Drugs & Teratogenesis

Question 1

What is the most critical time period for the growing fetus?

Answer 1

first 8 weeks

Note: Cell division and differerentiation is when morphogenesis is at peak.

Question 2

What is this known as?

• Developmental defects increase in frequency and degree as dose increases
• Greater the exposure during pregnancy, the more severe the phenotypic effect (Continuous vs. one day)
• Most dangerous when drug is innocuous to mother but destructive to fetus

Answer 2

Dose-response effect

Question 3

Teratogens show considerable differences between individuals and different species. True or false?

Answer 3

True

Question 4

What is the FDA Pregnancy Rating?

Controlled studies show no risk

Answer 4

Category A

Question 5

What is the FDA pregnancy rating?

No evidence of risk in humans

Answer 5

Category B

Question 6

What is the FDA pregnancy rating?

Risk cannot be ruled out

Answer 6

Category C

Question 7

What is the FDA pregnancy rating?

Positive evidence of risk

Answer 7

Category D

Question 8

What is the FDA pregnancy rating?

Contraindicated in pregnancy (example: thalidomide)

Answer 8

Category X

Question 9

What paternal occupations with increased risk of birth defects?

Answer 9

Janitors
Painters
Printers
Occupations exposed to solvent
Fire fighters
Occupations related to agriculture

Question 10

What are some known teratogens? (6)

Answer 10

Thalidomide
DES
Alcohol
Phenytoin
Tobacco, cocaine
Retinoids

Question 11

What drug causes the following symptoms:

Prescribed for pregnancy-associated nausea in 1960s
Bilateral limb reduction
Defects in eyes, ears, kidney, heart

Answer 11

Thalidomide

Question 12

What drug:

• Was approved by the FDA for the treatment of multiple myeloma and epilepsy
• Can only be prescribed by physicians who are registered in the STEPS program
• Mandatory contraceptive measures (2 forms)

Answer 12

Thalidomide

Question 13

What drug:

• Oral synthetic non-steroidal estrogen analog
• To prevent miscarriages; 1940s and 1950s

Answer 13

Diethylstilbesterol (DES)

Question 14

What drug:

• Delayed teratogen where effects are seen 20-30 years later
• Daughters: 40x likely to develop vaginal adenocarcinoma
• Sons show genital abnormalities/non-cancerous growths
• Grandchildren have genital anomalies as well

Answer 14

Diethylstilbesterol (DES)

Question 15

What does this describe?

• Most common cause of mental retardation and birth defects
• Low birth weight
• Flat maxillary area
• Flat philtrum
• Thin upper lip

Answer 15

Fetal Alcohol Syndrome (FAS)

Question 16

What drug:

• Anti-epileptic
• Teratogenic effects resemble FAS and are referred to as “fetal hydantoin syndrome”
• Craniofacial abnormalities (broad nasal bridge, cleft lip and palate, microcephaly)
• Mild mental retardation, growth deficiency, developmental delay, heart defects

Answer 16

Phenytoin (Dilantin, diphenylhydantoin)

Question 17

What drug:

• Growth retardation: Low birth weight (dose-dependent effect), reduced fetal length, reduced head circumference, behavioral alterations
• Placenta development (placenta previa)
• Association with cognitive impairment
• Restricts uterine blood vessels- chronic hypoxia and malnutrition

Answer 17

Nicotine

Question 18

What drug:

• Similar to nicotine
• Growth retardation
• Microcephaly
• Cerebral infarction
• Increased risk of SIDS

Answer 18

Cocain

Question 19

What drug class and what 2 drugs:

• Extremely high risk of fetal abnormalities
• Hydrocephaly, heart defects, small head, mental retardation, craniofacial abnormalities (cleft lip)

Answer 19

Retinoids

Accutane

Question 20

Soriatane

Do not become pregnant withing ___ years.

If taking alcohol with soriatane, how long can pregnancy be contraindicated?

Answer 20

3 years

indefinitely