Fetal & Neonatal Pharm

Question 1

What can corticosteroids be used for in fetal pharm?

Answer 1

Stimulation of lung maturation

Question 2

What can be used to treat fetal arrythmias?

Answer 2

Digoxin, flecainide

Question 3

Which drugs promote closure of a patent ductus arteriosus?

Answer 3

NSAIDs

Question 4

What is unique about fetal pharmacology?

Answer 4

Amniotic fluid is another compartment

Question 5

What is the weight cutoff for drugs that traverse placenta and those that definitely won’t?

Answer 5

< 600 go through

> 1000 do not

Question 6

What kind of metabolism can the placenta do?

Answer 6

Aromatic oxidation

Question 7

What is a particular carcinogen that the placenta increases exposure to via metabolism?

Answer 7

Benzpyrene

Question 8

What is thalidomide’s teratogenic target?

Answer 8

cereblon

Question 9

What are the general phases of in utero defects based on drug exposure?

Answer 9

Weeks 1-2: prenatal death or not
Weeks 3 thru 7: major morphologic abnormalities
Week 8 on: physiologic defects/minor morphologic abnormalities

Question 10

What are the necessary qualifications of a teratogen?

Answer 10

1. Characteristic set of malformations
2. Effect at a particular stage of development
3. Dose-dependent incidence

Question 11

What are the six drug mechanisms identified as teratogenic?

Answer 11

1. Folate antagonism
2. Neural crest disruption
3. Endocrine disruption
4. Oxidative stress
5. Vascular disruption
6. Specific receptor/enzyme events

Question 12

Cholestyramine AE

Answer 12

Depletion of B12

Question 13

Valproic acid AE

Answer 13

Folate antimetabolite

Question 14

Bosentan AE MOA

Answer 14

Interferes with neural crest migration

Question 15

Isotretinoin AE MOA

Answer 15

Interferes with neural crest migration

Question 16

DES AE MOA

Answer 16

Androgen-Estrogen balance

Question 17

Thalidomide AE MOA

Answer 17

ROS from fetal metabolism

Question 18

Misoprostol AE MOA

Answer 18

Placental obstruction/spasm

Question 19

Ergotamine AE MOA

Answer 19

Placental obstruction/spasm

Question 20

ACEIs and ARBs AE MOA

Answer 20

Renal development and bloodflow

Question 21

Statins AE MOA

Answer 21

Cholesterol depletion

Question 22

NSAIDs

Answer 22

COX inhibition

Question 23

Sumatriptan AE MOA

Answer 23

SSRI probs

Question 24

Fluoxetine AE MOA

Answer 24

SSRI probs

Question 25

What are the effects of early SSRI exposure?

Answer 25

``` Spontaneous abortion Preeclampsia Preterm birth Neurotransmitter issues Anencephaly Cardiac abnormalities PAH Autism Psychomotor developmental issues ```

Question 26

Category A meaning?

Answer 26

Adequate studies in PREGNANT WOMEN show no risk

Question 27

Category B meaning?

Answer 27

Studies in ANIMALS show no risk but no adequate studies in pregnant women or animal studies show AE but studies in pregnant women have not

Question 28

Category C meaning?

Answer 28

Animal studies show AE but no adequate studies in humans; or, no animal or human studies at all

Question 29

Category D meaning?

Answer 29

Evidence of human fetal risk, but benefits may outweigh risks

Question 30

Category X meaning?

Answer 30

Studies in human OR animals indicate fetal abnormalities and risks clearly outweigh benefits

Question 31

What are some concerns about retrospective cohort studies?

Answer 31

Recall bias | Cannot establish causality

Question 32

What are the advantages and disadvantages of a case control study?

Answer 32

Can establish causality Good for rare events (-) Recall bias and time bias

Question 33

What is the 2007 FDA Amendments Act?

Answer 33

Post-marketing studies when safety is in question - may issue a PMR (post-marketing requirement)

Question 34

Isotretinoin fetal abnormalities?

Answer 34

CNS, hydrocephalus, skull abnormalities, low IQ, thymus insufficiency

Question 35

What must a pt do before being prescribed isotretinoin?

Answer 35

``` 2 negative pregnancy tests Monthly tests Abstain from sex or use 2 kinds of BC Register with nationwide survey Avoid blood donation and med sharing ```

Question 36

In what ways are newborns and fetuses different in terms of pharmacokinetics?

Answer 36

``` Slower GI abs Faster IM abs More body water Less lipid mass Less protein binding Larger liver:body ratio Immature enzymes Larger brain:body ratio Higher BBB permeability Immature kidneys ```

Question 37

Compare the t 1/2s of neonates and adults

Answer 37

MUCH longer half lives

Question 38

How are peds doses calculated, and what is the best way to do so?

Answer 38

Usually use weight, but surface area is best

Question 39

What properties of breastmilk make it able to transfer certain drugs well and what kinds of drugs?

Answer 39

Acidic pH and high fat content --> concentrates bases and lipid soluble agents

Question 40

Chloral hydrate AE

Answer 40

Drowsiness

Question 41

Chloramphenicol AE

Answer 41

Grey baby, bone marrow suppression, blood dyscrasia

Question 42

Diazepam AE

Answer 42

Sedation, accumulation in neonates

Question 43

Heroin AE

Answer 43

neonatal dependence

Question 44

Iodine AE

Answer 44

Thyroid suppression

Question 45

Li AE

Answer 45

Avoid unless you check levels

Question 46

Methadone AE

Answer 46

Withdrawal if drug interrupted

Question 47

PTU AE

Answer 47

Thyroid suppression

Question 48

Which psychoactive drugs cause SSRI effects?

Answer 48

-prams -amines -apines -alines etc

Question 49

Keep in mind this delay in paternal teratogenicity

Answer 49

Sperm maturation from germ cells takes 64 days

Question 50

Things that cause paternal teratogenicity

Answer 50

``` heavy metals solvents pesticides anesthetic gases hydrocarbons ```

Question 51

These drugs are absolutely contraindicated in pregnancy

Answer 51

boceprevir | telaprevir

Question 52

Drug classes that are labelled as precaution

Answer 52

``` Antivirals Cytotoxic cancer agents Vismodegib Teniposide Retinoids Many mAbs ```