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Flashcards in Prescribing in Pregnancy Deck (47):
1

When was Thalidomide being prescribed?

1958 - 1961

2

What was wrong with Thalidomide?

3,500 deaths in first year of life
>10,000 born with deformities

3

What is Thalidomide used for now?

Leprosy
Myeloma

4

What drugs don't cross the placenta?

large molecular weight e.g. heparin

5

What drugs cross the placenta more quickly than others?

Small, lipid-soluble drugs

6

What may effect the absorption of a drug during pregnancy?

Morning sickness

7

What effects the distribution of a drug in pregnancy?

Increased plasma volume and fat stores

8

What causes increased free drug amounts during pregnancy?

decreased protein binding

9

What is Phenytoin assoc. with?

Increased liver metabolism of some drugs

10

How is elimination of drugs during pregnancy effected?

Increased GFR

11

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

Lithium
Digoxin

12

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

2nd trimester

13

What doses of Folic acid has benefit?

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

14

What is common in the first trimester?

Risk of early miscarriage
Organogenesis

15

When is the greatest teratogenic risk?

4th - 11th week

16

When should drugs be given during the first trimester?

Only if benefits outweigh the risks

17

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

Intellectual impairment
Behavioural abnormalities
Toxic effects on foetal tissue

18

What foetal issue can opiates cause?

Respiratory depression

19

What drug can cause bleeding?

Warfarin

20

What drugs can cause withdrawal in the foetus?

Opiates
SSRI's

21

What drug was thought to be able to prevent miscarriages?

Diethylstilbestrol

22

What were the effects of Diethylstilbestrol?

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

23

What are seizures associated with in pregnancies?

Lower verbal IQ in child
Hypoxia
Bradycardia
Antenatal death
Maternal death

24

What can antiepileptics cause?

Congenital abnormalities

25

What drugs should be avoided?

Valproate
Phenytoin

26

What should be taken?

Folic acid, 5mg daily

27

Is Insulin safe?

yes

28

Are Sulfonylureas safe?

No, convert to insulin

29

What happens to BP in the 2nd trimester?

Lowers

30

What 3 drugs can treat hypertension in pregnancy?

labetalol
Methydopa
Nifedipine MR

31

What antihypertensives should be avoided?

ACEi/ARBs
Beta blockers - inhibit foetal growth

32

What drug can be used for N+V?

Cyclizine

33

What drugs can be used for UTI's?

Nitrofurantoin
Cefalexin
Trimethorprim (3rd trimester)

34

What drug can be used for pain?

Paracetamol

35

What drug can be used for heartburn?

Antacids

36

What should all women be assessed for?

Risk of VTE

37

What should women with a significant risk of VTE receive?

Thrombopropylaxis with LMWH

38

What are risk factors for VTE?

Obesity
Age >35 years
Smoking
Para >3
Previous CS

39

What drug for VTE should be avoided and why?

Warfarin.
Early = Teratogenic
Late = Haemorrhage risk

40

What drugs especially enter the breast milk?

Small molecules
Fat soluble drugs (Lipophilic)

41

What milk is protein rich?

Foremilk

42

What has a higher fat content?

Hindmilk

43

What can Phenobarbitone cause?

Suckling difficulties

44

What can Amiodarone cause?

Neonatal hypothyroidism

45

What can cytotoxics cause?

Bone marrow suppression

46

What can benzodiazepines cause?

Drowsiness

47

What can Bromocriptine cause?

Suppresses lactation