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Special Pops FINAL > teratogenicity > Flashcards

teratogenicity Flashcards

1
Q

what is considered a major teratogen?

A

includes teratogenicity of an organ or organ system

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2
Q

what is considered a minor teratogen?

A

hernias, ear tags, extra fingers/toes

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3
Q

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

A

recall bias

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4
Q

true or false: the placenta is a barrier

A

false

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5
Q

what is the most common mode of transfer to the placenta?

A

passive diffusion

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6
Q

what molecular weight of drugs can easily pass through the placental barrier?

A

<500 Da

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7
Q

what are the 4 characteristics of medications that allow them to ross the placental barrier?

A
  1. low molecular weight
  2. highly lipid soluble
  3. unionized
  4. protein binding
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8
Q

when can major teratogenicity occur?

A

week 3-8

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9
Q

when can minor teratogenicity occur?

A

week 8-birth

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10
Q

what is used to convert folate to its naturally active form?

A

vitamin b12

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11
Q

what is the main drug class that is seen to have folate antagonism?

A

anticonvulsants

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12
Q

what anticonvulsant has lower risks of birth defects?

A

keppra

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13
Q

what are 3 medications that can cause neural crest cell disruption?

A
  1. bosentan
  2. isotretinoin
  3. ketoconazole
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14
Q

what must patient register with when taking isotretinoin?

A

iPLEDGE

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15
Q

what are 3 requirements with ipledge?

A
  1. must sign informed consent
  2. must see a doctor every month
  3. female patients must have a pregnancy test every month and get the prescription filled within 7 days
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16
Q

what are 3 medications that can cause hormone disruption?

A
  1. drugs used in fertility treatment
  2. oral contraceptives
  3. 5-alpha reductase inhibitors (finasteride)
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17
Q

true or false: female development is more susceptible to endocrine disruption due to greater hormone dependence

A

false (males)

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18
Q

true or false: finasteride is a pregnancy category x

A

true

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19
Q

what are 3 medications that can cause oxidative stress?

A
  1. class III antiarrhythmics
  2. terbutaline
  3. phenytoin
  4. tetracycline
  5. valproic acid
  6. thalidomide
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20
Q

what are 4 medications that can cause vascular disruption?

A
  1. antihypertensives (ACEi/ARBs!)
  2. aspirin
  3. ephedrine
  4. NSAIDs
21
Q

what should you tell patinets about the drugs that can cause vascular disruption?

A

requires pre-pregnancy counseling: timing is important

22
Q

when should you avoid the use of ACEi/ARBs?

A

in the second and third trimester

23
Q

when should you avoid aspirin use?

A

not recommended at any dose or trimester

24
Q

when can aspirin be used?

A

if low dose and the patient has preeclampsia or as an alternative to warfarin

25
Q

if you use regular dose aspirin close to delivery, what may happen?

A

premature closure of the ductus arteriosus

26
Q

if the ductus arteriosus is closed prematurely, what may happen?

A

hyperoxygenated blood and potential for pulmonary hypertension

27
Q

what are 2 drugs that can cause the premature closure of the ductus arteriosus?

A
  1. aspirin
  2. NSAIDs
28
Q

true or false: statins can be used in pregnancy since it has a category C rating

A

false (category x)

29
Q

what is needed for the normal growth patterns in embryonic tissues?

A

cholesterol

30
Q

what SSRI has the highest risk of fetal complications?

A

paroxetine

31
Q

if an SSRI needs to be used, what is recommended before the baby is born?

A

tapering and discontinuing the medication 2 weeks prior to birth

32
Q

what antipsychotics have a tendency to cause neonatal toxicity and withdrawal?

A

the first generations (haloperidol) and risperidone

33
Q

true or false: oral anticoagulants are not recommended in pregnancy

A

true

34
Q

true or false: heparins can be used in pregnancy

A

true

35
Q

what is recommended as first line in patients who need anticoagulation?

A

low molecular weight heparin

36
Q

why can heparins be used in pregnancy?

A

they do not cross the placental barrier

37
Q

what are 3 main differences with the new FDA risk classifications?

A
  1. removes pregnancy letter categories
  2. also includes men and fertility
  3. changed labor and delivery to lactation
38
Q

the availability of a pregnancy registry can be seen where?

A

in the patient counseling information section

39
Q

what are 5 things that any medication that is contraindicated in pregnancy must have listed first in the risk summary?

A
  1. risk based on human data
  2. risk based on animal data
  3. risk based on pharmacology
  4. background risk info in general population
  5. background risk info in disease population
40
Q

for pregnant women or women looking to conceive, what should they limit their caffeine intake to?

A

<200-300 mg/day

41
Q

what can occur if a patient drinks alcohol while pregnant?

A

fetal alcohol syndrome disorder

42
Q

what can the use of nicotine during pregnancy cause?

A

impaired fetal oxygenation

43
Q

what are 2 things that can be used in replacement of opioids?

A
  1. methadone
  2. buprenorphine
44
Q

what is is called when a neonate has a sensation of withdrawal symptoms from an opioid or opiate?

A

neonatal abstinence syndrome

45
Q

when is the risk of neonate abstinence syndrome low?

A

after 1 week of birth

46
Q

what is the treatment for a neonate experiencing NAS?

A
  1. morphine
  2. methadone
47
Q

when can patients use marijuana during pregnancy?

A

should not use marijuana during both pregnancy and lactation

48
Q

what can happen to the baby if the mom used cocaine during pregnancy?

A
  1. preterm birth
  2. low birth weight
  3. small for gestational age
49
Q

true or false: amphetamines can cross the placenta barrier

A

true

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