Prescribing in pregnancy and lactation Flashcards
(17 cards)
How is absorption of drugs affected by pregnancy?
delayed/reduced appearance of oral drug in plasma:
- vomiting
- reduced GI motility
- slower gastric emptying
increased absorption from IM:
- increased tissue perfusion due to vasodilation
Name some teratogenic drugs
phenytoin - craniofacial + limb abnormalities
sodium valproate - neural tube abnormalities, spina bifida
ACE inhibitors - abnormalities of skull
stilbestrol - vaginal adenocarcinoma
mycophenolate - abortion, abnormalities of ear, heart, face, limbs
What drugs can affect foetus later in pregnancy?
hormones, androgens, prostaglandins - can cause foetal masculinisation
lithium, iodide and antithyroid drugs - goitre
tetracyclines - interfere with tooth and bone development
ACE-is - hypoplasia of lungs and kidneys
aspirin/NSAIDs - delay onset of labour, close ductus arteriosus
chloroquine may cause retinopathy
What analgesics are preferred in pregnancy?
paracetamol
opioids
aspirin - risk of bleeding at high dose, 75-150mg safe
NSAIDs - avoid after 30 weeks
First line drug treatments for nausea and vomiting in pregnancy
cyclizine
prochlorperazine
promethazine
chlorpromazine
2nd line drug treatments for nausea and vomiting in pregnancy
metoclopramide
domperidone
ondansetron
Treatment of epilepsy in pregnancy
lamotrigine and levetiracetam considered very safe
use most appropriate drug for seizure
don’t change drugs
avoid valproate
lowest dose possible
monitor plasma levels
avoid drug combinations if possible
Pre-eclampsia drug treatment
labetalol
nifedipine
methyldopa
hydralazine
Which antihypertensives are contraindicated in pregnancy?
nitroprusside
ace inhibitors
angiotensin receptor blockers
How is diabetes managed in pregnancy?
insulin and metformin
all other oral hypoglycaemics contraindicated
avoid hypoglycaemia and ketoacidosis
achieve near normal blood sugar control
Insulin requirements during pregnancy
1st trimester = less insulin required due to reduced food intake
rise in 2nd trimester
peaks in 3rd trimester then drops due to due increased foetal energy requirements
closed loop insulin pumps for T1Ds in pregnancy
Which anticoagulant is preferred in pregnancy?
heparin
Antibiotics to avoid in pregnancy
tetracyclines
metronidazole
quinolones
isoniazid
rifampicin
aminoglycosides
trimethoprim
Safe drugs in lactation
penicillins
cephalosporins
theophylline
beta agonists
glucocorticoids unless high dose
anticonvulsants
TCA
chlorpromazine
methyldopa
hydralazine
warfarin
heparin
Drugs to avoid in lactation
aspirin
ergotamine
sulphonamides
ciprofloxacin
tetracyclines
chloramphenicol
benxodiazepines
lithium
antithyroid drugs/iodine
sulphonylureas
antineoplastic drugs
Drugs that inhibit lactation
bromocriptine
oestrogen and progestogens (high dose)
thiazide
What website can you use to see if a drug is safe in pregnancy and lactation?
bumps (best use of medicines in pregnancy)
