teratogenicity Flashcards
what is considered a major teratogen?
includes teratogenicity of an organ or organ system
what is considered a minor teratogen?
hernias, ear tags, extra fingers/toes
when a mother is more likely to remember each medication that she took when her child is sick vs a mother of a healthy baby
recall bias
true or false: the placenta is a barrier
false
what is the most common mode of transfer to the placenta?
passive diffusion
what molecular weight of drugs can easily pass through the placental barrier?
<500 Da
what are the 4 characteristics of medications that allow them to ross the placental barrier?
- low molecular weight
- highly lipid soluble
- unionized
- protein binding
when can major teratogenicity occur?
week 3-8
when can minor teratogenicity occur?
week 8-birth
what is used to convert folate to its naturally active form?
vitamin b12
what is the main drug class that is seen to have folate antagonism?
anticonvulsants
what anticonvulsant has lower risks of birth defects?
keppra
what are 3 medications that can cause neural crest cell disruption?
- bosentan
- isotretinoin
- ketoconazole
what must patient register with when taking isotretinoin?
iPLEDGE
what are 3 requirements with ipledge?
- must sign informed consent
- must see a doctor every month
- female patients must have a pregnancy test every month and get the prescription filled within 7 days
what are 3 medications that can cause hormone disruption?
- drugs used in fertility treatment
- oral contraceptives
- 5-alpha reductase inhibitors (finasteride)
true or false: female development is more susceptible to endocrine disruption due to greater hormone dependence
false (males)
true or false: finasteride is a pregnancy category x
true
what are 3 medications that can cause oxidative stress?
- class III antiarrhythmics
- terbutaline
- phenytoin
- tetracycline
- valproic acid
- thalidomide
what are 4 medications that can cause vascular disruption?
- antihypertensives (ACEi/ARBs!)
- aspirin
- ephedrine
- NSAIDs
what should you tell patinets about the drugs that can cause vascular disruption?
requires pre-pregnancy counseling: timing is important
when should you avoid the use of ACEi/ARBs?
in the second and third trimester
when should you avoid aspirin use?
not recommended at any dose or trimester
when can aspirin be used?
if low dose and the patient has preeclampsia or as an alternative to warfarin
if you use regular dose aspirin close to delivery, what may happen?
premature closure of the ductus arteriosus
if the ductus arteriosus is closed prematurely, what may happen?
hyperoxygenated blood and potential for pulmonary hypertension
what are 2 drugs that can cause the premature closure of the ductus arteriosus?
- aspirin
- NSAIDs
true or false: statins can be used in pregnancy since it has a category C rating
false (category x)
what is needed for the normal growth patterns in embryonic tissues?
cholesterol
what SSRI has the highest risk of fetal complications?
paroxetine
if an SSRI needs to be used, what is recommended before the baby is born?
tapering and discontinuing the medication 2 weeks prior to birth
what antipsychotics have a tendency to cause neonatal toxicity and withdrawal?
the first generations (haloperidol) and risperidone
true or false: oral anticoagulants are not recommended in pregnancy
true
true or false: heparins can be used in pregnancy
true
what is recommended as first line in patients who need anticoagulation?
low molecular weight heparin
why can heparins be used in pregnancy?
they do not cross the placental barrier
what are 3 main differences with the new FDA risk classifications?
- removes pregnancy letter categories
- also includes men and fertility
- changed labor and delivery to lactation
the availability of a pregnancy registry can be seen where?
in the patient counseling information section
what are 5 things that any medication that is contraindicated in pregnancy must have listed first in the risk summary?
- risk based on human data
- risk based on animal data
- risk based on pharmacology
- background risk info in general population
- background risk info in disease population
for pregnant women or women looking to conceive, what should they limit their caffeine intake to?
<200-300 mg/day
what can occur if a patient drinks alcohol while pregnant?
fetal alcohol syndrome disorder
what can the use of nicotine during pregnancy cause?
impaired fetal oxygenation
what are 2 things that can be used in replacement of opioids?
- methadone
- buprenorphine
what is is called when a neonate has a sensation of withdrawal symptoms from an opioid or opiate?
neonatal abstinence syndrome
when is the risk of neonate abstinence syndrome low?
after 1 week of birth
what is the treatment for a neonate experiencing NAS?
- morphine
- methadone
when can patients use marijuana during pregnancy?
should not use marijuana during both pregnancy and lactation
what can happen to the baby if the mom used cocaine during pregnancy?
- preterm birth
- low birth weight
- small for gestational age
true or false: amphetamines can cross the placenta barrier
true
