Prescribing in Pregnancy

Question 1

Terotogenic drugs (8)

Answer 1

ACEI/ARB
Androgens
Antiepileptics
Cytotoxic
Lithium 
Methotrexate
Retinoids (Vit A)
Warfarin

Question 2

ACEI/ARB

Answer 2

renal hypoplasia

Question 3

Androgens

Answer 3

female fetus virilisation

Question 4

Antiepileptics

Answer 4

cardiac
NTD
facial (cleft)

Question 5

Cytotoxics

Answer 5

abortion

Multiple

Question 6

Lithium

Answer 6

cardiac

ebsteins anomaly - RV failure

Question 7

Methotrexate

Answer 7

skeletal abnormalities

Question 8

Retinoids

Answer 8

Ear
Cardiovascular
Skeletal

Question 9

Warfarin

Answer 9

Limb and facial defects

Question 10

When are teratogenic drugs the worse?

Answer 10

week 4 - week 11 (first trimester)

Question 11

2nd to 3rd trimester: how will drugs affect the development of the fetus

Answer 11

growth

functional - intellectual, behavioural

toxic effects on foetal tissue

Question 12

how do drugs affect the foetus around term?

Answer 12

adverse effects on labour

on baby after delivery

Question 13

How may labour be adversely be affected? (4)

Answer 13

progress of labour

adaptation of foetal circulation - premature closure of PDA

Suppression of foetal systems - opiates (respiratory depression)

Bleeding - Warfarin

Question 14

Adverse effects on baby after delivery?

Answer 14

withdrawal syndrome - opiates, SSRI (fluoxetine/citalopram highest levels in breastmilk)

Sedation

Question 15

diethylstilbestrol was used for what initially? did it work

Answer 15

prevention recurrent miscarriage (didnt work)

Question 16

what delayed effects on the baby did diethylstilbestrol

Answer 16

vaginal adenocarcinoma in girls aged 15-20yrs

Urological malignancy in boys

Question 17

What are epileptic seizures assoc with in untreated women with epilepsy

Answer 17

congenital malforms (higher than gen pop)

Frequent seizures = lower verbal IQ, hypoxia, bradycardia, antenatal death, maternal death

Question 18

Why are there increased seizures in women with epilepsy during pregnancy and by what %

Answer 18

10%

non-compliance

changes in plasma conc = persistent vomiting, increased clearance

Question 19

antiepileptics increase risk of congen malformations by what %

Answer 19

20-30% if on 4 drugs

monotherapy preferred

Question 20

what antiepileptic should be avoided

Answer 20

valproate

phenytoin (enzyme inducer)

Question 21

What extra precaution to take on antiepileptics

Answer 21

folic acid 5mg daily (3m before into 1st trim)

Question 22

%of babies born to women taking antiepileptics will not have major congenital malformations

Answer 22

96

benefits of treatment outweigh risks in most cases

Question 23

diabetes whats safe and not safe

Answer 23

safe: insulin

not safe: sulfonylureas (convert to insulin)

Question 24

how is treatment affect in DM

Answer 24

requirements change during pregnancy

poor control increases risk of congen malform and IUD

Question 25

HT and medications

Answer 25

``` BP falls during 2nd trimester If need to treat, use one of: Labetalol (x severe asthma) Methyldopa (x depro) (Nifedipine MR) ``` Avoid ACE inhibitors / ARB Beta blockers may inhibit foetal growth in late pregnancy (IUGR)

Question 26

what to use in N/V

Answer 26

cyclizine is safest

Question 27

UTI?

Answer 27

Amoxicilin or cefalaxin

Question 28

Pain?

Answer 28

paracetamol

Question 29

Heartburn?

Answer 29

Antacids

Question 30

prevention of VTE

Answer 30

encourage to mobilise and hydrate adequately (ALL) TED stockings significant risk factors: thromboprophylaxis with LMWH

Question 31

who should thromboprophylaxis by used for (risk factors)

Answer 31

2 or more risk factors: ``` obesity smoker >35years Para >3 Previous DVT C-section ```

Question 32

when is thromboprophylaxis with LMWH used?

Answer 32

at delivery and up to 7 days post-partum

Question 33

warfarin is pregnancy?

Answer 33

AVOID in early - teratogenic AVOID in late - risk of haemorrhage during delivery use LMWH instead (warfarin is OK in breastfeeding though)

Question 34

Which drugs enter breast milk? (chemistry)

Answer 34

small molecules fat soluble (lipophillic) few enter in sufficient quantities to cause a problem

Question 35

how can feeding patterns affect the amount?

Answer 35

foremilk = protein rich hindmilk = higher fat content longer feeds = higher amounts of fat soluble drugs in milk

Question 36

why may drugs accumulate?

Answer 36

immature metabolism

Question 37

Drug that is actively concentrated in breast milk

Answer 37

phenobarbitone - suckling difficulties

Question 38

Amiodarone in breastfeeding

Answer 38

neonatal hypothyroidism

Question 39

Cytotoxics in breastfeeding

Answer 39

bone marrow suppresion

Question 40

benzos in breastfeeding

Answer 40

drowsiness

Question 41

bromocriptine in breastfeeding

Answer 41

suppresses lactation

Question 42

which antibiotic given during pregnancy or in early childhood can cause problems with TEETH

Answer 42

tetracyclines - staining of bones and teeth avoid in kids up to age 8 doxycycline

Question 43

what drug in early preg causes a child with a facial appearance of thin upper lip, indistinct philtrum, short nose, flat midface, epicanthal folds, low nasal bridge, minor ear anormalies..

Answer 43

alcohol - FAS

Question 44

Which antiepileptic drug is particularly associated with the following congenital anomaly? - cleft lip

Answer 44

phenytoin (but all the antiepileptics too)

Question 45

Which drug taken during pregnancy can cause this problem in female offspring? - adenocarcinoma of the cervix in age 15-20

Answer 45

stilbestrol

Question 46

Which antiepileptic drug is particularly associated with the following defects? - NTD (spina bifida, anencephaly)

Answer 46

Na Valproate

Question 47

What drugs are contraindicated in breastfeeding?

Answer 47

tetracycline Li Substance of abuse Amiodarone Clozapine