Rx Note

Introduction A stretch mark (stria) is a type of scar that develops when our skin stretches or shrinks quickly . The abrupt changes cause the collagen and elastin, which support our skin, to rupture. As the skin heals, stretch marks may appear. Early stretch marks are usually red or purple due to inflammatory reaction in the skin . Over time, stretch marks lose their colour and become white or silvery in appearance (replaced by scar tissue). Causes If you develop stretch marks, you are most likely to do so during these times. Growth spurts that happen in puberty Pregnancy Rapid weight loss or gain Weight training when you have rapid muscle growth Other potential causes include: Prolonged use of oral or topical corticosteroid and from anabolic steroids People with Cushing syndrome or Marfan syndrome Treatment Available Stretch marks are non-life-threatening and asymptomatic . They naturally fade and usually become less conspicuous over time, so in many cases, treatment may not be n...

Introduction Pregnancy, typically lasts 37-40 weeks, is a critical period of rapid foetal growth and development as well as maternal physiological change. Nutrient requirements are increased to provide for the optimal growth and development of the foetus and to support maternal health. An additional of 340 to 450 kcal/day for pregnant women in second or third trimester. Lifestyle Modifications When treating pregnant patients, lifestyle modifications should always be considered first. Avoid alcohol and other known or potentially harmful substances (e.g. smoking, illicit drug and mercury) Avoid fish containing high levels of mercury (shark, billfish, tuna, swordfish). Limit caffeine intake to less than 200-300 mg per day. Be mindful of other forms of caffeine in black tea, coke, energy drinks and gym supplements. Teratogenic drugs should be discontinued prior to pregnancy, if possible. Preconception Care with Folic Acid Folic acid is recommended in all women of childbearing age. It is ...

Introduction Epilepsy is a long-term condition and so people can be on medicines for a long time. Every year in the UK, around 2500 women with epilepsy have a baby. A 2014 study reported that many women with epilepsy report limited knowledge about key issues regarding pregnancy and childbirth. Key Considerations of Epilepsy on Pregnancy The structural and neurodevelopmental teratogenic effects of antiepileptic drug , especially sodium valproate. Evidence supports a rate of congenital malformations of 10% in infants whose mothers took valproate during pregnancy and neurodevelopmental disorders in approximately 30% to 40% of children. Women with epilepsy are at increased risk for a range of perinatal complications compared with the general population, including preeclampsia , premature delivery, haemorrhage, foetal growth restriction, stillbirth and a dramatically increased risk of maternal mortality. At least 50% of women with epilepsy will have no alteration of their seizure patte...

Introduction Given the potential for teratogenic effects of certain drugs, this article explores the safe use of over-the-counter medications during pregnancy. Products containing alcohol should be avoided. Pain The use of paracetamol (acetaminophen) in recommended doses during pregnancy has not be associated with an increased risk of miscarriage or still birth. Nonetheless, paracetamol should be used at the lowest effective dose for the shortest duration of time to effectively treat the mother and protect the health of the foetus (inconclusive data on adverse events such as wheezing and asthma in early childhood, adverse effects on male reproductive development and ADHD or autism spectrum disorders) An increase in foetal death or spontaneous abortion may been seen following maternal overdose if treatment is delayed. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks' gestation because of the risk of Miscarriage in early pregnancy; however, evi...

Introduction The thalidomide tragedy was a great lesson for all of us to investigate safety data of drugs, particularly during pregnancy. Thalidomide was initially marketed for morning sickness , but later found to cause congenital defects , leading to its withdrawal from the market. Today, thalidomide is indicated for multiple myeloma, but it is crucial to provide contraceptive advice before starting the medication. It is worth noting that many commonly prescribed drugs, which we dispense on a daily basis, may not necessarily be safe or recommended during pregnancy. The MHRA UK has been actively raising awareness about the teratogenicity of sodium valproate . Additionally, statins should be avoided in pregnancy due to potential teratogenicity, although some conflicting data exists. Similarly, ACE inhibitors are not the first line treatment for hypertension during pregnancy due to their teratogenicity . Maternal use of topical methyl salicylate should be avoided beginning at 20 wee...

Introduction Levothyroxine is classified as a narrow therapeutic index drug. Therapeutic drug monitoring based on serum Thyroid Stimulating Hormone (TSH) and total or free-levothyroxine levels is routinely employed to facilitate levothyroxine dose titration. The goal is to achieve a satisfactory balance between maximizing efficacy and minimizing serious dose-related toxicity. Over-replacement and under-replacement of thyroid hormone can increase cardiovascular risk. To ensure safe maintenance of thyroid hormone levels, authorities are adopting stricter potency specifications for L-T4, the most stringent of these being 95-105% of the labelled dose over the whole shelf-life. Dosing in Hypothyroidism The dosage of levothyroxine is individualized based on clinical response and serum thyroid stimulating hormone (TSH) and/or free T4 concentrations. Individual T4 requirements correlate better with lean body weight than total body weight. Adjust the levothyroxine dose at 4- to 8-weekly inter...

Introduction Most COCs contain the oestrogen ethinyl estradiol (EE) and a progestin (e.g. norethisterone, levonorgestrel, drospirenone). There are different formulations of COCs. Monophasic COCs have the same dose of oestrogen and progestin throughout the pill pack. Biphasic, triphasic and quadriphasic pill packs mimic the oestrogen and progesterone levels during a menstrual cycle . NOTE: COCs containing levonorgestrel and norethisterone have been used for many years and are associated with a lower risk of VTE than other COCs. Drospirenone is structurally related to spironolactone; it has progestogenic, antiandrogenic, and anti-mineralocorticoid activity. There is no evidence that a certain type of progestin in a COC formulation is any more effective in treating hyperandrogenic symptoms, such as acne or hirsutism, than another type. In patients with conditions requiring chronic therapy with medications that may increase potassium, monitor serum potassium during the first treatment...

Introduction Hypertensive disorders during pregnancy affect approximately 8-10% of all pregnant women and the complications can be associated with significant morbidity and mortality to the mother and baby. Major Hypertensive Disorders Major hypertensive disorders that can occur in pregnant women are: Chronic hypertension Hypertension (BP >140/90) that exist before pregnancy or diagnosed in the first 20 weeks of gestation. Gestational hypertension New-onset of hypertension after 20 weeks gestation Preeclampsia Hypertension occur after 20 weeks gestation with features of multi-organ involvement Symptoms of pre-eclampsia include severe headache, problems with vision, severe pain below ribs, vomiting and sudden swelling of hands, feet or face accompanied with significant proteinuria and blood pressure greater than 140/90 mg Hg. In 2013, the American College of Obstetricians and Gynaecologists removed proteinuria as an essential criterion for diagnosis of preeclampsia. Eclampsia Ne...

Drug Safety Update Ondansetron is a 5HT 3 -receptor antagonist indicated for Prevention of nausea and vomiting induced by chemotherapy and radiotherapy. Prevention and treatment of postoperative nausea and vomiting. Epidemiological studies have identified a small increased risk of cleft lip and/or cleft palate in babies born to women who used oral ondansetron during the first 12 weeks of pregnancy . However, there were conflicting results of cardiac malformations. Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring, 2018 Ondansetron for Treatment of Nausea and Vomiting of Pregnancy and the Risk of Specific Birth Defects, 2018 Ondansetron use in the first trimester of pregnancy and the risk of neonatal ventricular septal defect, 2020 Recommendations The use of ondansetron during pregnancy is not recommended . If there is a clinical need for ondansetron in pregnancy, patients should be counselled on the potential benefits and ...