Drug associations Flashcards
Depressed nasal bridge
Nail hypoplasia
Stippled bone epiphyses
Also:
low birthweight
Seizure activity
Cognitive disabilities
Warfarin
*less impact if exposure
Cocaine (increases risk of…)
Increased risks of:
stillbirths
*placental abruption
skull abnormalities
cutis aplasia
porencephaly (cysts)
illeal atresia
cardiac anomalies
urogenital anomalises
Indomethacin (maternal)
pPHTN
renal insufficiency
illeal perf
NEC
Lithium
Ebstein
fetal goiter
premature birth
hypotonia
arrhythmia
seizure
DI
Mag sulfate (maternal)
(decreases acetylcholine release from NMJ via calcium antagonism)
decreased RR
hypotonia
decreased peristalsis
hypotension
Nifedipine
utero-placental insufficiency
(calcium channel blocker - decreases uterine contractility)
Terbutiline
(beta-2 agonist)
fetal tachycardia but minimal effect on neonate
Window of NAS symptoms
up to 2 weeks of age
Alcohol/FAS features
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
Hypotheses of FAS mechanism
- 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
Valproate
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
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
Valproate
captopril
(ACE inhibitors)
renal tubular dysgeneisis
hypoplasia of the skull
fetal compression syndrome w/ limb deformities
pulmonary hypoplasia (oligo)
phenobarbital
cleft lip and palate
cardiac anomalies
hydantoin
digit/nail hypoplasia
IUGR
valproic acid
neural tube defects
cleft palate
hypospadias
craniosynostosis
polydactyly
*overal prevalence of major birth defects in exposed infants is 9%
Ayurvedic medications
a/w lead exposure
*Manganese + lead worsen neurodevelopemental outcomes
carbamazepine
neural tube defects
craniofacial defects
hemorrhagic disease of the newborn
developmental delay
methimazole
choanal atresia
esophageal atresia
hypothyroidism, goiter
cutis aplasia
Tetracyclines (doxy, mono, tetra)
enamel hypoplasia
permanent yellowing of the teeth
slowed bone growth
ACE inhibitors
oligo
renal failure
lung hypoplasia
skull ossification defects
beta blockers (propranolol)
fetal bradycardia
hypOglycemia
possible FGR
cardiac (e.g. TGA)
microtia
triangular facies
hydrocephalus
Retinoic acid
(1st trimester)
Interfere with fetal oxidation of Vitamin K
phenytoin
phenobarbital
isoniazid
rifampin
warfarin
cephalosporins
