9-1: 11/3: Drug Effects In Mother And Fetus

Front 1

Is a teratogen always a drug?

Back 1

No, can be drug, chemical, infectious or physical agent, maternal dz, altered metabolic state (DM, fever)

Front 2

What stage of pregnancy is most susceptible to teratogens?

Caveats?

Back 2

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)

Front 3

Which organ system is susceptible to teratogens through the first 16 weeks of pregnancy?

Back 3

CNS; it is the most susceptible organ system!

Front 4

What is the placental mode of drug transfer?

What factors contribute to this transfer?

Back 4

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

Front 5

What fetal factors affect drug transfer and effect?

Back 5

Fetal placenta blood flow
Fetal circulatory distribution
Drug clearance mechanisms (reduced hepatic metabolism, reduced enzymatic activity)

Front 6

Thalidomide

Back 6

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)

Front 7

ACE Inhibitors

Back 7

1st trimester use: CV and CNS system defects

2nd, 3rd trimester: oligohydramnios w/pulm hyperplasia, joint contractures, hypocalvaria, renal failure, hypotn and death

Front 8

Fetal Hydantoin Syndrome:
Definition
Causes

Back 8

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

Front 9

Valproate

Back 9

Fetal Hydantoin Syndrome
Reduced IQ (6-9 points)

Front 10

Warfarin

Back 10

Embryopathy

Nasal/Facial hypoplasia
Skeletal abnlts; calcifications of axial skeleton
Prenatal growth deficiency
Cognitive defects

Front 11

Accutane

Back 11

Asymmetry to cranial vault
Uneven distribution of brain
Huge ventricles

In addition to facies (see images)

Front 12

What is the grace period for teratogenic effects of retinoic acid?

Back 12

15 days

Front 13

SSRI:
Effects
Examples

Back 13

Paxil>Prozac, Celexa, Zoloft

No effects in 1st trimester

Neonatal adaptation syndrome (3rd trimester use); respiratory distress, jitteriness, irritability (more common with Paxil)

Front 14

Fetal Alcohol Syndrome

Back 14

Growth restriction: pre- and postnatal growth deficiency

CNS dysfn

Front 15

Fetal Alcohol Effects

Back 15

Probably due to lower quantities of EtOH consumed during pregnancy

Attention deficits
Impulse control
Judgment issues
Memory issues

Front 16

Cocaine

Back 16

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

Front 17

Heroin

Back 17

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

Front 18

Prevention of premature lung syndrome

Back 18

Ante-natal steroids

Front 19

Treatment of fetal arrhythmias

Back 19

Digoxin, Procainamide (given to mother)

Front 20

Prevention of neural tube defects

Back 20

Folic acid

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