Prescribing in Pregnancy Flashcards

1
Q

most drugs cross the placenta, except what?

A

large molecular weight eg heparin

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2
Q

what type of drugs cause the placenta more quickly?

A

small, lipid-soluble drugs

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3
Q

absorption of drugs may be effected by what condition which commonly occurs in pregnancy?

A

morning sickness

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4
Q

other than absorption, how else can pregnancy affect the pharmacokinetics of a drug?

A

increased PV and fat stores so volume of distribution increases

decreased protein binding so increased free drug

increased liver metabolism of some drugs eg phenytoin

elimination of renally excreted drugs increases due to increased GDR

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5
Q

what kind of drugs can pregnancy women be more sensitive to?

A

antihypertensives - get hypotension in 2nd trimester

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6
Q

what is the recommended dose of folic acid?

A

400mcg daily for 3 months prior and first 3 months of pregnancy

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7
Q

what trimester of pregnancy has greatest teratogenic risk?

A

1st (4th to 11th week)

*avoid drugs if at all possible unless maternal benefit outweighs risk of foetus

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8
Q

what foetal defects can be caused by the following teratogenic drugs:

a) ACE inhibitors / ARB
b) androgens
c) anti-epileptics
d) cytotoxics
e) lithium
f) methotrexate
g) retinoids
h) warfarin

A

a) renal hypoplasia
b) virilisation of female foetus
c) cardiac, facial, limb and neural tube defects
d) multiple defects, abortion
e) CV defects
f) skeletal defects
g) ear, cardiovascular and skeletal defects
h) limb and facial defects

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9
Q

what type of development can teratogenic drugs impair in 2nd and 3rd trimester?

A

intellectual impairment

behavioural abnormalities

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10
Q

what drug can cause the suppression of foetal systems?

A

opiates - respiratory depression

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11
Q

what drugs can cause withdrawal syndrome in babies?

A

opiates

SSRIs

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12
Q

why do 10% of epileptic pregnant women experience increased in seizures?

A

non-compliance

changes in plasma concentrations of drugs eg persistent vomiting and increased clearance

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13
Q

frequent seizures during pregnancy are thought to cause what conditions?

A
lower verbal IQ in child
hypoxia 
bradycardia 
antenatal death 
maternal death
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14
Q

what antiepileptics should you avoid in pregnancy?

A

valproate

phenytoin

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15
Q

how much folic acid should epileptic pregnant women take?

A

5mg

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16
Q

what type of diabetic medication is thought to be unsafe in pregnancy?

A

sulfonylureas

*convert to insulin

17
Q

if you do need to treat hypertension, you should use one of what three drugs?

A

labetalol
methyldopa
(nifedipine MR)

  • avoid ACE inhibitors / ARBs
  • beta blockers may inhibit foetal growth in late pregnancy
18
Q

what is the safest drug for nausea and vomiting in pregnancy?

A

cyclizine

19
Q

what drugs should be used for UTI in pregnancy?

A

nitrofurantoin

3rd trimester - trimethoprim

20
Q

what drug should be used for pain in pregnancy?

A

paracetamol

21
Q

what drug should be used for heartburn in pregnancy?

A

antacids

22
Q

what is the leading cause in maternal death in pregnancy and therefore all pregnant women should be risk assessed for it?

A

VTE

23
Q

women with significant risk factors for VTE should receive prophylaxis with what treatment?

A

LMWH

*2 or more risk factors eg obesity, >35yo, smoking, para>3, previous DVT, C section

24
Q

which drugs can affect babies through breastfeeding?

A
phenobarbitone - suckling difficulties 
amiodarone - neonatal hypothyroidism
cytotoxics - bone marrow suppression 
benzos - drowsiness
bromocriptine - suppresses lactation
25
Q

which antibiotic given during pregnancy or early childhood can cause staining of bones and teeth?

A

tetracycline

*avoid in children up to age 12

26
Q

which drug taken in excess in early appearance can cause the following features: short palprebral fissures, flat midface, short nose, indistinct philtrum, thin upper lip?

A

alcohol

27
Q

which antiepileptic drug is particularly associated with cleft lip and palate?

A

phenytoin

28
Q

which drug taken during pregnancy can cause vaginal adenocarcinoma in female offspring?

A

stillbestrol

29
Q

which antiepileptic drug is particularly associated with neural tube defects such as spina bifida and anencephaly?

A

valproate