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46 Cards in this Set
- Front
- Back
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Drugs of what molecular size can easily cross placenta?
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150-500 daltons
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Where do the drugs go next after crossing placenta?
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- unbilical vein then
- 40-60% goes to fetal liver, rest bypass liver and go to fetal general circulation |
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What is the primary mode of drug transfer cross placenta's brush border membrane of the syncytiotrophobloast?
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passive non-ionic diffusion
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T/F: As the placenta develops, its physiology changes including transport of drugs, enzyme that can degrade or metabolize drugs.
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T.
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Why do some drug affect fetus more than mom?
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placenta metabolize the drug into a more toxic form
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What happens if fetus is exposed to teratogens in the first week after conception?
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miscarrage (period of zygote)
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What happens if fetus is exposed to teratogens during embryinic period (2nd to 8th week) after conception?
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- catastrophic structural defects (thalidomide)
- fetal wastage - fetal growth restriction - transplacental carcinogenesis (DES) This is the period of organogenesis (CNS, heart, extremities, eyes, palate, external genitalia) |
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What happens if fetus is exposed to teratogens during fetal period (3rd to 9th month) after conception?
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defective CNS development
behavoral developement |
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Which category drug are anticonvulsants?
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Category D
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Which teratogen is this?
- used to treat epilepsy - blocks sustained high-frequency repetitive firing of action potentials - fetus receives a higher dose than mom, especially during fist trimester |
Dilantin (phenytoin)
- alters Na, K, Cl conductance |
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What is this called? Name some drugs that cause this.
- growth deficiency - developmental delay - cleft palate - facial characteristics - heart defects - GU abnormalities - abnormalities of fingers and nails |
Hydantoin syndrome
- hydantoin: colorless base glycourea - phenobarbital: antileptic - carbamazepine: antileptic |
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Name some drugs that have risk for spina bifida and neural tube defect.
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- valproic acid
- antileptics: phenobarbital, carbamazepine |
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What teratogen is this?
- used to treat acne vulgaris - high risk in all trimesters - mucocutaneous, skeletal, liver toxicity |
Tretinoin (RetinA)
- category C if topical - category D if oral - induce terminal differentiation - retinoic acid receptor expressed early in development |
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Which teratogen is this?
- treatment for BPH, male pattern hairloss - hypospadia - abnormal opening of male urethra - ambuguous genitalia in male infants |
Finasteride (Propecia)
- steroid 5-a-reductase inhibitor: binds to androgen receptors in the skin and other organs, blocks sustained high frequency repetitive firing of action potentials - category X |
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What teratogen is this?
- sleeping pill (old days) - FDA approved for Hansen's disease (leprosy) - phocomelia (shortening or complete absence of limbs) |
Thalidomide
- category X - greatest sensitivity period: 21-33 days of gestation - metabolozed to stop angiogenesis - binds and intercalates DNA - interferes with gene expression of integrins |
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What teratogen is this?
- metabolozed to stop angiogenesis - binds and intercalates DNA - interferes with gene expression of integrins |
thalidomide
- interferes with gene expression of integrins: binds to promotor region (poly G site) |
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What are some requiement for women with leprosy to be treated with thalidomide?
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- pregnancy test before treatment
- women must use 2 forms of contraception - men must use condoms |
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What disease are Thalidomide (category X) used to treat?
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- Hansen's disease (leprosy)
- studied for HIV, breast cancer, prostate cancer, kaposi's sarcoma - testing in macular degeneration |
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What is this teratogen?
- treatment for cushing's syndrome (experimentally): binds to glucocorticoid receptor - also useful in treating endometriosis and breast cancer: binds strongly to progesterone: competitive antangonist |
RU486
- category X - inhibit progesterone: competivie antagonist - used to terminate pregnancies |
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How does RU486 treat endometriosis and breast cancer?
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- interrupts progesterone support to endometrium
- ripen cervix - increase synthesis and decrease metabolism of prostaglandins |
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What is this teratogen?
- now used for early pregnancy termination - categpry X - binds to progesterone and glucocorticoid receptors |
RU486 (Mifepristone)
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What is this teratogen?
- nonsteroidal estrogen activity - used for morning after contraceptive |
DES
- category X - vaginal adenosis - clear cell vaginal adenocarcinoma - risk of infertility, ectopic pregnancy, premature delivery - shortened fingers |
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What is this teratogen?
- vaginal adenosis - clear cell vaginal adenocarcinoma - risk of infertility, ectopic pregnancy, premature delivery - shortened fingers |
DES
- category X |
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What happens the baby when a pregnant women has uncontrolled diabetes during first week of pregnancy?
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- spontaneous abortion
- congenital |
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What happens the baby when a pregnant women has uncontrolled diabetes during third trimester?
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- fetal distress
- polymacrosomia |
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What happens the baby when a pregnant women has uncontrolled diabetes later in pregnancy?
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- polyhydramnios
- preterm delivery |
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What are some congenital maliformations caused by uncontrolled diabetic mon during first week?
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- caudal regression
- anencephaly - spina bifida, hydrocephalus - cadiac: ASD, VSD - anal/rectal atresia - renal anomalies: cystic kidney, ureter duplex - situs inversus |
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How to manage a pregnant women who is diabetic?
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- instituted prior to conception
- continued throughout pregnancy - detect fetal distress: fetal movement, maternal estriol level (>40% drop before fetal demise) |
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What does this tell you?
- maternal estriol level drops more than 40% |
fetal distress
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What is this teratogen?
- low birth weight - premature labor - ASD, VSD - pulmonary HTN - category D |
antidepressants
- fluoxetine (Prozac) - Paroxetine (Paxil) - placenta has transporter for 5HT reuptake which is blocked by these drugs |
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What is this medication used during pregnancy?
- used treat pre-eclampsia: control or prevent convulsions |
magnesium sulfate
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What is this condition in pregnant women called and what can be used to treat it?
- edema, decreased plasma volume - vasoconstriction, HTN - intrauterine growth retardation |
- try to enhance NO level by L-arginine supplement
- magnesium sulfate - keep in bed |
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Name some labor inducing agents.
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- Pitocin
- Oxytocin/Pitocin infusion: may cause autism (oxytocin has effect on social, sexual, and bonding behavior) |
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Name some anti-nausea medications.
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- Tigan: category C. act on chemoreceptor trigger zone in the medulla oblongata.
- Ranitidine (Zantac) - Pepsid (famotidine) and Tagamet (cimetidine) |
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What is this teratogen?
- treatment for nausea during pregnancy - category C |
Tigan: act on chemoreceptor trigger zone in the medulla oblongata
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What is this drug?
- antihistamine H2 receptor antagonist - treatment for nasea during pregnancy - category B |
- Ranitidine (Zantac)
- Pepsid (famotidine) - Tagamet (cimetidine) |
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Name a non-medical treatment for nausea during pregnancy.
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Sea bands
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Name three teratogenic recreational drugs.
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- alcohol
- crack - tobacco |
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What is the cause of the baby's condition?
- mental retardation - growth deficiencies - CNS dysfunction - craniofacial abnormalities - behavioral maladjustment |
fetal alcohol syndrome
- fetus has little or no EtOH dehydrogenase in the liver |
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What is the cause of the baby's condition?
- lethargy - irritable, easily overstimulated - unconsolable - shun physical contact - ADHD - detachment |
crack baby
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What is the biggest substance abuse during pregnancy?
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smoking
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What is the cause of this?
- spontaneous abortion - abnormal placental implatation - premature placental detachment - low birth weight - vaginal bleeding - premature delivery - SIDs - perinatal death - asthma and other respiratory problems |
smoking during pregnancy
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What would the baby have if mon smoked 21 cigarettes per day during pregnancy?
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cleft palate (70% risk)
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Name some teratogenic dietary supplements.
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- blue cohosh
- flase unicorn root, Hellebore - Hemlock - Tragacanth |
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What is the cause of this in a baby?
- cerebral palsy - mental retardation - skeletal dysplasia - cleft palate - siamese twinning - hydratidiform mole |
agent orange baby
- toxic defoliants (agent orange) |
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What is this teratogen?
- treatment against organophosphate exposure for soldiers - also treat for myasthenia gravis - able to cross BBB and maternal-fetal barrier - cause apoptosis and cell death in testicular tissue |
pyridostigmine
- binds reversibly to active site in acetylcholinesterase - prevents nerve agent from binding long enough for the body to break down the nerve agent |
