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Pharm II- Exam 2 > teratogens > Flashcards

teratogens Flashcards

1
Q

Thalidomide original use

A

originally used for tx of influenza, became used as anti-emetic and sleep aid

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2
Q

Thalidomide critical period

A

between 34th and 50th day after last menstrual period

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3
Q

20-30% of children exposed to thalidomide during critical period in 1st trimester developed…

A

limb defects aka phocomelia

Other abnormalities produced include external ear defects, visceral anomalies (agenesis of organs)

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4
Q

what are the 3 stages of development involved w/teratogenesis

A
  1. The ovum prior to fertilization is resistant to teratogenic agents
  2. During approximate 2wk period between conception and implantation (preimplantation stage)
  3. Organogenesis occurs from days 18 – 60 gestation
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5
Q

what teratogenic changes can occur during

A

fertilized ovum is generally resistant to teratogenic insults

relatively isolated from the maternal circulation

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6
Q

what teratogenic changes can occur during Organogenesis occurs from days 18 – 60 gestation

A

most gross malformations are determined before day 36

genitourinary and craniofacial anomalies can occur later

period of susceptibility (“critical period”) varies for each organ system

palate has period of sensitivity lasting about 3 weeks

CNS sensitivity lasts from about 2wks to near the end of gestation

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7
Q

teratogenesis and fetal phase

A

From end of embryonic state to term characterized by growth of already developed organs

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8
Q

Teratogens usually don’t cause gross structural abnormalities, but may cause…

A

CNS dysfunction, intrauterine growth retardation, or dysfunction of a particular organ (e.g., renal failure

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9
Q

when do effects of teratogenesis occur more frequently??

A

at higher doses rather than lower doses

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10
Q

Possible MOA of teratogenesis?

A

cytotoxicity of critical cell masses

directly interact w/DNA

angiogenesis during critical periods of development

inhibit enzymes

nutrient and vitamin deficiences

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11
Q

FDA pregnancy category A?

A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (no evidence of risk in later trimesters)

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12
Q

2 examples of FDA category A

A

Folic acid

levothyroxine

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13
Q

FDA pregnancy category B?

A

Animal reproduction studies have failed to demonstrate a risk to the fetus

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14
Q

2 examples of category B

A

Amoxicillin

Insulin R and N

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15
Q

FDA pregnancy Category C?

A

Animal reproduction studies have shown an adverse effect on the fetus

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16
Q

examples of category C?

A

Sertraline, fluoxetine

albuterol

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17
Q

T or F: Not all know animal teratogens have been found to be teratogenic in humans

A

True.

almost all known human teratogens have also been found to be teratogenic in animals

18
Q

potential adverse pregnancy outcomes of anti-epileptic drugs? ie. Carbamazepine, phenytoin, valproate

A

causes craniofacial, cardiac, and limb defects

NTD 1%-10x background rate

Fetal hydantoin syndrome

19
Q

management or prevention options for using anti-epileptic drugs in pregnancy

A

Use lowest possible dose to maintain control

Folic acid 4 mg daily

20
Q

potential adverse pregnancy outcomes of isotretinoins?

A

Miscarriage

Known teratogen; causes CNS, craniofacial, and cardiac defects

21
Q

management or prevention options for using isotretinoins?

A

Use effective pregnancy prevention

22
Q

potential adverse pregnancy outcomes of oral anticoagulants?

A

fetal warfarin syndrome

23
Q

management or prevention options for using oral anticoagulants?

A

Switch to nonteratogenic anticoagulant (e.g., LMWH) before becoming pregnant

24
Q

Carbamazepine has a 1% risk of…

A

neural tube defects

possibly similar effects to phenytoin embryopathy

25
Q

Valproate teratogenic effects during pregnancy

A

Neural tube defects from 1st trimester exposure, small mouth, developmental delay, narrow forehead, flat philtrum

26
Q

Isotretinoin (retinoids) teratogenic effects

A

Abnormalities include external ear defects/absence, congenital heart defects, hydrocephalus, mental retardation, hypertelorism, and clefts.

~40% Miscarriag

27
Q

Warfarin teratogenic effects during 1st trimester exposure (6-9wks)

A

produces fetal warfarin syndrome:
nasal hypoplasia,
calcific stippling of epiphyses, short stubby fingers

28
Q

Warfarin teratogenic effects after first trimester

A

CNS defects from in utero hemorrhage with scarring

Bone defects–including dwarfism, scoliosis, skull defects

29
Q

Alcohol misuse teratogenic effects? management?

A

Fetal alcohol syndrome –> cease alcohol intake before conception

30
Q

teratogenic effects and obesity? management?

A

NTD
Preterm delivery
Diabetes, HTN, VTE
Cesarean section

wt. loss w/approp. nutritional intake

31
Q

characteristics of fetal alcohol syndrome?

A

IUGR and postnatal growth retardation, Microcephaly, Mental retardation, Facial abnormalities

32
Q

facial abnormalities seen in fetal alcohol syndrome?

A

small head, low nasal bridge, small eye openings, short nose, thin upper lip, smooth philtrum, underdeveloped jaw

33
Q

ACE’s and ARB’s can result in…

A

Congenital renal failure, skull abnormalities, Oligohydramnios –> deformities (limb contractures, skull, facial)

34
Q

Methtrexate MOA

A

Folic acid antagonist

MTX inhibits dihydrofolate reductase

35
Q

embryopathy caused from methotrexate

A

Microcephaly
Short limbs
IUGR
Hypoplastic skull with wide fontanels and craniosynostosis

Typically requires doses > 10 mg/wk

36
Q

adverse outcomes w/tobacco use during pregnancy

A

Preterm birth
Low birth weight
Spontaneous abortion
Increased perinatal mortality

37
Q

management for tobacco use and pregnancy

A

cease tobacco use before conception

Nonpharmacologic therapies (CBT)

No consensus for NRT product, dosing, or frequency

38
Q

what is DES causes

A

Clear cell vaginal adenocarcinoma

Premature labor (as teenager or adult) in female offspring

Hypospadias in male offspring

39
Q

radiation and pregnancy

A

Microcephaly and mental retardation

If intense enough, concern for cancer

40
Q

Tetracycline?

A

Bacteriostatic drug that inhibits protein synthesis

41
Q

tetracycline ADE’s

A

Discolored teeth (yellow-brown staining) from deposition of antibiotic in calcifying teeth

Risk only after 17 weeks of gestation

Pharm II- Exam 2 (4 decks)

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