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Prescribing in Pregnancy Flashcards

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1
Q

First pregnancy scan

A

12 weeks

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2
Q

What tragic wonder drug given to treat morning sickness in pregnant women in 1958-1961.

A

Thalidomide

—–now used to treat LEPROSY and MYELOMA

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3
Q

What are non-drug alternatives for anti-depressants and CBT?

A
  • physiotherapy instead of NSAIDs

- CBT instead of antidepressants

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4
Q

When may you actually prescribe to pregnant women?

A
  • when benefits OUTWEIGH the risk
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5
Q

What are the best drugs to give to pregnant ladies?

A
  • olders drugs with BETTER safety records
  • LOWEST effective dose for shortest period
  • discuss risks and benefits and DOCUMENT this
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6
Q

What drugs cross the placenta?

A
  • MOST cross it
  • those with LOW molecular weight
  • small, LIPID-soluble drugs (crosses faster)
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7
Q

How may ADME. be affected in Pregnancy?

A

Absorp: - by morning sickness
Distrib.: - volume of distribution of durg is INCREASED IN BODY (INCREASED plasma volume and fat stores)
Metabol.- increased free drug d/t decr. protein binding
- incr. liver metabolism
Excret.- incr. renal excretion (incr. GFR)

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8
Q

How may pharmacodynamic be affected in pregnancy?

A
  • no real changes
  • preg. women are just more SENSITIVE to some drugs
    (hypotension with hypertensive drugs in 2ND trimester)
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9
Q

What supplement is advised in preg. women?

A
  • intake of Folic Acid -400mcg for 3 months prior and 1st 3 months of preg.
  • couselling re-chronic condition (epilepsy, DM, h/t)
  • review if drug therapy is necessary
  • choose safest drugs
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10
Q

Highest risk of teratogenesis.

A

4th -11th week

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11
Q

What risks are there in 1st trimester?

A
  • miscarriage risk

- time of organogenesis; sp avoid drugs if possible unless maternal benefit outweighs risk to fetus

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12
Q

Risks at 2nd and 3rd trimesters?

A
  • growth of fetus is affected
  • functional development (intellectual Impairment and behavioural abnormalities)
  • toxic effects of fetal tissue
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13
Q

What effects do NSAIDS (use around labor) have on fetal circulation?

A
  • premature closure of ductus arteriosus
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14
Q

What effects does Diethylstilbestrol have on babies?

A
  • vaginal ADENOCARCINOMA in girls aged 15-20 years old

- urological malignancy in boys

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15
Q

WHy is there increased seizures in 10% of women?

A
  • non compliance to anti-epileptic drugs ( therefore should stay on therapy)
  • changes in plasma conc. (persistent vomitting and incr. clearance)
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16
Q

RIsk of mom having seizure during pregnancies on baby ?

A

with lower verbal IQ in child, hypoxia, bradycardia, antenatal death, maternal death

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17
Q

WHat is recommended for anti-epileptic prescription in pregnanct ladies?

A
  • 20-30% of CONGENITAL malformations if on 4 drugs
  • MONOTHERAPYY!!
  • AVOID valproate and phenytoin
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18
Q

Poor control of sugar in preg. women results in….

A
  • congenital malformations
  • ## intra-uterine death
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19
Q

dIABETIC DRUGS not safe in preg. women?

Study These Flashcards
A
  • Sulfonylureaas
20
Q

Safe diabetic drug in preg. women

21
Q

Recommended rx for N.V ?

22
Q

UTI recommended rx?

Study These Flashcards
A
  • Nitrofurantoin
  • cefalexin
  • 3rd trimester : Trimethoprim
23
Q

Thromboprophylaxis?

24
Q

RIsk Factors for TBE?

Study These Flashcards
A 
OBESITY,
>35 Y.O 
SMOKING,
PARA>3
PREVIOUS DVT 
C-SECTION
25
What drug to avoid fro TBE?
- warfarin in early (teratogen) and LATE pregnancy (risk of hemorrhage)
26
Drugs that can enter breast milk?
- small molecules | - fat soluble drugs
27
WIth longer feeds _______
- higher amounts of FAT soluble drugs will be found
28
Name drugs that make it to the breast milk and what effects do they it bring out ?
- Phenobarbitone: Sucklin problems - Amiodarone- Neonatal hypothyroidism - Cyotoxics: BM supression - Bromocriptine: supresses lactation - benzodiazepines: drowsiness
29
First line drug for hypertension in pregnancy>
- Labetalol - Methyldopa - -----first advise lifestyle changes
30
Permanent greyish staining of the teeth in early childhood/pregnancy
- tetracycline
31
What does valproate result in ?
- spina bifida and anencephaly
32
Name some self-medications that pregnant women may take...
1. NSAIDs 2. St. John's Wort 3. Other herbal preparations
33
What may androgens cause if consumed in 1st trimester?
Virilisation of Female Fetus
34
WHat defects do anti-epileptics and lithium bring about in 1st trimester?
- cardiac, limb, facial, NTD | - Lithium: Cardiovascular defects
35
WHat does methotrexate and warfarin bring about in 1st trimester?
- methotrexate: SKELETAL defects | - warfarin: limb and facial defects
36
What do ACE-Is/ ARBs and cytotoxics cause in 1st trimester exposure?
- renal Hypoplasia | - Multiple defects and abortion
37
WHat do retinoids cause in 1st trimester?
-ear, cardiovascular, skeletal defects
38
What happens with consumption of opiates around term?
- supression of fetal systems | - respiratory depression
39
What occurs with comsumption of warfarin around term?
- bleeding
40
What adverse effects may occur to a baby after delivery ?
- withdrawal syndrome with consumption of Opiates, SSRI | - Sedation
41
What are the effects on the baby if the mom experiences frequent seizures?
- lower verbal IQ - Hypoxia - bradycardia - antenatal death - maternal death
42
What is the risk of giving Labetalol for rx of Hypertension in late pregnancy?
- Beta blockers may inhibit fetal growth | - ---still Labetalol is good for treating H/T
43
What is the leading cause of maternal Death?
- Venous Thromboembolism; pregnancy has a 10-fold incr. in VTE
44
What advise is given to pregnant mothers/ woemn in the puerperium/in labor to avoid VTE?
- women should be encouraged to MOBILIZE and stay hydrated
45
``` Which drug is the cause of a baby' face to look like this? - low nasal bridge - micrognathia - thin UPPER lip flat midface -epicanthal folds ```
Alcohol | Fetal Alcohol Syndrome
46
Which anti-epileptic drug results in a cleft-palate?
- cleft lip palate

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