Prescribing in Pregnancy, Breastfeeding and Children

Question 1

What drugs are teratogenic (birth abnormalities)

Answer 1

• Methotrexate, Trimethoprim
• Statins
• ACE Inhibitors / ARBs
• Lithium
• Sodium Valproate

Question 2

What drugs cause dental hypoplasia and teeth staining in babies

Answer 2

Tetracyclines

Question 3

What drugs can cause a miscarriage

Answer 3

Prostoglandin Analogues
e.g Misoprostol

Question 4

What drug can cause congenital malformations and foetal haemorrhage

Answer 4

Warfarin

Question 5

What drug can causes grey baby syndrome

Answer 5

Chloramphenicol

Question 6

What is grey baby syndrome

Answer 6

• grey skin
• haemodynamic collapse

Question 7

What drugs can cause early closure of ductus arterious in babies

Answer 7

• Aspirin
• NSAIDs

Question 8

What drug causes a cleft plate in babies

Answer 8

Topiramate

Question 9

What is cleft plate in babies

Answer 9

opening in roof of mouth

Question 10

What drug can cause the feminisation of a male foetus

Answer 10

Finasteride

Question 11

What drug can cause arthropathy in babies

Answer 11

Quinolones

Question 12

What is arthopathy and what can it be associated with

Answer 12

It is a joint disease and it is associated with Lyme disease

Question 13

What is Lyme Disease

Answer 13

a form of arthritis caused by bacteria that are transmitted by ticks.

Question 14

What drugs cause auditory and vestibular damage in the 2nd and 3rd trimester

Answer 14

Amino glycosides

Question 15

What medications stay in high amounts in breast milk

Answer 15

• Ethosuximide
• Lamotrigine
• Fluvastatin

Question 16

What drug inhibits infant’s suckling reflex

Answer 16

Phenobarbital

Question 17

What drug inhibits lactation (breast milk production)

Answer 17

Bromocriptine

Question 18

What is a pre-term neonate

Answer 18

baby born <37 weeks

Question 19

What is a term neonate

Answer 19

baby born between 37 and 42 weeks

Question 20

What is a post-term neonate

Answer 20

> =42 weeks

Question 21

What is a neonate

Answer 21

0 to 28 days old

Question 22

What is an infant

Answer 22

28 days to 24 months

Question 23

What is a child

Answer 23

2 years till 12 years

Question 24

Children and hepatic impairment

Answer 24

• children have a large reserve of hepatic metabolism
• don’t need dose adjustments usually

Question 25

At which age are liver enzymes still immature

Answer 25

- preterm neonate to - Infant

Question 25

How to calculate neonate eGFR

Answer 25

30 x Height (cm) ----------------------- serum creatinine

Question 26

How to calculate child over 1 year eGFR

Answer 26

40 x Height (cm) ----------------------- serum creatinine

Question 27

Why should you avoid intramuscular injections in children

Answer 27

it is painful

Question 28

What can benzyl alcohol do in neonates

Answer 28

fata toxic syndrome

Question 29

Why should you avoid lactose in medication

Answer 29

if severe lactose intolerance

Question 30

What can polyoxyl castor oil do in children

Answer 30

cause anaphylaxis

Question 31

If propylene glycerol is not eliminated from the body correctly, it can cause what

Answer 31

adverse effects

Question 32

What should you stick with when prescribing biosimilar medication

Answer 32

- prescribe by brand name - do not switch brand

Question 33

How should multiple injections be administered

Answer 33

- separate sites - not mixed Except when using syringe drivers in palliative care

Question 34

What type of injection is more painful

Answer 34

one mixed with water for injection (isotonic)

Question 35

What drugs have injection site reactions together

Answer 35

- prochlorperazine - chlorpromazine - diazepam

Question 36

The risk of what increases when giving more than one drug with saline solution or NaCl 0.9% solution

Answer 36

increases risk of precipitation

Question 37

When does IV Cyclizine precipitate when mixed with diamorphine

Answer 37

- At a concentration >10mg/ml - When conc of diamorphine to cyclizine increases

Question 38

How quickly are mixtures of diamorphine and cyclizine precipitate

Answer 38

after 24 hours

Question 39

How quickly are mixtures of diamorphine and Haloperidol precipitate and at which concentration of haloperidol

Answer 39

- after 24 hours - at a haloperidol concentration of >2mg/ml

Question 40

What medications can be mixed with diamorphine

Answer 40

- cyclizine - haloperidol - dexamethasone - hyoscine - levomepromazine - metoclopramide - midazolam

Question 41

Problems with intravenous infusions

Answer 41

- microbial contamination - Incompatibility (increases toxicity and side effects)

Question 42

What is incompatibility in IV fusions

Answer 42

- wrong pH - concentration change - 'salt out' (where addition of salts causes crystallisation or precipitation)

Question 43

Why is precipitation in IV fusions bad

Answer 43

- no control over dose - can initiate or exacerbate adverse effects

Question 44

Specifically what drugs and why should you avoid IV precipitations

Answer 44

- Diazepam - Cytotoxics you should avoid it as these drugs cause thrombophlebitis (inflammation of vein wall)

Question 45

Which substances are commonly incompatible as IV fusions

Answer 45

- Amino Acids - Mannitol - Sodium Bicarbonate

Question 46

Why should you not inject into blood

Answer 46

because it can cause irreversible crenation of red blood cells

Question 47

Why should you change the infusion administering set after giving the infusion

Answer 47

- avoid contamination - avoid blood clot (clotting factors from previous injection can cause a clot to form in the set. -increases chance of microbial growth - increase chance of embolisms)

Question 48

Why should you not add antibiotics or electrolytes to infusion sets

Answer 48

- precipitation - break down of emulsion, causing a separation of phases. increases likely hood of embolism.

Question 49

Why should extemporaneous formulations should be made immediately

Answer 49

- minimise microbial contamination - prevents degradation

Question 50

What does degraded ampicillin injection form if newly made and left.

Answer 50

- forms polymers - which can cause sensitivity reactions

Question 51

Intravenous infusions things to make sure are done

Answer 51

- use infusion fluid of correct pH with some drugs - mix drug additions well - ensure it is a quick process from adding mixing the infusion and administering - protect some injections from light

Question 52

Give an example of a drug that requires a specific pH when given in infusions

Answer 52

furosemide

Question 53

Why do you need to protect some infusions from the light

Answer 53

to prevent oxidation

Question 54

How is a continuous infusion diluted and set

Answer 54

- diluted in large volume - infused over long time

Question 55

How is a intermintant infusion diluted and set

Answer 55

- diluted in small volume - infused over short time

Question 56

How would you minimise extravasation with cytotoxic drugs in infusion

Answer 56

- infuse via the drip tubing