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54 Cards in this Set
- Front
- Back
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What is the most prevalent cause of congenital abnormalities?
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Idiopathic 72-73%
Genetic Predisposition 25% Drug Use 2-3% |
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What are the three ways to think of teratogenicity?
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Anatomic malformations
Behavioral Changes/Occult malformations Long Term Changes |
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Give four examples of drugs that cause physical anatomic malformations
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Thalidomide
Phenytonin Warfarin Alochol |
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Give an example of a drug that causes behavioral/occult changes/malformation
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SSRI
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Give a example of a drug that causes long term changes in a fetus
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Diesthylstibestrol - DES
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Why was thalidomide given to women?
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For N/V during the first trimester in the 1950's
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What does thalidomide cause in the fetus
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Phocomelia
Flippers |
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How did thalidomide effect the FDA
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Prompted laws regarding proof of saftey and efficacy of drugs in intended populations - the "saftey and efficacy warning"
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Why is Phenytoin given to women?
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To control seziures
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T or F -
Phenytoin causes childen to be born with congenital defects |
True. Women who take Phenytoin are 2-3 times more likely to have a a child who has a congenital defect
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What impact does Phenytoin have on the nutritional intake of the fetus?
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Phenytoin reduces the amoints of vitimin K and folic acid in the newborn - this could explain the MOA for the defects
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Describe the effects of Fetal Hydantoin Syndrome
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Broad nose, wide fontanelle, low set hairline, short neck, ptosis of eyelids, epicanthal folds, abnormal or low set ears, hypoplastic digits, small or absent nails, absent thubs
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When a women needs to be on Warfarin what should you consul the mother on?
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Birth Control
Posiablly have her switch to Heprin |
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What are the problems that arise with Warfarin (Coumadin)
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Spontaneous abortion, still birth, prematurity, hemorrhage, CNS defects > these mostly occur during embryopathy during the first 6-9 weeks of gestation
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What is the CNS effect of Warfarin cuased by - what is the MOA?
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Due to hemorrhage/scarring and subsequent impaired growth of brain tissue.
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Is there any effect on the fetus after the first 9 weeks to the fetus with Warfarin?
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We don't know - however 70% of all warfarin pregnancies are WNL
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What is fetal Warfarin Syndrome?
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Nasal hypoplasia, RDS, blindness, optic atrophy, macrophthalima, abnormal bone calcification, LBW, hypoplasia, retardation, seizures, deafness, CHD
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Describe the rediscovery of Fetal Alcohol Syndrome.
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IT was historically recognized, however dismissed as superstition in the 1940's. In 1970 it was rediscovered
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Describe mild FSA.
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Occurs with 2 drinks a day
Low birth weight |
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When do you see "Complete Syndrome" of FAS
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when a mother takes 4-5 drinks a day
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What are the three main abnormalities seen with FAS?
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Craniofacial dysmorphology
CNS dysfunction Cardiac and renogeintal defects |
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How common is FAS?
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1/300 births to 1/2000 births
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T or F
FAS might have a paternal influence as well |
True
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What is the MOA for FAS?
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No one really knows - however it is thought to be due to alcohol metabolites disrupting protein synthesis.
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What is Bendectin?
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The combo of doxylamine, pyridoxine, and dicyclomine
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What is Doxylamine?
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an antihistamine
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What is Pyridoxine?
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B 6
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What is Dicyclomine
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An anticolonergic
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Why was Bendectin given to pregant women?
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to prevent N/V durind pregancy
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If you can't get Bendectin - what can you give?
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Docylamine and Pyridoxine
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What are the three SSRI?
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Fluoxetine (Prozac)
Paroxetine (Paxil) Sertraline (Zoloft) |
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What occurs with SSRI's in pregnant women?
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occult malformations - an withdrawal syndrome.
Neurobehavioral disruptions |
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What is Diethylstilbestrol?
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A drug given to women to prevent spontaneous abortions.
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What are the effects to children who's mother took diethylstilbestrol?
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they get clear cell adenocarcinoma and are twice as likely to be diagnosed with breast cancer - they too are at in increased risk of infertility and pregnancy problems
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What are the effects of the male offspring who's mother took diethylstilbestrol?
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Epididymal cysts
Meatal stenosis Hypospadias Testicular caricoceles |
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What is the MOA of teratogenicity?
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No one really knows - but it is thought that the drug may affect maternal receptors with indirect effects on the fetus. They may also have a direct effect on embryonic development. They affect nutritional status of fetus by interfering with paddate of nutients across the placenta - may cause alterations in placental metabolism
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When does the human placenta become less thick?
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After 16 weeks
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When is there a greater concentration of drugs in the baby?
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Early in the pregancy when the placenta is big and thick - the drugs can cross over better and there is more concentration.
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What kind of molecule size can cross the placenta
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a small one - heprin for example is too big to get to the fetus
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Do lipid or water soluble agents cross the placenta
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lipophilic/fat soluable drugs will cross the placenta
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What kind of charged molecule crosses the placenta?
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A nonionized molecule can cross eaisir
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T or F
A low protein bound molecule will cross eaiser. |
True
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T or F
Medications should be avoided while pregnant if possiable |
ture
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How do we get the majority of inforamtion we have about drugs in pregancy
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Case studies
Retrospective reviews Animal models |
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What the types of pregancy categories. who gives these drugs the classification?
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a - x
The drug companies |
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T or F
Vitiamins are class a pregnancy catagories |
true
They have controlled studies to support the data |
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Give me some examples of type B drugs
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antibiotics, insulin
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Most drugs are what catagory
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C
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What are some examples of class d drugs
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ace inhibitors, warfain, lithuim, phenytoin, tetracycline
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How are drugs given their classification?
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Drug companies and the FDA assign the category at time of drug approval - no human data us usually avaliable at the time. There is one incentive for the manufacture to change pregancy catagory as data becomes avaliable. For example Valium is a drug C due to cleft palate in rats
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What are the different resources for understanding drug safety
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Pregnancy Category
Brigg's Drug in Pregnancy and Lactation Primary Literature (what is written recently SSRI for example) |
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What occurs during the first trimester
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most critical for physical defects
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what occurs during the second trimester
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the tissue differentiation/growth
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What occurs during the third trimester
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growth/delivery
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