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OS Reproductive > Fetal & Neonatal Pharm > Flashcards

Fetal & Neonatal Pharm Flashcards

1
Q

What can corticosteroids be used for in fetal pharm?

A

Stimulation of lung maturation

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2
Q

What can be used to treat fetal arrythmias?

A

Digoxin, flecainide

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3
Q

Which drugs promote closure of a patent ductus arteriosus?

A

NSAIDs

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4
Q

What is unique about fetal pharmacology?

A

Amniotic fluid is another compartment

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5
Q

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

A

< 600 go through

> 1000 do not

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6
Q

What kind of metabolism can the placenta do?

A

Aromatic oxidation

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7
Q

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

A

Benzpyrene

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8
Q

What is thalidomide’s teratogenic target?

A

cereblon

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9
Q

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

A

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

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10
Q

What are the necessary qualifications of a teratogen?

A
  1. Characteristic set of malformations
  2. Effect at a particular stage of development
  3. Dose-dependent incidence
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11
Q

What are the six drug mechanisms identified as teratogenic?

A
  1. Folate antagonism
  2. Neural crest disruption
  3. Endocrine disruption
  4. Oxidative stress
  5. Vascular disruption
  6. Specific receptor/enzyme events
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12
Q

Cholestyramine AE

A

Depletion of B12

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13
Q

Valproic acid AE

A

Folate antimetabolite

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14
Q

Bosentan AE MOA

A

Interferes with neural crest migration

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15
Q

Isotretinoin AE MOA

A

Interferes with neural crest migration

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16
Q

DES AE MOA

A

Androgen-Estrogen balance

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17
Q

Thalidomide AE MOA

A

ROS from fetal metabolism

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18
Q

Misoprostol AE MOA

A

Placental obstruction/spasm

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19
Q

Ergotamine AE MOA

A

Placental obstruction/spasm

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20
Q

ACEIs and ARBs AE MOA

A

Renal development and bloodflow

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21
Q

Statins AE MOA

A

Cholesterol depletion

22
Q

NSAIDs

A

COX inhibition

23
Q

Sumatriptan AE MOA

A

SSRI probs

24
Q

Fluoxetine AE MOA

A

SSRI probs

25
Q

What are the effects of early SSRI exposure?

A 
Spontaneous abortion
Preeclampsia
Preterm birth
Neurotransmitter issues
Anencephaly 
Cardiac abnormalities
PAH
Autism
Psychomotor developmental issues
26
Q

Category A meaning?

A

Adequate studies in PREGNANT WOMEN show no risk

27
Q

Category B meaning?

A

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

28
Q

Category C meaning?

A

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

29
Q

Category D meaning?

A

Evidence of human fetal risk, but benefits may outweigh risks

30
Q

Category X meaning?

A

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

31
Q

What are some concerns about retrospective cohort studies?

A

Recall bias

Cannot establish causality

32
Q

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

A

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

33
Q

What is the 2007 FDA Amendments Act?

A

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

34
Q

Isotretinoin fetal abnormalities?

A

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

35
Q

What must a pt do before being prescribed isotretinoin?

A 
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
36
Q

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

A 
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
37
Q

Compare the t 1/2s of neonates and adults

A

MUCH longer half lives

38
Q

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

A

Usually use weight, but surface area is best

39
Q

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

A

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

40
Q

Chloral hydrate AE

A

Drowsiness

41
Q

Chloramphenicol AE

A

Grey baby, bone marrow suppression, blood dyscrasia

42
Q

Diazepam AE

A

Sedation, accumulation in neonates

43
Q

Heroin AE

A

neonatal dependence

44
Q

Iodine AE

A

Thyroid suppression

45
Q

Li AE

A

Avoid unless you check levels

46
Q

Methadone AE

A

Withdrawal if drug interrupted

47
Q

PTU AE

A

Thyroid suppression

48
Q

Which psychoactive drugs cause SSRI effects?

A

-prams
-amines
-apines
-alines
etc

49
Q

Keep in mind this delay in paternal teratogenicity

A

Sperm maturation from germ cells takes 64 days

50
Q

Things that cause paternal teratogenicity

A 
heavy metals
solvents
pesticides
anesthetic gases
hydrocarbons
51
Q

These drugs are absolutely contraindicated in pregnancy

A

boceprevir

telaprevir

52
Q

Drug classes that are labelled as precaution

A 
Antivirals
Cytotoxic cancer agents
Vismodegib
Teniposide
Retinoids
Many mAbs

OS Reproductive (9 decks)

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