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Flashcards in Prescribing in pregnancy Deck (44):
1

what do most drugs do across the placenta except which kind of drugs

cross it
large molecular weight such as heparin

2

which kind of drugs cross more quickly across the placenta

small lipid soluble drugs

3

pharmacokinetics of drugs in preg

absorption may be affected by morning sickness

distribution is increased as there is an increase in plasma volume and fat stores

theres increased liver metabolism of some drugs

and due to decreased protein binding theres increased free drug

increased GFR leads to increased elimination of renal excreted drugs

4

which 2 drugs require concentration checks and alter doses during and after delivery

lithium
digoxin

5

changes in pharmacodynamics

no significant changed
pregnant woman may be more sensitive to some drugs

6

what drug is given during pregnancy

folic acid 400mcg for 3 months prior to pre conception and first 3 months of pregnancy

7

risks of drugs in first trimester

early miscarriage
organogenesis
period of greatest teratogenic risk is 4-11 weeks

avoid all risks unless maternal benefit outweighs risk to fetus

8

ACE/ARB leads to what in fetus
androgens
antiepiletics
cytotoxicx
lithium
methotrexate
retinoids
warfarin

enal hypoplasia

virilisation of female fetus

cardiac, facial, limb, NT defects

multiple defects, abortion

CVS defects

skeletal defects

ear, CVS, skeletal defects

limb and facial defects

9

effects drugs have on second and third trimesters

growth of the fetus
functional development = intellectual impairment, behavioural abnormalities
toxic effects on fetal tissue

10

adverse effects in labour

progress of labour
adaption of fetal circulation - premature closure of DA
suppression of fetal systems -opiates
bleeding - warfarin

11

what does opiates do

respiratory depression

12

what can lead to withdrawel syndrome in the baby after delivery

opiates
SSRIs

13

what does diethylstilbestrol lead to

vaginal adenocarcinoma in girls aged 15-20 in mothers who were exposed to this drug

urological malignancy in boys

14

mothers with asthma during pregnancy

many avoid taking their inhalers

15

mothers with epilepsy during pregnancy

20% stop antiepilectic drugs

16

incidence of what is higher in women with untreated epilepsy compares to women without epilepsy

congenital malformations

17

why are there increased seizures in 10% of women

non compliance
changes in plasma concentrations of drugs - persistent vom and increased clearance

18

what are frequent seizures during pregnancy associated with

lower verbal IQ in child
hypoxia
bradycardia
antenatal death
maternal death

19

what do anti epileptics increase the risk of

congenital malformations

20

what anti epileptic drugs should be avoided

valproate, phenytoin

21

what drug should be given in women with epilepsy

folic acid 5mg daily

22

what drug is not safe in diabetic pregnant women

SUs - convert to insulin

23

what does poor control of diabetes lead to

increased risk of urogenital malformations and IUD

24

what should be given to treat hypertension

labetolol
methyldopa
nifedipine

25

what should be avoided in hypertension

ACEI/ARB

26

what can BBs do

inhibit fetal growth in late pregnancy

27

treatment for nausea and vomiting in pregnancy

cyclizine

28

treatment for UTI in pregnancy

Nitro, cefalexine
in 3rd trimester trimethoprim

29

pain in pregnancy

paracetamol

30

heartburn in pregnancy

antacids

31

what is the increased risk of VTE in pregnancy women compared to non pregnancy mown

10 fold increased risk

32

what is the leading cause of maternal death in pregnancy

VTE

33

when should treatment be given for VTE in pregnancy

2 or more risk factors:
obesity
>35
smoker
para >3
previous DVT
C sec

34

how long should rx be given in VTE

at delivery and up to 7 days post partum

35

treatment of VTE

LMWH

36

why should warfarin be avoided

teratogenic in early preg
risk of haemorrhage during delivery in late preg

37

what kind of drugs can enter breast milk

small molecules
fat soluble drugs

38

what can happen in longer feeds

high amount of fat soluble drugs in milk

39

what drug can be actively concentrated in breast milk

phenobarbitone - suckling difficulties

40

amiodarone
cytotoxic
BZDs
bromocriptine

effects through breast milk

neonatal hypothyroid
bone marrow suppression
drowsiness
surpasses lactation

41

which antibiotic given during pregnancy or early childhood causes staining of ones and teeth

tetracycline - avoid in children up to 8

42

which anti epileptic drug can cause cleft lip and palate

phenytoin

43

which drug taken during pregnancy can lead to vaginal adenocarcinoma

stillbestrol

44

which anti epileptic drug can lead to neural tube defects such as spina bifida and anencephaly

valproate