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44 Cards in this Set

  • Front
  • Back
Leading cause of infant deaths
Birth defects (20%)
What % of babies are born with birth defects
What percentage of birth defects are caused by drugs and environmental chemicals
Def: Teratogen
An agent or factor that causes morphological or functional alterations in teh exposed embryo/fetus
Name 5 birth defects
1. Physical - major malformations or minor anomalies
2. Developmental abnormalities
3. Deficits in intelligence
4. Disturbances in growth
5. Neoplasms
4 Criteria for Establishing a Teratogen
1. Genetics
2. Timing - developmental stage
3. Specificity - characteristic manifestation
4. Dose Effect
When was thalidomide usually taken and what was the consequence
24-36days postconception when limbs and heart were developing
When are NSAID efffects the worst and why
3rd trimester--> prolonged bleeding with labor and premature closure of ductus arteriosus
Outcome of defects occuring in the first 2wks
spontaneous abortion
When is the fetus susceptible to...
1. major morphologic abnormalities
2. physiologic defects and minor morphologic abnormalities
1. first 7wks
2. 8-38
Animal studies limitations
1. Different species have different responses. Rodents have high baseline of birth defects
2. Higher doses given to animals so results aren't alsways comparable to therapeutic doses
Human studies limiations
1. Can only study live births
2. Some malformations are difficult to assess at first
3. Many defecdts don't manifest until later in life
Case-Control studies limitations
Retrospective, so rely on the recollection of mothers. Moms are more likely to remember if htey took a drug if their babies were born with malformations
Case-Control studies are best for...
Id the odds ratio for moderate-risk teratogens. (What are hte odds that if the mother took the drug, the baby will be born with a certain abnormality)
Cohort studies limitations
prospective. Need to expose a lg no of women to obtain significant results. Takes long time to gather data
Cohort studies are best for...
id high-risk teratogens
Relative risk assessment
MCC of birth defects
CNS and facial effects, growth retardation
renal failure, decreased skull ossification, renal tubular dysgenesis
DOC for HTN in pregnancy
methyldopa, labetalos
DOC for hyperthyroidism during pregnancy
Antithryoid Drugs
Fetal goiter and hypothyroidism
Name 3 antiepileptic drugs that are teratogenic
Carbamazapine and Valproic acid --> neural tube defects
Phenytoin --> hypoplasia of fingers and toes, fetal hydantoin syndrome
Fetal Hydantoin Syndrome
low set ears, wide nose/mouth, short neck, strabismus caused by phenytoin
small for gestational age baby
Diethylstilbestrol (DES)
Vaginal carcinoma, GU defects in offspring
Androgenic drugs
masculinization of female fetus
Hypoglycemic drugs
neonatal hypoglycemia
DOC for Diabetic pregnant moms
Ebstein's Anomaly (downward displacement of tricuspid valve --> regurgitation into R. atrium w/ mild to severe symptoms)
CNS and limb malformations
premature closure of ductus arteriosus and necrotizing enterocolitis
Psychoactive drugs (barbiturates, opioids, benzo)
Neonatal withdrawal syndrome when drug is taken late in pregnancy, lethal
Small for gestational age
Vasoconstiction--> decreased o2 and nutrients to fetus
Increased spontaneous abortions and premature delivers
What % of moms quit smoking while pregnant
Retinoids (Isotretinoin)
1. Associated defect
2. FDA Cat
1. CNS, cardio, craniofacial defects
2. X
Anomalies of teeth, bones b/c it chelates Ca --> decreased availability
Phocomelia, ear changes, internal organ defects
very short or absent long bones and flipper-like appearance of hands and sometimes feet. Associated with thalidomide
Skeletal and CNS defects, Dandy-walker syndrome (malformation of cerebellum causing hydrocephalus)
DOC for DVT in women of child-bearing age
HMW Heparin b/c it can't cross BBB
Drugs the affect the fetus the same as they do the mom
2. Enzyme Inducers
3. Drugs producing dependence
4. Oral hypoglycemics
5. Anticoags
6. CNS depressants
7. ototoxic agents
FDA prenancy categories
A Controlled studies in humans show no risk
B No evidence of risk in humans
C Risk can't be r/o.
D Positive evidence of risk
X Contraindicated
What do you do if pt has adverse effects
report to FDA (required)
CDC has surveillance system
Drug/vaccine manufacturers