Prescribing in Pregnancy

Question 1

When was Thalidomide being prescribed?

Answer 1

1958 - 1961

Question 2

What was wrong with Thalidomide?

Answer 2

3,500 deaths in first year of life

>10,000 born with deformities

Question 3

What is Thalidomide used for now?

Answer 3

Leprosy

Myeloma

Question 4

What drugs don’t cross the placenta?

Answer 4

large molecular weight e.g. heparin

Question 5

What drugs cross the placenta more quickly than others?

Answer 5

Small, lipid-soluble drugs

Question 6

What may effect the absorption of a drug during pregnancy?

Answer 6

Morning sickness

Question 7

What effects the distribution of a drug in pregnancy?

Answer 7

Increased plasma volume and fat stores

Question 8

What causes increased free drug amounts during pregnancy?

Answer 8

decreased protein binding

Question 9

What is Phenytoin assoc. with?

Answer 9

Increased liver metabolism of some drugs

Question 10

How is elimination of drugs during pregnancy effected?

Answer 10

Increased GFR

Question 11

Name 2 drugs where it is important to check concentrations and alter doses according during pregnancy and after delivery?

Answer 11

Lithium

Digoxin

Question 12

When are women more at risk of hypotension when on antihypertensives?

Answer 12

2nd trimester

Question 13

What doses of Folic acid has benefit?

Answer 13

400mcg daily for 3 months prior and first 3 months of pregnancy

Question 14

What is common in the first trimester?

Answer 14

Risk of early miscarriage

Organogenesis

Question 15

When is the greatest teratogenic risk?

Answer 15

4th - 11th week

Question 16

When should drugs be given during the first trimester?

Answer 16

Only if benefits outweigh the risks

Question 17

What problems can arise in the 2nd and 3rd trimester?

Answer 17

Intellectual impairment
Behavioural abnormalities
Toxic effects on foetal tissue

Question 18

What foetal issue can opiates cause?

Answer 18

Respiratory depression

Question 19

What drug can cause bleeding?

Answer 19

Warfarin

Question 20

What drugs can cause withdrawal in the foetus?

Answer 20

Opiates

SSRI’s

Question 21

What drug was thought to be able to prevent miscarriages?

Answer 21

Diethylstilbestrol

Question 22

What were the effects of Diethylstilbestrol?

Answer 22

Vaginal adenocarcinoma in girls aged 15-20 whose mothers were exposed to it
Urological malignancy in boys

Question 23

What are seizures associated with in pregnancies?

Answer 23

Lower verbal IQ in child
Hypoxia
Bradycardia
Antenatal death
Maternal death

Question 24

What can antiepileptics cause?

Answer 24

Congenital abnormalities

Question 25

What drugs should be avoided?

Answer 25

Valproate | Phenytoin

Question 26

What should be taken?

Answer 26

Folic acid, 5mg daily

Question 27

Is Insulin safe?

Answer 27

yes

Question 28

Are Sulfonylureas safe?

Answer 28

No, convert to insulin

Question 29

What happens to BP in the 2nd trimester?

Answer 29

Lowers

Question 30

What 3 drugs can treat hypertension in pregnancy?

Answer 30

labetalol Methydopa Nifedipine MR

Question 31

What antihypertensives should be avoided?

Answer 31

ACEi/ARBs | Beta blockers - inhibit foetal growth

Question 32

What drug can be used for N+V?

Answer 32

Cyclizine

Question 33

What drugs can be used for UTI's?

Answer 33

Nitrofurantoin Cefalexin Trimethorprim (3rd trimester)

Question 34

What drug can be used for pain?

Answer 34

Paracetamol

Question 35

What drug can be used for heartburn?

Answer 35

Antacids

Question 36

What should all women be assessed for?

Answer 36

Risk of VTE

Question 37

What should women with a significant risk of VTE receive?

Answer 37

Thrombopropylaxis with LMWH

Question 38

What are risk factors for VTE?

Answer 38

``` Obesity Age >35 years Smoking Para >3 Previous CS ```

Question 39

What drug for VTE should be avoided and why?

Answer 39

Warfarin. Early = Teratogenic Late = Haemorrhage risk

Question 40

What drugs especially enter the breast milk?

Answer 40

Small molecules | Fat soluble drugs (Lipophilic)

Question 41

What milk is protein rich?

Answer 41

Foremilk

Question 42

What has a higher fat content?

Answer 42

Hindmilk

Question 43

What can Phenobarbitone cause?

Answer 43

Suckling difficulties

Question 44

What can Amiodarone cause?

Answer 44

Neonatal hypothyroidism

Question 45

What can cytotoxics cause?

Answer 45

Bone marrow suppression

Question 46

What can benzodiazepines cause?

Answer 46

Drowsiness

Question 47

What can Bromocriptine cause?

Answer 47

Suppresses lactation