased levels of albumin ?
due to higher overall volume
46
what does decreased protein binding do to the body? (this is due to lower albumin levels)
it means that there is more free drug circulating the body
47
who is at higher risk of neural tube defects and require + mg of folic acid?
-previous NTD -taking anti epileptics -Coeliac disease -Diabetes -Thalassaemia trait -BMI >30 (obese)
48
what medication is given for pain?
paracetamol
49
who is given 400ug folic acid?
every pregnant woman until 12th week

Obs and Gynae (60 decks)

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