Teratogens

Question 1

Define teratogen

Answer 1

A substance that results in malformations in the fetus.

Question 2

What are the pharmacokinetic principles in pregnancy?

Answer 2

Dependence on lipid solubility and drug ionization; highly lipophilic drugs will readily cross the placenta and breast milk; large molecular weights will not cross.

Question 3

Describe the FDA’s new method of categorizing drugs in pregnancy.

Answer 3

Risk vs Benefit assessment; counseling pregnant patients or those wanting to become pregnant on drug use is necessary.

Question 4

What are the fetal effects of teratogens?

Answer 4

Direct action on differentiating tissues, interference with oxygen or nutrient passage across the placenta, and deficiency of critical substances.

Question 5

List some drugs considered safe for pregnant patients.

Answer 5

• Methyldopa
• Lamotrigine
• Levetiracetam

Question 6

What fetal effects are associated with barbiturates?

Answer 6

Increase duration of GABA action; fetal effect: respiratory arrest.

Question 7

What fetal effects are associated with benzodiazepines?

Answer 7

Enhance GABA activity; fetal effect: neonatal dependence, ‘floppy infant syndrome’(hypotonicity of the neonate).

Question 8

What is the fetal effect of opioids?

Answer 8

Neonatal dependence, respiratory arrest.

Question 9

What effects do antidepressants have on the fetus?

Answer 9

Reversible block of NE and 5-HT presynaptic reuptake; fetal effects: neonatal withdrawal.

Question 10

What is the fetal effect of SSRIs, particularly Paroxetine?

Answer 10

Worst fetal effects among SSRIs. Assoc. w/ atrial septum deformities

Question 11

What fetal effects are associated with valproic acid?

Answer 11

Valproate Syndrome includes abnormal facial features, spina bifida, neural tube defects, and autism.

Mechanism: valproate inhibits folate synthesis

Question 12

What is the fetal effect of carbamazepine?

Answer 12

Neural tube defects.
this drug also has an inhibitory effect on folate synthesis

Question 13

What is the fetal effect of phenytoin?

Answer 13

Fetal Hydantoin Syndrome:
Cleft palate and facial dysmorphism.

digital hypoplasia w/ missing nails (nail dysplasia)

intrauterine growth retardation

Question 14

What is the recommended folate supplement dosage during pregnancy?

Answer 14

600 mcg during pregnancy.

Question 15

What effects does lithium have on the fetus?

Answer 15

Congenital cardiac anomalies. Ebstein’s anomaly

Question 16

What are the fetal effects of isotretinoin?

Answer 16

Facial paralysis; underdeveloped 6th and 7th cranial nerve.

Question 17

What fetal effects are associated with thalidomide?

Answer 17

Phocomelia-short or absent long bones of the limbs.
Mechanism: reduces levels of TNFalpha which subsequently decreases angiogenesis

Question 18

What fetal effects are associated with warfarin?

Answer 18

Fetal Warfarin Syndrome; skeletal abnormalities.

Question 19

What are the fetal effects of aspirin?

Answer 19

Fetal acidosis, respiratory depression; low dose reduces preeclampsia risk when used after 12 weeks gestation

Question 20

What fetal effects are associated with diethylstilbestrol (DES)?

Answer 20

Adenocarcinoma of vagina and cervix in young women whose mothers took DES.

Question 21

What are the fetal effects of finasteride?

Answer 21

Feminization of male fetus.

Question 22

What is the fetal effect of danazol?

Answer 22

Masculinization of female fetus.

Question 23

What are the fetal effects of sulfonamides?

Answer 23

Jaundice with an increase in the risk of brain damage, particularly in the third trimester.

Question 24

What fetal effects are associated with fluoroquinolones?

Answer 24

Bone growth abnormalities - decrease in chondrocytes

Question 25

What is the fetal effect of chloramphenicol?

Answer 25

'Gray Baby Syndrome'- neonate is hypotensive and cyanotic

Question 26

What is the fetal effect of antiviral ribavirin?

Answer 26

Teratogenic effects; caution advised. ribavirin inhibits guanine synthesis can also cause hemolytic anemia

Question 27

What is the effect of inadequate thyroid hormone during pregnancy?

Answer 27

Cretinism and developmental issues in the fetal nervous system. Increased risk for pre-term labor and preeclampsia

Question 28

What fetal effects are associated with thioamides?

Answer 28

Fetal goiter and hypothyroidism - inhibition of Iodide organification

Question 29

What is the role of corticosteroids in preterm delivery?

Answer 29

They prevent fetal lung immaturity and accelerate surfactant production.

Question 30

What is the treatment for opiate withdrawal in neonates?

Answer 30

Start treatment as early as possible with methadone or morphine.

Question 31

What HIV medications are considered during pregnancy?

Answer 31

* NRTIs: tenofovir alafenamide-emtricitabine, abacavir-lamivudine * Integrase inhibitor: dolutegravir * Protease inhibitors: atazanavir, darunavir

Question 32

What is the effect of gestational diabetes treatment?

Answer 32

Insulin is commonly used.

Question 33

What recreational substance can restrict intrauterine growth of the fetus?

Answer 33

nicotine

Question 34

T or F: Heparin is pregnancy friendly b/c it is too big of a molecule to cross the placenta.

Answer 34

true

Question 35

what PK-PD complications arise when a pregie is admin. sulfonamides?

Answer 35

During pregnancy, albumin is scarce this will increase plasma concentrations of sulfonamides b/c this drug class relies on binding to albumin to exert their therapeutic effects

Question 36

Why are statins not used during pregnancy?

Answer 36

these drugs are used to lower cholesterol cholesterol is used in the growing fetus to build cell membranes and synthesise hormones

Question 37

Drugs that demonstrate no teratogenic effects in well-controlled humans studies fall under what category?

Answer 37

category A

Question 38

A drug that demonstrates no risk or a risk in animal studies but has not been tested on humans would fall under what category?

Answer 38

Category B

Question 39

Category C is almost the same as Category B w/ what difference?

Answer 39

for Category C drugs, the benefits have been proven to outweigh the risks

Question 40

What is the criteria for a drug to be placed in Category D & X?

Answer 40

human studies have demonstrated a risk but potential benefits may outweigh the risks

Question 41

what are the key differences in the MOAs of barbiturates and benzodiazepines?

Answer 41

barbiturates increase the DURATION of chloride channels in their open form benzodiazepines increase the FREQUENCY

Question 42

The use of amphetamines during pregnancy has been assoc. w/ what complications?

Answer 42

preeclampsia - one MOA of amphetamine is to enhance the effects of NE: a potent vasoconstrictor Intellectual Disability for the baby leading to decreased performance in school

Question 43

what physical abnormalities are commonly seen in neonates suffering from Fetal Alcohol syndrome?

Answer 43

microcephaly low nasal bridge short nose underdeveloped jaws flat midface epicanthal folds small eye openings thin upper lip

Question 44

Anticonvulsants fall under which category?

Answer 44

C & D

Question 45

If a pregie chooses to continue anticonvulsants medication, what should be monitored?

Answer 45

maternal alpha fetoprotein (checks for neural tube defects) high-dose folate supplementation

Question 46

what is the MOA of lithium?

Answer 46

blocks Gq

Question 47

List the important AEs of lithium.

Answer 47

SIADH hypothyroidism (inhibits release of thyroid hormones from the colloid)

Question 48

what is isotretinoin used for?

Answer 48

A retinoic agent that reduces sebaceous gland size for pts. w/ severe cystic acne

Question 49

What are the requirements for taking Isotretinoin?

Answer 49

Two forms of birth control MUST be used 2 negative pregnancy tests prior to starting drug regimen after drug regimen is started, pregnancy tests must be completely monthly in order to continue getting refills

Question 50

what should pts., both male and female, not donate blood for 3 yrs. when taking acitretin

Answer 50

acitretin has an extremely long half-life - 120 days used to treat psoriasis

Question 51

what are the primary uses of thalidomide?

Answer 51

leprosy multiple Myeloma

Question 52

Describe the Teratogenic effects of ACEIs?

Answer 52

renal and cardiovascular malformations oligohydramnios- due to effect on Angiotensin II

Question 53

what drugs can be used to manage HTN during labor and delivery?

Answer 53

nifedipine labetalol hydralazine

Question 54

what is a preggie friendly alternative to statins?

Answer 54

bile acid resins - do not get absorbed

Question 55

What delivery complications can arise if the mother is on aspirin?

Answer 55

prolonged labor and significant maternal blood loss

Question 56

How does Finasteride exhibit its teratogenic effect?

Answer 56

it inhibits 5-alpha reductase: an enzyme required for conversation of testosterone to DHT

Question 57

what is the MOA of danazol?

Answer 57

anti-estrogen agent

Question 58

If a preggie needs to be put on radioactive chemotherapy, when should they start?

Answer 58

it is recommend to wait until after the 1st trimester

Question 59

What are the teratogenic effects of aminoglycosides?

Answer 59

CN VIII (ototoxicity) & nephrotoxicity

Question 60

what Abxs are safter alternatives for preggies?

Answer 60

macrolides & beta lactams

Question 61

What drug is used to treat maternal hypothyroidism?

Answer 61

levothyroxine

Question 62

what drugs can be given to preggies w/ hyperthyroidism?

Answer 62

Propylthiouracil & Methimazole

Question 63

What corticosteroid is given to prevent fetal lung immaturity?

Answer 63

betamethasone

Question 64

List the symptoms of neonatal opiate withdrawal?

Answer 64

difficulty feeding irritability tremors insomnia

Question 65

what medications are commonly given to treat opiate withdrawal?

Answer 65

methadone morphine

Question 66

Admin. of protease inhibitors during pregnancy increases the risk of what pregnancy complication?

Answer 66

gestational diabetes - these drugs can cause hyperglycemia

Question 67

If HIV viral load is >1000, this drug can be given via IV right before delivery?

Answer 67

zidovudine