Teratogens

Question 1

What 3 things was Thalidomide originally used for?

Answer 1

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

Question 2

POPCORN

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

Answer 2

Phocomelia (limb defects)

Question 3

POPCORN

Thalidomide inhibits what?

Answer 3

inhibits angiogenesis during limb bud formation

Question 4

What are the 5 possible mechanisms of teratogenesis?

Answer 4

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)

Question 5

POPCORN

Antineoplastic agents often produce teratogenicity through what?

Answer 5

Cytotoxicity

Question 6

Which 3 antiepileptic drugs are known teratogens

Answer 6

1. Carbamazepine
2. Phenytoin
3. Valproate

Question 7

Antiepileptic drugs can cause what syndrome in the fetus

Answer 7

Fetal hydantoin syndrome

Question 8

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

Answer 8

1. Craniofacial
2. Cardiac
3. Limb

Question 9

Which two antiepileptic drugs cause NTDs?

Answer 9

Carbamazepine and valproate

Question 10

How do you manage a pregnant patient on antiepileptic drugs?

Answer 10

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

Question 11

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

Answer 11

phenytoin embryopathy

Question 12

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

Answer 12

True

Question 13

Isotretinoin (Retinoids) can cause what 6 abnormalities

Answer 13

1. External ear defects/absence

2. Congenital heart defects

3. Hydrocephalus

4. mental retardation
5. hypertelorism
6. clefts

Question 14

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

Answer 14

Isotretinoin (retinoids)

Question 15

How do you manage patients on isotretinoins in regards to pregnancy

Answer 15

effective pregnancy prevention

Question 16

What can warfarin cause in pregnancy at 6-9wks

Answer 16

Fetal-warfarin Syndrome

Question 17

What 3 sxs make up Fetal Warfarin Syndrome

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

Switch to nonteratogenic anticoagulant (LMWH) before becoming pregnant

Question 20

What can alcohol misuse in pregnancy cause

Answer 20

Fetal Alcohol syndrome

Question 21

What 4 things can alcohol use in pregnancy cause

Answer 21

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

Question 22

ACE/ARBs cause what in pregnancy

Answer 22

Congenital renal failure

Question 23

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

Answer 23

reflect the fetal hemodynamic effects of ACE inhibition or angiotensin blockade

Question 24

Methotrexate causes what when taken in pregnancy

Answer 24

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

Question 25

What 4 things are seen in **Embryopathy** caused by **Methotrexate**

Answer 25

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

Question 26

# POPCORN Which med causes hypoplastic skull w/ wide fontanels and craniosynostosis

Answer 26

Seen in embryopathy caused by Methotrexate

Question 27

What are the 3 main adverse pregnancy outcomes caused by **_obesity_**?

Answer 27

1. Diabetes 2. HTN 3. VTE

Question 28

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

Answer 28

Weight loss w/ appropriate nutritional intake before pregnancy

Question 29

Which drug can cause **clear cell vaginal adenocarcinoma**

Answer 29

Diethylstillbestrol (DES)

Question 30

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

Answer 30

Female offspring= **premature labor** Male offspring= **Hypospadies**

Question 31

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

Answer 31

Tetracycline

Question 32

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

Answer 32

Doxycycline

Question 33

Which trimesters are especially bad to take ACEs in

Answer 33

second and third

Question 35

Which drug group can cause **hypocalvaria**?

Answer 35

ACE inhibitors

Question 36

Which trimester is Carbamazepine teratogenic in?

Answer 36

first

Question 37

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

Answer 37

All

Question 38

What trimester(s) is Isotretinoin teratogenic in?

Answer 38

all

Question 39

Which trimester(s) is Methotrexate teratogenic in

Answer 39

first

Question 40

Which drug causes Fetal hydantoin syndrome?

Answer 40

Phenytoin

Question 41

Which trimester(s) is Phenytoin teratogenic in

Answer 41

all

Question 42

What 4 things does smoking in pregnancy cause

Answer 42

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

Question 43

**Topiramate** in 1st trimester of pregnancy can cause what

Answer 43

oral cleft

Question 44

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

Answer 44

true

Question 45

Warfarin in the **first trimester** can cause what 2 things?

Answer 45

1. Hypoplastic nasal bridge 2. Chondrodysplasia punctata

Question 46

Warfarin can cause CNS malformation in which trimester

Answer 46

second

Question 47

Warfarin: Risk of bleeding in which trimester?

Answer 47

**_third_** discontinue use 1 month before delivery