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P2 E3 Shea > Teratogens > Flashcards

Teratogens Flashcards

1
Q

What 3 things was Thalidomide originally used for?

A
  1. Tx of influenza
  2. anti-emetic
  3. Sleep aid
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2
Q

POPCORN

20-30% of kids exposed to Thalidomide during a critical period in the first trimester developed what?

A

Phocomelia (limb defects)

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3
Q

POPCORN

Thalidomide inhibits what?

A

inhibits angiogenesis during limb bud formation

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4
Q

What are the 5 possible mechanisms of teratogenesis?

A
  1. Antineoplastic agents–> through cytotoxicity
  2. Directly interact w/ DNA
  3. Affect Angiogenesis
  4. Inhibit enzymes
  5. Cause Nutrient and vitamin deficiencies (ex: folate antagonists)
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5
Q

POPCORN

Antineoplastic agents often produce teratogenicity through what?

A

Cytotoxicity

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6
Q

Which 3 antiepileptic drugs are known teratogens

A
  1. Carbamazepine
  2. Phenytoin
  3. Valproate
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7
Q

Antiepileptic drugs can cause what syndrome in the fetus

A

Fetal hydantoin syndrome

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8
Q

The antiepileptic drugs (Carbamazepine, phenytoin and valproate) cause what 3 defects

A
  1. Craniofacial
  2. Cardiac
  3. Limb
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9
Q

Which two antiepileptic drugs cause NTDs?

A

Carbamazepine and valproate

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10
Q

How do you manage a pregnant patient on antiepileptic drugs?

A
  • Use lowest possible dose to maintain control
  • Folic acid 4mg daily
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11
Q

Some suggest that Carbamazepine has the ability to produce effects similar to what

A

phenytoin embryopathy

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12
Q

T/F: Isotretinoins (Retinoids) can cause miscarriage in ~40%

A

True

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13
Q

Isotretinoin (Retinoids) can cause what 6 abnormalities

A

1. External ear defects/absence

2. Congenital heart defects

3. Hydrocephalus

  1. mental retardation
  2. hypertelorism
  3. clefts
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14
Q

Which drug can cause external ear defects/absence and hydrocephalus?

A

Isotretinoin (retinoids)

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15
Q

How do you manage patients on isotretinoins in regards to pregnancy

A

effective pregnancy prevention

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16
Q

What can warfarin cause in pregnancy at 6-9wks

A

Fetal-warfarin Syndrome

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17
Q

What 3 sxs make up Fetal Warfarin Syndrome

A
  1. Nasal hypoplasia
  2. Calcific stippling of epiphyses
  3. Short stubby fingers
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18
Q

What 2 things can Warfarin cause when used after the first Trimester

A
  1. CNS defects (from in utero hemorrhage w/ scarring)
  2. Bone defects (dwarfism, scoliosis, skull defects)
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19
Q

How do you manage a patient on Warfarin in regards to pregnancy

A

Switch to nonteratogenic anticoagulant (LMWH) before becoming pregnant

20
Q

What can alcohol misuse in pregnancy cause

A

Fetal Alcohol syndrome

21
Q

What 4 things can alcohol use in pregnancy cause

A
  1. IUGR and postnatal growth retardation
  2. Microcephaly
  3. Mental retardation
  4. Facial abnormalities (marker of brain damage)
22
Q

ACE/ARBs cause what in pregnancy

A

Congenital renal failure

23
Q

Effects of ACE/ARBs in pregnancy reflect what in the fetus

A

reflect the fetal hemodynamic effects of ACE inhibition or angiotensin blockade

24
Q

Methotrexate causes what when taken in pregnancy

A

Embryopathy (microcephaly, short limbs, IUGR, hypoplastic skull w/ wide fontanels and craniosynostosis)

25
Q

What 4 things are seen in Embryopathy caused by Methotrexate

A
  1. microcephaly
  2. short limbs
  3. IUGR
  4. hypoplastic skull w/ wide fontanels and craniosynostosis
26
Q

POPCORN

Which med causes hypoplastic skull w/ wide fontanels and craniosynostosis

A

Seen in embryopathy caused by Methotrexate

27
Q

What are the 3 main adverse pregnancy outcomes caused by obesity?

A
  1. Diabetes
  2. HTN
  3. VTE
28
Q

What should you recommend in an obese patient prior to pregnancy?

A

Weight loss w/ appropriate nutritional intake before pregnancy

29
Q

Which drug can cause clear cell vaginal adenocarcinoma

A

Diethylstillbestrol (DES)

30
Q

What can Diethylstillbestrol cause in female offspring? In male offspring?

A

Female offspring= premature labor

Male offspring= Hypospadies

31
Q

Which med can cause Discolored teeth (yellow-brown staining( from deposition of antibiotic calcifying teeth?

A

Tetracycline

32
Q

Which Tetracycline is less likely to produce teeth staining, but some might still be possible

A

Doxycycline

33
Q

Which trimesters are especially bad to take ACEs in

A

second and third

34
Q
A
35
Q

Which drug group can cause hypocalvaria?

A

ACE inhibitors

36
Q

Which trimester is Carbamazepine teratogenic in?

A

first

37
Q

Which trimester(s) is Diethylstillbestrol cause teratogenic effects such as vaginal adenosis or clear cell vaginal adenocarcinoma

A

All

38
Q

What trimester(s) is Isotretinoin teratogenic in?

A

all

39
Q

Which trimester(s) is Methotrexate teratogenic in

A

first

40
Q

Which drug causes Fetal hydantoin syndrome?

A

Phenytoin

41
Q

Which trimester(s) is Phenytoin teratogenic in

A

all

42
Q

What 4 things does smoking in pregnancy cause

A
  1. IUGR
  2. Prematurity
  3. Sudden infant death syndrome
  4. Perinatal complications
43
Q

Topiramate in 1st trimester of pregnancy can cause what

A

oral cleft

44
Q

T/F: Valproic acid in pregnancy can cause developmental delay and possibly autism

A

true

45
Q

Warfarin in the first trimester can cause what 2 things?

A
  1. Hypoplastic nasal bridge
  2. Chondrodysplasia punctata
46
Q

Warfarin can cause CNS malformation in which trimester

A

second

47
Q

Warfarin: Risk of bleeding in which trimester?

A

third

discontinue use 1 month before delivery

P2 E3 Shea (9 decks)

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