Teratogens

Question 1

What is the most famous teratogen

Answer 1

Thalidomide

Question 2

List the abnormalities found with thalidomide

Answer 2

1. Limb Defects: Phocomelia* (1st trimester)
2. External ear defect
3. Visceral anomalies

Question 3

List te Thalidmodes

Answer 3

1. Lenalidomide

2. Pomalidomide

Question 4

what are thalidmodes currently FDA approved in the treatment of?

Answer 4

1. Erythema nodosum leprosum

2. Multiple myeloma

Question 5

When does organogenesis occur?

Answer 5

18-60 weeks gestation

Question 6

When do most gross malformations occur?

Answer 6

Before day 36

Question 7

How long does CNS sensitivity last for?

Answer 7

2 weeks-end of gestation

Question 8

Palate sensitivity?

Answer 8

lasts about 3 weeks

Question 9

Define fetal phase

Answer 9

End of embryonic state to term

Question 10

What do teratogens usually affect?

Answer 10

1. CNS growth
2. Intrauterine growth
3. Dysfunction of a particular organ: e.g. renal failure

Question 11

List the MOA of teratogenesis

Answer 11

1. Cytotoxicity: Depressed mitosis and promotion of cell death
2. Directly interfere with DNA
3. Affect angiogenesis (e.g. thalidomide)
4. Inhibit enzymes (e.g. warfarin)
5. Nutrient and Vitamin deficiencies (e.g. folate antagonist)

Question 12

Carbamazepine teratogenic

Answer 12

Neural Tube Defect (1%)

Question 13

Phenytoin Teratogenic

Answer 13

1. Short Fingers
2. Flat, broad bridge of nose
3. Far apart eyes

Question 14

Valporate teratogenic

Answer 14

1. Neural Tube Defect: 1st trimester exposure
2. Developmental delay
3. Narrow forehead
4. Flat Philtrum

Question 15

Isotretinoin (retinoids) teratogenic

Answer 15

1. External Ear defects/absence
2. Congenital Heart Dz
3. Hydrocephalus
4. Mental Retardation
5. Wide spacing of eyes (hypertelorism)
6. Clefts

Question 16

What is the % of miscarriages with the use of isotretinoin

Answer 16

40%

Question 17

Warfarin effects during the 1st trimester (6-9 weeks)

Answer 17

Fetal Warfarin Syndrome:

1. Nasal Hypoplasia
2. Calcific Stippling of epiphyses
3. Short stubby fingers

Question 18

Warfarin effects AFTER 1st trimester

Answer 18

1. CNS defects from in utero hemorrhage with scarring

2. Bone defects: Dwarfism, scoliosis, skull defects

Question 19

Alcohol effects

Answer 19

1. IUGR & Postnatal Growth Retardation
2. Microcephaly (small head)
3. Mental Retardation
4. Facial Abn: low nasal bridge, small eye openings, shot nose, smooth phitrum

Question 20

How many drinks a week is associated with FAS?

Answer 20

2-14 drink

Question 21

ACE-I/ ARB effects

Answer 21

1. Oligohydraminos
2. Congenital renal failure
3. Skull abn.

Question 22

Methotexate MOA

Answer 22

Folic Acid antagonist: MTX inhibits dihydrofolate reductase

Question 23

Methotexate embryopathy

Answer 23

1. Microcephaly
2. Short Limbs
3. IUGR
4. Hypoplastic skull w/ wide fontanels & craniosyntosis

Question 24

What Methotexate dose is typically required to cause embryopathy

Answer 24

> 10 mg/wk

Question 25

Tobacco use effects

Answer 25

1. Preterm birth
2. Low birth wt.
3. Spontaneous AB
4. Increased perinatal mortality

Question 26

Diethylstibestol (DES) effects

Answer 26

1. Clear Cell adenocarcinoma
2. Premature labor (teenagers or adult) in female offspring
3. Hypospadias

Question 27

Radiation effects

Answer 27

1. Microcephaly

2. Mental retardation

Question 28

Tetracycline MOA

Answer 28

Bacteriostatic drug that inhibits protein synthesis

Question 29

What is amphetamine use associated with?

Answer 29

Decreased school performance

Question 30

What is cocaine use associated with?

Answer 30

abrupt placentae