Flashcards in Prescribing in Pregnancy Deck (47):
When was Thalidomide being prescribed?
1958 - 1961
What was wrong with Thalidomide?
3,500 deaths in first year of life
>10,000 born with deformities
What is Thalidomide used for now?
What drugs don't cross the placenta?
large molecular weight e.g. heparin
What drugs cross the placenta more quickly than others?
Small, lipid-soluble drugs
What may effect the absorption of a drug during pregnancy?
What effects the distribution of a drug in pregnancy?
Increased plasma volume and fat stores
What causes increased free drug amounts during pregnancy?
decreased protein binding
What is Phenytoin assoc. with?
Increased liver metabolism of some drugs
How is elimination of drugs during pregnancy effected?
Name 2 drugs where it is important to check concentrations and alter doses according during pregnancy and after delivery?
When are women more at risk of hypotension when on antihypertensives?
What doses of Folic acid has benefit?
400mcg daily for 3 months prior and first 3 months of pregnancy
What is common in the first trimester?
Risk of early miscarriage
When is the greatest teratogenic risk?
4th - 11th week
When should drugs be given during the first trimester?
Only if benefits outweigh the risks
What problems can arise in the 2nd and 3rd trimester?
Toxic effects on foetal tissue
What foetal issue can opiates cause?
What drug can cause bleeding?
What drugs can cause withdrawal in the foetus?
What drug was thought to be able to prevent miscarriages?
What were the effects of Diethylstilbestrol?
Vaginal adenocarcinoma in girls aged 15-20 whose mothers were exposed to it
Urological malignancy in boys
What are seizures associated with in pregnancies?
Lower verbal IQ in child
What can antiepileptics cause?
What drugs should be avoided?
What should be taken?
Folic acid, 5mg daily
Is Insulin safe?
Are Sulfonylureas safe?
No, convert to insulin
What happens to BP in the 2nd trimester?
What 3 drugs can treat hypertension in pregnancy?
What antihypertensives should be avoided?
Beta blockers - inhibit foetal growth
What drug can be used for N+V?
What drugs can be used for UTI's?
Trimethorprim (3rd trimester)
What drug can be used for pain?
What drug can be used for heartburn?
What should all women be assessed for?
Risk of VTE
What should women with a significant risk of VTE receive?
Thrombopropylaxis with LMWH
What are risk factors for VTE?
Age >35 years
What drug for VTE should be avoided and why?
Early = Teratogenic
Late = Haemorrhage risk
What drugs especially enter the breast milk?
Fat soluble drugs (Lipophilic)
What milk is protein rich?
What has a higher fat content?
What can Phenobarbitone cause?
What can Amiodarone cause?
What can cytotoxics cause?
Bone marrow suppression
What can benzodiazepines cause?