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Flashcards in Prescribing in Pregnancy Deck (46):
1

Do most drugs cross placenta?

Yes, except LMW drugs e.g. Heparin

2

What drugs cross more quickly than others?

Small, lipid soluble

3

How is absorption effected in pregnancy?

Morning sickness

4

How is distribution effected in pregnancy?

Volume of distribution increased due to increased PV and fat stores
Decreased protein binding, so increased free drug

5

How is metabolism effected in pregnancy?

Increased liver metabolism of some drugs e.g. phenytoin

6

How is elimination effected in pregnancy?

Elimination of renally excreted drugs increases- increased GFR

7

Are pharmacodynamics effected in pregnancy?

No significant changes- pregnant women can be more sensitive to some drugs e.g. hypotension with antihypertensives in 2T

8

What should be taken pre-conception?

Folic acid 400mcg daily for 3 months prior and first 3 months of pregnancy
Safest drug therapy for existing chronic conditions

9

When is the period of greatest teratogenic risk?

4th to 11th week

10

Describe drug use in 1T?

Avoid drugs if at all possible unless maternal benefit outweighs risk to fetus

11

What teratogenic effects can ACEI/ARBs have?

Renal hypoplasia

12

What teratogenic effects can androgens have?

Virilisation of female fetus

13

What teratogenic effects can antiepileptics have?

Cardiac, facial, limb, neural tube defects

14

What teratogenic effects can cytotoxics have?

Multiple defects, abortion

15

What teratogenic effects can lithium have?

CV defects

16

What teratogenic effects can methotrexate have?

Skeletal defects

17

What teratogenic effects can retinoids?

Ear, CV, skeletal defects

18

What teratogenic effects can warfarin have?

Limb and facial defects

19

What can opiates around term?

Respiratory depression

20

What can warfarin cause around term?

Bleeding

21

What did diethylstilbestrol cause?

Vaginal adenocarcinoma in girls aged 15-20yo whose mothers took drug
Urological malignancy in boys

22

Can untreated epilepsy lead to congenital malformations?

Yes- incidence higher than that of women without epilepsy

23

Why does pregnancy increase seizures in 10% of women?

Non-compliance
Changes in plasma concentrations of drugs: persistent vomiting, increased clearance

24

What are frequent seizures during pregnancy associated with?

Lower verbal IQ
Hypoxia
Bradycardia
Antenatal death
Maternal death

25

Do antiepileptics increase the risk of congenital malformations?

Yes- 20/30% risk if on 4 drugs, monotherapy preferred
Avoid valproate, phenytoin
(96% won't have major malformations)

26

Are insulin and sulfonylureas safe during pregnancy?

Insulin yes, sulfonylureas no- switch to insulin

27

What does poor diabetic control increase the risk of?

Congenital malformations
IUD

28

Do diabetic requirements change during pregnancy?

Yes

29

What can beta blockers do in late pregnancy?

Inhibit fetal growth

30

How should N & V be treated in pregnancy?

Cyclizine

31

How should UTI be treated in pregnancy?

Nitrofurantoin, cephalexin (3T trimethoprim)

32

How should mild pain be treated in pregnancy?

Paracetamol

33

How should heartburn be treated in pregnancy?

Antacids

34

By how much does pregnancy increase the risk of VTE?

10x

35

What thromboprophylaxis for VTE should be used in pregnancy and by who?

LMWH at delivery and up to 7 days post partum if:
2 or more RFs e.g. obesity, >35yo, smoking, para >3, previous DVT, Caesarean delivery

36

How should suspected or established DVT or PE be treated?

Therapeutic dose of LMWH
Avoid warfarin in early pregnancy (teratogenic) and late pregnancy (risk of haemorrhage during delivery)

37

What drugs enter breast milk?

Most, especially small or fat soluble drugs

38

How can feeding patterns affect amounts of drugs in breastfeeding?

Foremik- protein rick
Hindmilk- higher fat content
Longer feeds, higher amounts of fat soluble drugs in milk

39

What drug is actively concentrated in breast milk?

Phenobarbitone- suckling difficulties

40

What can amiodarone cause when passed through breast milk?

Neonatal hypothyroidism

41

What can cytotoxics cause when passed through breast milk?

Bone marrow suppression

42

What can benzodiazepines cause when passed through breast milk?

Drowsiness

43

What can bromocriptine cause when passed through breast milk?

Suppresses lactation

44

Which antibiotic given during pregnancy or in early childhood can cause staining of bones and teeth?

Tetracycline- avoid in children up to 8yo

45

Which antiepileptic drug is particularly associated with cleft lip and palate?

Phenytoin

46

Which antiepileptic drug is particularly associated with neural tube defects such as spina bifida and anencephaly?

Valproate