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Repro and Sexual Health > Prescribing in Pregnancy > Flashcards

Prescribing in Pregnancy Flashcards

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1
Q

What percentage of women will take drugs in pregnancy?

A

> 90%

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2
Q

What drugs are taken most frequently in pregnancy?

A

Painkillers
Antibiotics
Antacids

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3
Q

Will drugs cross the placenta?

A

Yes; except large molecular weight such as heparin

Small, lipid soluble drugs pass quicker

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4
Q

How is absorption of drugs affected in pregnancy?

A

May be affected by things like morning sickness

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5
Q

How distribution of drugs affected in pregnancy?

A

Increased plasma volume and fat stores
Volume of distribution increases
Decreased protein binding and therefore increased free drug

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6
Q

How is the metabolism of drugs affected in pregnancy?

A

Increased liver metabolism e.g. phenytoin

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7
Q

How is elimination of drugs affected in pregnancy?

A

Increased GFR

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8
Q

Are pharmacodynamics affected in pregnancy?

A

No significant changes

Pregnant women may be more sensitive to some drugs

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9
Q

What needs to be considered when women are preconception?

A 
Are they pregnant?
Are they planning a pregnancy?
Could they become pregnant?
Counselling re chronic conditions; epilepsy, diabetes, hypertx
Optimise therapy to choose safest drug
Review whether drug therapy necessary
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10
Q

How much folic acid should be taken pre and post conception?

A

400 mcg 3 months prior and first 3 months of pregnancy

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11
Q

What are the risks of prescribing in 1st trimester?

A

Risk of early miscarriage
Organogenesis
Avoid drugs if at all possible unless maternal benefit outweighs risk to foetus

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12
Q

What is the period of greater teratogenic risk?

A

4-11 week

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13
Q

List of teratogenic drugs

A 
ACEi
Androgens
Antiepileptics
cytotoxics
Lithium
Methotrexate
Retinoids
Warfarin
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14
Q

What is the abnormality assoc with ACEi in pregnancy?

A

Renal hypoplasia

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15
Q

What is the abnormality assoc with androgens in pregnancy?

A

Virilisation of female foetus

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16
Q

What is the abnormality assoc with antiepileptics in pregnancy?

A

Cardiac, facial, limb and neural tube defects

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17
Q

What is the abnormality assoc with cytotoxics in pregnancy?

A

Multiple defects

Abortion

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18
Q

What is the abnormality assoc with lithium?

A

CV defects

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19
Q

What is the abnormality assoc with methotrexate?

A

Skeletal defects

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20
Q

What is the abnormality assoc with retinoids?

A

Ear, cv, skeletal defects

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21
Q

What is the abnormality assoc with warfarin?

A

Limb and facial defects

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22
Q

What are the risks in the 2nd and 3rd trimester in terms of prescribing?

Study These Flashcards
A

Growth of foetus
Functional development; intellectual, behavioural
Toxic effects on foetal tissue

23
Q

What effects can prescribing have around term?

Study These Flashcards
A

Adverse effects on labour; progres of labour, adaptation of foetal circulation (premature closure of ductus with NSAIDs)
Suppression of foetal systems (opiates)
Bleeding (Warfarin = catastrophic)

24
Q

What adverse effects can prescribing have on the baby after delivery?

Study These Flashcards
A

Withdrawal syndrome; Opiates, SSRI

Sedation

25
What effects did diethylstilbestrol have on children?
Vaginal adenocarcinomas in girls aged 15-20 | Urological malignancy in boys
26
What can lead to the 10% increased in seizures seen in epileptic women whilst pregnant?
Non-compliance | Changes in plasma conc of drug; persistent vomiting, increased clearance
27
What are frequent seizures in pregnancy associated with?
``` Lower verbal IQ Hypoxia Bradycardia Antenatal death Maternal death ```
28
Which antiepileptics should be avoided in pregnancy?
Valproate | Phenytoin
29
How much folic acid should be given to epileptic women whilst pregnant?
5mg daily
30
What % of babies born to women taking epileptics have a major congenital malformation?
4% | 96% do not
31
Is insulin safe in pregnancy?
Yes
32
What is the risk associated with poor diabetic control in pregnancy?
Increases risk of congenital malformation and intrauterine death
33
Are sulfonylureas safe in pregnancy?
No; convert to insulin
34
What can be used to treat hypertension in pregnancy?
Labetalol Methyldopa; assoc with depression Nifedipine AVOID ACEI
35
What risk is assoc with beta blockers in pregnancy?
Can inhibit foetal growth in late pregnancy
36
How is N+V tx in pregnancy?
Cyclizine
37
How are UTIs tx in pregnancy?
Nitrofurantoin in 1st and 2nd trimester | Trimethoprim in 3rd trim
38
How is pain tx in pregnancy?
Paracetamol
39
How is heartburn tx in pregnancy?
Antacids
40
What is the risk of VTE in pregnancy?
10 fold increase | Leading cause of maternal death in pregnancy
41
What advice is given to all pregnant women to prevent VTE?
Mobilise | Adequate hydration
42
Who should receive LMWH prophylaxis for VTE in pregnancy?
2 or more risk factors; age >35, obesity, smoking, para >3, previous DVT, C-section
43
When should high risk mothers receive LMWH?
Delivery | 7 days post-partum
44
How is VTE tx in pregnancy?
Therapeutic dose of LMWH AVOID WARFARIN: 1st trim; teratogenic 3rd trim; hemorrhage in delivery
45
Do drugs enter the breast milk?
Most but especially small and lipophilic molecules | Tend to enter in small quantities
46
How can feeding patterns affect drug distribution in breast feeding?
Foremilk; protein rich Hindmilk; higher fat content Longer feeds, higher amounts of fat soluble drugs in milk
47
What will amiodarone in breast milk result in?
Neonatal hypothyroidism
48
What will cytotoxics in breast milk result in?
Bone marrow suppression
49
What will BZD in breast milk result in?
Drowsiness
50
What will bromocriptine in breast milk result in?
Suppresses lactation
51
Which antibiotic given in pregnancy or early childhood results in brown teeth staining?
Tetracycline
52
Which drug taken in excess can cause; short palpebral fissure, flat midface, short nose, thin upper lip?
FAS
53
Which antiepileptic is assoc with a cleft lip and palate?
Phenytoin
54
Which antiepileptic is assoc with spina bifida and anencephaly?
Valproate

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