Drug associations

Question 1

Depressed nasal bridge
Nail hypoplasia
Stippled bone epiphyses

Also:
low birthweight
Seizure activity
Cognitive disabilities

Answer 1

Warfarin

*less impact if exposure

Question 2

Cocaine (increases risk of…)

Answer 2

Increased risks of:
stillbirths
*placental abruption
skull abnormalities
cutis aplasia
porencephaly (cysts)
illeal atresia
cardiac anomalies
urogenital anomalises

Question 3

Indomethacin (maternal)

Answer 3

pPHTN
renal insufficiency
illeal perf
NEC

Question 4

Lithium

Answer 4

Ebstein
fetal goiter
premature birth
hypotonia
arrhythmia
seizure
DI

Question 5

Mag sulfate (maternal)

Answer 5

(decreases acetylcholine release from NMJ via calcium antagonism)
decreased RR
hypotonia
decreased peristalsis
hypotension

Question 6

Nifedipine

Answer 6

utero-placental insufficiency

(calcium channel blocker - decreases uterine contractility)

Question 7

Terbutiline

Answer 7

(beta-2 agonist)
fetal tachycardia but minimal effect on neonate

Question 8

Window of NAS symptoms

Answer 8

up to 2 weeks of age

Question 9

Alcohol/FAS features

Answer 9

3 areas - physical, growth, and neurodevelopment

short palpebral fissures
thin upper vermillion border
smooth philtrum
ptosis/strabismus/epicanthal folds
maxillary hypoplasia
short nose, flat nasal bridge
microcephaly (persistant)
growth restriction - prenatal and failure to thrive

cardiac - VSD, ToF + PS
CNS
Neurodev impairment
Short stature
renal
small 5th fingernails, small distal phalanges
minor anomalies of face, eyes, heart, joints, genitalia

Question 10

Hypotheses of FAS mechanism

Answer 10

• apoptotic effect via blockade of NMDA glutamate receptors and activation of GABA-A receptors
• reduction in fetus’s ability to respond to free radical damage
• direct inhibit of Sonic hedgehog gene signaling

Question 11

Valproate

Answer 11

Facial - high forehead, anteverted nostrils, mid face hypoplasia, long philtrup, cleft lip

Cardiac - coarc, HLHS, AV stenosis, Interrupted AA, ASD, pulm atresia w/ intact septum

Extremeties - long, thing fingers/toes, HYPERCONVEX fingernails

Question 12

Facial - high forehead, anteverted nostrils, mid face hypoplasia, long philtrup, cleft lip

Cardiac - coarc, HLHS, AV stenosis, Interrupted AA, ASD, pulm atresia w/ intact septum

Extremeties - long, thing fingers/toes, HYPERCONVEX fingernails

Answer 12

Valproate

Question 13

captopril

Answer 13

(ACE inhibitors)

renal tubular dysgeneisis
hypoplasia of the skull
fetal compression syndrome w/ limb deformities
pulmonary hypoplasia (oligo)

Question 14

phenobarbital

Answer 14

cleft lip and palate
cardiac anomalies

Question 15

hydantoin

Answer 15

digit/nail hypoplasia
IUGR

Question 16

valproic acid

Answer 16

neural tube defects

cleft palate
hypospadias
craniosynostosis
polydactyly

*overal prevalence of major birth defects in exposed infants is 9%

Question 17

Ayurvedic medications

Answer 17

a/w lead exposure

*Manganese + lead worsen neurodevelopemental outcomes

Question 18

carbamazepine

Answer 18

neural tube defects
craniofacial defects
hemorrhagic disease of the newborn
developmental delay

Question 19

methimazole

Answer 19

choanal atresia
esophageal atresia
hypothyroidism, goiter
cutis aplasia

Question 20

Tetracyclines (doxy, mono, tetra)

Answer 20

enamel hypoplasia
permanent yellowing of the teeth
slowed bone growth

Question 21

ACE inhibitors

Answer 21

oligo
renal failure
lung hypoplasia
skull ossification defects

Question 22

beta blockers (propranolol)

Answer 22

fetal bradycardia
hypOglycemia
possible FGR

Question 23

cardiac (e.g. TGA)
microtia
triangular facies
hydrocephalus

Answer 23

Retinoic acid

(1st trimester)

Question 24

Interfere with fetal oxidation of Vitamin K

Answer 24

phenytoin
phenobarbital
isoniazid
rifampin
warfarin
cephalosporins