Prescribing in Pregnancy

Question 1

When are US scans for microcephaly and short limbs carried out?

Answer 1

usually after 22 weeks

Question 2

What type of drug doesn’t cross the placenta?

Answer 2

large molecular weight eg heparin

Question 3

What type of drug crosses the placenta quickly?

Answer 3

small, lipid soluble drugs

Question 4

How is absorption of drugs affected by pregnnacy?

Answer 4

morning sickness

Question 5

How is distribution of drugs affected by pregnancy?

Answer 5

increased- increased plasma volumes and fat stores; decreased protein binding- increased free drug

Question 6

How is metabolism of drugs affected by pregnnacy?

Answer 6

increased liver metabolism of some drugs eg phenytoin

Question 7

How is elimination of drugs affected by pregnancy?

Answer 7

elimination of renally excreted drugs increases- increased GFR

Question 8

When is the period of greatest teratogenic risk?

Answer 8

4th-11th weeks

Question 9

What type of development occurs during the 1st trimester?

Answer 9

organogenesis

Question 10

What problems can ACEi and ARBs cause?

Answer 10

renal hypoplasia

Question 11

What problems can androgens cause?

Answer 11

virilisation of femal foetus

Question 12

What problems can antiepileptics cause?

Answer 12

cardiacl faical; limb and NTDs

Question 13

What problems can cytotoxic drugs cause?

Answer 13

multiple defects; abortion

Question 14

What problems can methotrexate cause?

Answer 14

skeletal defects

Question 15

what problems can retinoids cause?

Answer 15

ear; CVS and skeletal defects

Question 16

What problems can warfarin cause?

Answer 16

limb and facial defects

Question 17

What type of development occurs during hte 2nd and 3rd trimesters?

Answer 17

growth of fetus; functional development

Question 18

What problems do drugs during the 2nd and 3rd trimesters cause?

Answer 18

intellectual impriamnet and behavioural abnormalities

Question 19

What problem did diethylstilbestrol cause?

Answer 19

vaginal adenocarcinoma in teenagers

Question 20

How does seizure frequency during pregnnacy change for epilpetics?

Answer 20

increased in 10% women

Question 21

Why does seizure frequency increase during women?

Answer 21

non-compliance; changes in plasma con. of drugs

Question 22

What are frequent seizures during pregnancy associated with?

Answer 22

lower verbal IQ; hypoxia; bradycardia; IUD; maternal death

Question 23

What epileptic drugs should really be avoided in pregnnacy?

Answer 23

valproate and phenytoin

Question 24

What hypoglycaemic drug is not safe in pregnnacy?

Answer 24

SUs

Question 25

What effect do beta blockers have on the fetus in late pregnnacy?

Answer 25

inhibit fetal growth

Question 26

What drug should be used to treat N and V?

Answer 26

cyclizine

Question 27

What drugs should be given for UTI in 1st and 2nd trimesters in pregnancy?

Answer 27

nitrofurantoin and cefalexin

Question 28

What drugs should be given for UTI in the 3rd trimester?

Answer 28

trimethoprim

Question 29

What is the risk of VTE in pregnnacy?

Answer 29

10x risk

Question 30

Who should receive thromboprophylaxis with LMWH?

Answer 30

2 or more RF- obesity; age >35; smoking; para >3; prev DVT; C/S

Question 31

What is the make up of foremilk?

Answer 31

protein rich

Question 32

What is the make up of hindmilke?

Answer 32

higher fat content

Question 33

What happens with longer feeds in terms of drugs?

Answer 33

longer feeds result in higher amounts of fat soluble drugs in mlik

Question 34

What problems can phenobarbitone cause if taken whilst breastfeeding?

Answer 34

suckling difficulties

Question 35

What problem can amiodarone cause if taken whilst breastfeeding?

Answer 35

neonatal hypothyroidism

Question 36

What problem do cytotoxics cause if taken during breastfeeding?

Answer 36

bone marrow suppression

Question 37

What problem can BZDs cause whilst breastfeeding?

Answer 37

drowsiness

Question 38

What problem does bromocriptine cause whilst breastfeeding?

Answer 38

suppresses lactation

Question 39

What problem does tetracycline cause if taken during pregnnacy or early childhood?

Answer 39

staining of bones and teeth

Question 40

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

Answer 40

phenytoin

Question 41

Who should be given electrical stimulation for pelvic floor?

Answer 41

muscle strength grade 2 or less

Question 42

Who should have physio input after delivery?

Answer 42

women who have had forceps delivery or 3rd/4th degree tear