Final study guide
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| Teratogen | Any environmental agent sucha s a drug, chemical infection or pollutant which potentially harms the developing fetus
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| FDA Guidelines only apply to... | pregnant women
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| FDA Guidelines A | Adequate studies in pregnant women have not demonstrated risk
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| FDA Guidelines B | Animal studies have not demonstrated risk but no studies in pregnant women OR animal studies suggest risk but human studies have not shown risk
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| FDA Guidelines C | Animal studies show risk but there are no human studies OR there are no studies in humans or laboratory animals
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| FDA Guidelines D | Evidence of human risk but benefits may make use acceptable
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| FDA Guidelines X | Studies show risk; risk of use clearly outweighs any possible benefit
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| Dangers of relying on FDA Pregnancy Categories | 1. Prevent quality clinical assessment of original studies 2. Only useful for prescribing, not retrospective risk assessment
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| What do you need to utilize other resources? | 1. Known teratogenic exposure 2. Complicated inquiry 3. Patient anxiety 4. Conflicting opinions
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| Strategies to Reduce Risk for previous ONTD | mg of folic acid prior to and during pregnancy
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| What plays into the effects of a teratogenic exposure? | 1. Route 2. Timing (critical period) 3. Dosage 4. Duration 5. genotype of fetus
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| Background risk for a baby to have a congenital anomaly is | 3%
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| Lithium | 1. Ebsteins anomaly, recommended fetal echocardiogram at 20 weeks, 3rd trimester use associated with neonatal cyanosis, hypotonia, disturbances of cardiac rhythm, diabetes insispidus and hypothyroidism.
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| Anticonvulsants: Worst one... | Depakote, Dilatin, Phenobarbatal
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| Chemotherapeutic agents | 1. Malformations 2. IUGR 3. Pancytopenia 4. CNS damage 5. Pregnancy loss 6. Cardiomyopathy 7. Prematurity 8 MR 9 Limb anomalies
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| ACE Inhibitors | Critical period of exposure: Second and third trimester IUGR, Hypocalcaria manifested by very large anterior fontanel, persistent PDA, renal tubular dysplasia leading to oligohydramnios and Potter's sequence
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| ACE inhibitors mechanism of action | reduce uterine blood flow, leading to decreased placental perfusion and severe fetal hypotension. Block fetal ACE activity, thereby affecting systemic and renal hemodynamics in the fetus
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| Anticonvulsants... potential risks | 1. Malformations 2. OB complications 3. hemorrhage and other problems in the newborn, 4 developmental delays 5. behaviorial problems
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| Anticonvulsant embryopathy | 1. Broad depressed nasal bridge 2. short nose with anteverted nares 3. Long philtrum 4. Maxillary hypoplasia 5. fingernail hypoplasia
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| Androgenic hormones | Masculinization of the female fetus, dose-dependent and critical period 8-13 weeks (labial fusion) later in pregnancy (clitoral hypertrophy)
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| DES critical period of development (andro. hormone) | up to 20 weeks gestation, highest risk for adenocarcinomas between weeks 10 and 13
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| Fluconazole (Andro. hormone) | Antley-Bixler like phenotype, Pattern of malformations: brachycephaly, craniosynostosis, proptosis, low nasal brdige, cleft palate, femoral bowing, thin ribs and long bones' joint contractures, congenital heart defects
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| Retinoids | Isotretinoin, etretinate, tretinoin, dietary vitamin A, Patterns of malformations: CNS anomalies, ear anomalies, cardiovascular defects, thymus anomalies, intellectual deficiency
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| Critical period for isotretinoin/Retinoids | 15th day following conceptions through the end of the first trimester of pregnancy.
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| Tetracycline | increased risk for defects of primary teeth beyond the 4th month ofpregnancy, (binds to calcium)
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| Streptomycin | hearing loss (damage to the 8th nerve)
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| Thalidomide | Phocomelia, amelia, heart defects, renal and genitourinary anomalies, oral clefts, anomalies of the eyes and external ears
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| Warfarin | stippled epiphyses (between 6 and 9 weeks gestation)
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| Critical period for NTDs | 4-6 weeks
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| Critical period for MR | 7-16 weeks
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| less critical period for CNS | 32-38 weeks
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| Critical period for TA, ASD, and VSD | 3/5 through 6 weeks
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| less critical period for heart | 6 2/3rd through 8 weeks
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| Critical period for amelia/meromelia | 4 weeks to 6 weeks
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| Less critical period for upper limb | 6 weeks to 9 weeks
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| Less critical period for lower limb | 6 weeks to 9 weeks
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| Critical period for cleft lip | weeks 5 and 6
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| less critical period for upper lip | weeks 7 and 8
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| Low-set malformed ears and deafness | weks 4 through 9
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| less critical period ears | weeks 9 through 16
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| Critical period for microhthalmia, cataracts and glaucoma | weeks 4 through 8
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| less critical period for eyes | weeks 8 through birth
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| critical period for enamal hypoplasia and staining | weeks 7 and 8
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| less critical period for teeth | weeks 9 through birth
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| critical period for cleft palate | weeks 7 and 8
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| less critical period and palate | week 9
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| critical period for masculinization of female genitalia | weeks 7, 8 and 9
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| less critical period for external genitalia | weeks 16 and 38
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| What drugs are associated with clefting? | glucocorticoids and anticonvulsants
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| Chemotherapeutic agents critical period | 8-10 weeks gestation
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| ACE Inhibitors critical period | Second and third trimester
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| Androgenic hormones critical period | 8-13 weeks gestation
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Created by:
KChatham
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