Prescribing in Pregnancy

Question 1

Which anti coagulant does not cross the placenta and is therefore considered safe in pregnancy

Answer 1

Unfractionated heparin (large molecular weight)

Question 2

What are the four components of pharmacolkinetics

Answer 2

Absorption
Distribution
Metabolism
Elimination

Question 3

How is absorption affected in pregnancy

Answer 3

Morning sickness

Question 4

Distribution

Answer 4

More fat store
Increased plasma volume

Distriubution increases

Question 5

Metabolism

Answer 5

Decreased protein binding results in increased free drug

Increased liver metabolism of some drugs (phenytoin)

Question 6

Elimination

Answer 6

GFR increases so renally excreted drugs are eliminated quicker

Question 7

Name drugs which have narrow therapeutic windows

Answer 7

Lithium

Digoxin

Question 8

what drugs may pregnant women be more sensitive too

Answer 8

Antihypertensives- can cause hypotension in 2nd trimester

Question 9

When should folic acid be taken

Answer 9

for three months prior to and up to first 12 weeks of pregnancy

Question 10

When is the period of greatest tetatrogenic risk

Answer 10

4th-11th week

Question 11

Name teratogenic drugs

Answer 11

ACE/ARBs
Androgens
Antiepilptics
Cytotoxics
Lithium
Methotrexate
Retinoids
Warfarin

Question 12

ACE/ARBs

Answer 12

renal hypoplasia

Question 13

androgens

Answer 13

virilisation of femal foetus

Question 14

antiepileptics

Answer 14

cardiac, facial, limb, neural tube defects

Question 15

cytotoxins

Answer 15

defects, abortion

Question 16

lithium

Answer 16

CVS defects

Question 17

methotrexate

Answer 17

skeletal defects

Question 18

Retinoids

Answer 18

ear, CVS, skeletal defects

Question 19

Warfarin

Answer 19

limb and facial defects

Question 20

What was DES shown to cause

Answer 20

vaginal adenocarcinoma in the daughters of those exposed during pregnancy
Urological malignancy was also found in sons of those exposed

Question 21

What are frequent sezures in pregnancy associated with

Answer 21

lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death

Question 22

Which antiepileptics should be avoided in pregnancy

Answer 22

valproate
phenytoin

Monotherapy prefered

Question 23

What additional precaution should be taken for women with epilepsy in pregnancy

Answer 23

5mg (higher dose) of folic acid

Question 24

Is insulin safe in pregnancy

Answer 24

yes

Question 25

Are sulphonylureas safe in pregnancy

Answer 25

no

Question 26

what is the safes anto emetic

Answer 26

cyclizine

Question 27

what antibiotic is the best to use in pregnancy for a UTI

Answer 27

amoxicillin | cefalexin

Question 28

is paracetemol safe

Answer 28

yes

Question 29

Are antacids safe

Answer 29

yes

Question 30

what is the leading cause of maternal death in pregnancy

Answer 30

VTE - assess all women for their risk

Question 31

How should those with a high risk of VTE be treated

Answer 31

LMWH at delivery and 7 days post partum

Question 32

What are the risk factors for VTE in pregnancy

Answer 32

``` obesity age more than 35 para more than 3 previous DVT C section ``` treat if more than 2

Question 33

Amioderone in breasfeeding

Answer 33

neonatal hypothyroidism

Question 34

cytotoxics in breastfeeding

Answer 34

bone marrow suppression

Question 35

Benzodiazepines

Answer 35

drowsiness

Question 36

Bromocriptine

Answer 36

suppresses lactation

Question 37

Which antibiotic given during pregnancy or early childhood can cause teeth staining

Answer 37

tetracyclines

Question 38

which antiepileptic is particularly associated with cleft palate

Answer 38

phenytoin

Question 39

which antiepileptic drug is particularly associated with anencephaly and spinabifida

Answer 39

valproate