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Special Populations > Teratogenicity > Flashcards

Teratogenicity Flashcards

1
Q

How do most drugs cross the placenta?

A

passive diffusion

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2
Q

What are the characteristics of medications more likely to cross the placenta?

A
  1. MW <500 Da
  2. highly lipid soluble
  3. unionized
  4. free drug (low protein binding)
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3
Q

During what weeks is the baby most vulnerable to medications?

A

weeks 3-8; during organogenesis medications can cause major damage to the developing organs

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4
Q

At what week are most of the major organ systems already developed?

A

week 16

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5
Q

Which medications are known to impair folate absorption/ increase folate degradation?

A
  1. anticonvulsants
  2. Primidone
  3. Cyclosporine
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6
Q

What medications interfere with Vit B12?

A
  1. cholestyramine
  2. metformin
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7
Q

What anticonvulsants are associated with the risk of folate deficiency?

A
  1. valproate
  2. phenytoin
  3. phenobarbital
  4. carbamazepine
  5. lamotrigine
  6. topiramate
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8
Q

Which anticonvulsant is associated with a lower risk of birth defects?

A

Levetiracetam KEPPRA

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9
Q

What is recommended if a patient cannot D/C a medication associated with decreased folate?

A

folic acid supplementation (2.5-5 mg/day)

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10
Q

What is folate antagonism/deficiency associated with?

A
  1. neural tube defects
  2. cleft pallet
  3. limb defects
  4. developmental delays
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11
Q

What medications are associated with neural crest cell disruption?

A
  1. Bosentan (TRACLEER)
  2. Isotretinoin (CLARAVIS/ACCUTANE)
  3. Ketoconazole (systemic)
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12
Q

What medications can disrupt sex hormones needed for fetal growth?

A
  1. drugs used in fertility treatment
  2. oral contraceptives
  3. 5-alpha reductase inhibitors (finasteride)
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13
Q

What precautions should be taken with Finasteride (PROCAR) due to it being a pregnancy category X?

A
  1. pregnant females or females trying to conceive should not handle crushed or broken tablets (inhale/absorb)
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14
Q

What medications cause teratogenicity due to oxidative stress?

A
  1. class III antiarrhythmic drugs
  2. Phenytoin
  3. Terbutaline
  4. Tetracycline
  5. Thalidomide
  6. Valproic acid
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15
Q

What medications cause vascular disruption?

A
  1. anti-HTN meds (esp. ACE/ARBs)
  2. aspirin
  3. ephedrine
  4. NSAIDs
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16
Q

When should Aspirin be avoided in pregnancy?

A
  1. not recommended at any dose/ trimester for pain/ headache
  2. regular dose aspirin not recommended in 3rd trimester (FDA category D)
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16
Q

When should ACE/ ARBs be avoided in pregnancy?

A

2nd and 3rd trimester (FDA category D)

17
Q

Why might low-dose aspirin be used during pregnancy?

A

treatment for preeclampsia \; D/C just before delivery to decrease risk of bleed for mother/child

18
Q

Why should aspirin be avoided in late stages of pregnancy?

A
  1. premature closure of ductus arteriosus
  2. hyperoxygenated blood –> potential for pulmonary HTN and right-sided HF
19
Q

When should NSAIDs be avoided in pregnancy?

A
  1. not recommended in 3rd trimester (cat D)
  2. cat C in 1st and 2nd
  3. Tylenol linked to autism?
20
Q

Why should Statin be D/C as soon as pregnancy is suspected/ wanted?

A

CI in pregnancy (cat X)

21
Q

Which SSRI has the highest risk of birth defects?

A

Paroxetine (cat D)

22
Q

What are the risks of taking an SSRI during the first trimester of pregnancy?

A
  1. cardiac defects
  2. preterm birth
23
Q

What are s/s of SSRI withdrawal after birth?

A
  1. tremors
  2. jitteriness
  3. irritability/agitation
  4. increased muscle tone
  5. feeding problems
  6. colic (cries for a long time)
24
Q

What SSRIs have the highest incidence of withdrawal in newborns?

A
  1. Paroxetine
  2. Fluoxetine
25
Q

What is a recommendation to decrease risk of withdrawal symptoms?

A

taper and D/C SSRI about 2 weeks prior to birth

26
Q

What antipsychotic had the lowest risk of congenital malformation?

A

Quetiapine

27
Q

What are SEs associated with chronic exposure to other antipsychotics during pregnancy?

A
  1. abnormal movements
  2. abnormally increased/decreased muscle tone
  3. motor restlessness
  4. hyperreflexia
  5. agitation
  6. tremor
  7. tachycardia
  8. crying
28
Q

Which antipsychotics are more likely to cause neonatal toxicity and withdrawal?

A

first generation and risperidone

29
Q

What pregnancy cat is warfarin?
When is baby at highest risk?

A
  1. cat X
  2. weeks 6-12
30
Q

What anticoagulant is first line in pregnant patients?

A

LMWH does not cross placenta/ cause fetal anticoagulation

31
Q

What are benefits to the removal of FDA pregnancy categories?

A
  1. provides integrated risk summary
  2. includes men and fertility
32
Q

What should the pharmacist consult along with using clinical judgment to determine teratogenicity?

A

package insert

33
Q

What is the limit for caffeine in pregnancy?

A

<200-300 mg/day

34
Q

What are appropriate smoking cessation agents in pregnancy?

A
  1. NRT
  2. bupropion
35
Q

What opioid cessation treatments are preferred in pregnancy?

A
  1. methadone
  2. buprenorphine
36
Q

What are s/s of opioid withdrawal in newborns?

A
  1. high pitched cry
  2. sleep/wake disturbances
  3. alteration in tone/ movement
  4. feeding difficulties
  5. GI disturbances
  6. failure to thrive
37
Q

What are treatment options for opioid withdrawal in newborns?

A
  1. morphine
  2. methadone
38
Q

How does THC effect pregnancy and lactation?

A
  1. transferred into placenta/ breast milk
  2. plasma exposure ~10% of maternal THC
39
Q

What are the complications of cocaine use during pregnancy?

A
  1. preterm birth
  2. low birth weight
  3. small for gestational age
  4. miscarriage
  5. decreased head circumference
40
Q

What complications are associated with Amphetamine use during pregnancy?

A

maternal and neonatal morbidity and mortality

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