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35 Cards in this Set
- Front
- Back
Is a teratogen always a drug?
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No, can be drug, chemical, infectious or physical agent, maternal dz, altered metabolic state (DM, fever)
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What stage of pregnancy is most susceptible to teratogens?
Caveats? |
First trimester
Caveats: first two weeks generally unaffected by drug use as this is a period of pre-dx/dy and implantation (any major teratogens would cause loss of embryo at this time) |
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Which organ system is susceptible to teratogens through the first 16 weeks of pregnancy?
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CNS; it is the most susceptible organ system!
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What is the placental mode of drug transfer?
What factors contribute to this transfer? |
Simple diffusion
Rate of diffusion determined by diffusion constant (determined by lipid solubility, MW, pH, binding) of drug, surface area, concentration gradient, thickness of epithelium |
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What fetal factors affect drug transfer and effect?
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Fetal placenta blood flow
Fetal circulatory distribution Drug clearance mechanisms (reduced hepatic metabolism, reduced enzymatic activity) |
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Thalidomide
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Limb reduction anomaly
Symmetric defects Phocomelia (hands attached closed to trunk) Can also have absence of limbs (other anomalies: cranial facial, congenital HD, intestinal abnlts) |
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ACE Inhibitors
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1st trimester use: CV and CNS system defects
2nd, 3rd trimester: oligohydramnios w/pulm hyperplasia, joint contractures, hypocalvaria, renal failure, hypotn and death |
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Fetal Hydantoin Syndrome:
Definition Causes |
Fetal hydantoin S:
Cranial-facial features--hypertelorism (inc'd dist b/t eyes), broad nasal bridge, bowed upper lip Cause = anti-convulsants; valproate, carbamazepine, phenobarbital |
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Valproate
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Fetal Hydantoin Syndrome
Reduced IQ (6-9 points) |
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Warfarin
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Embryopathy
Nasal/Facial hypoplasia Skeletal abnlts; calcifications of axial skeleton Prenatal growth deficiency Cognitive defects |
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Accutane
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Asymmetry to cranial vault
Uneven distribution of brain Huge ventricles In addition to facies (see images) |
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What is the grace period for teratogenic effects of retinoic acid?
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15 days
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SSRI:
Effects Examples |
Paxil>Prozac, Celexa, Zoloft
No effects in 1st trimester Neonatal adaptation syndrome (3rd trimester use); respiratory distress, jitteriness, irritability (more common with Paxil) |
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Fetal Alcohol Syndrome
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Growth restriction: pre- and postnatal growth deficiency
CNS dysfn |
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Fetal Alcohol Effects
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Probably due to lower quantities of EtOH consumed during pregnancy
Attention deficits Impulse control Judgment issues Memory issues |
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Cocaine
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No embryopathy!
Placental abruptions Intrauterine growth restriction Prematurity CNS (infarct, schizencephaly, porencephaly) GI: atresias: gastrochisis (infant intestine sticks out through umbilical cord defect) INTENSE VASOCONSTRICTION |
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Heroin
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Absence of embryopathy!
Accelerates lung maturation Prenatal onset growth def Prematurity Neonatal Abstinence Syndrome: Wakefullness Irritability Tremulousness, temp instab, tachyp Diaphoresis, diarrhea Rub marks, rhinorrhea Autonomic dysfn Weight loss Alkalosis Lacrimation |
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Prevention of premature lung syndrome
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Ante-natal steroids
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Treatment of fetal arrhythmias
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Digoxin, Procainamide (given to mother)
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Prevention of neural tube defects
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Folic acid
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