First Aid - Teratogens

Question 1

ACE inhibitors

Answer 1

Renal damage

Question 2

Alkylating agents

Answer 2

Absence of digits, multiple anomalies

Question 3

Aminoglycosides

Answer 3

Ototoxicity

– A mean guy hit the baby in the ear.

Question 4

Antiepileptic drugs

Answer 4

Neural tube defects, cardiac defects, cleft palate, skeletal abnormalities (eg, phalanx/nail hypoplasia, facial dysmorphism)
–High-dose folate supplementation recommended. Most commonly valproate, carbamazepine, phenytoin, phenobarbital.

Question 5

Diethylstilbestrol

Answer 5

Vaginal clear cell adenocarcinoma, congenital Mullerian anomalies

Question 6

Folate antagonists

Answer 6

Neural tube defects

- Includes trimethoprim, methotrexate, antiepileptic drugs.

Question 7

Isotretinoin

Answer 7

Multiple severe birth defects

–Contraception mandatory, IsoTERATinoin.

Question 8

Lithium

Answer 8

Ebstein anomaly (apical displacement of tricuspid valve)

Question 9

Methimazole

Answer 9

Aplasia cutis congenita

Question 10

Tetracyclines

Answer 10

Discolored teeth, inhibited bone growth

–“Teethracyclines.”

Question 11

Thalidomide

Answer 11

Limb defects (phocomelia, micromelia-"flipper" limbs)
--Limb defects with "tha-limb-domide."

Question 12

Warfarin

Answer 12

Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities
–Do not wage warfare on the baby; keep it heppy with heparin (does not cross placenta).

Question 13

Alcohol

Answer 13

Common cause of birth defects and intellectual disability; fetal alcohol syndrome

Question 14

Cocaine

Answer 14

Low birth weight; preterm birth, IUGR, placental abruption

–Cocaine -> vasoconstriction

Question 15

Smoking (nicotine, CO)

Answer 15

Low birth weight (leading cause in developed countries), preterm labor, placental problems, IUGR, SIDS
– Nicotine -> vasoconstriction.
CO -> impaired O2 delivery

Question 16

Iodine (lack or excess)

Answer 16

Congenital goiter or hypothyroidism (cretinism)

Question 17

Maternal diabetes

Answer 17

Caudal regression syndrome (anal atresia to sirenomelia), congenital heart defects, neural tube defects, macrosomia

Question 18

Methylmercury

Answer 18

Neurotoxicity

– Highest in swordfish, shark, tilefish, king mackerel

Question 19

Vitamin A excess

Answer 19

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac)

Question 20

X-rays

Answer 20

Microcephaly, intellectual disability

–Minimized by lead shielding.