Special Pops
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Anticonvulsants 1st gen: CBZ, PHB, PHT, Primidone, VPA 2nd gen: Lamotrigenes | 1st trimester 3rd trimester | Structural defects
Hemorrhagic disease
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| Anti-infectives | Kanamycin, Streptomycin (throughout pregnancy), Fluconazole >400mg/d (1st trimester), Quinine @toxic doses (1st trimester), Tetracycline (>4mos) |
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| Anti-neoplastics | Busulfan (1st trimester), Cyclophosphamide (1st trimester), MTX >10mg/wk (6-8wks), Tamoxifen |
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| Corticosteroids | < 10 weeks Throughout pregnancy | Oral clefts [2-7x risk] Growth restriction [if prolonged therapy] | Cleft lip + palate
Growth restriction (300-400g)
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| B1-Blockers | 2nd - 3rd trimester | Dose and duration dep | ↓ placental weight, birth weight. IUGR.
d/t decreased fetal perfusion
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| Diethylstilbestrol | 10-18 week up to 20 weeks | Vaginal adenocarcinoma Genital defects | Female and male genital defects, infertility,
preterm birth, ectopic pregnancy, ↑SABs
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| Iodine | 2nd - 3rd trimester | Dose and duration dep | Hypothyroidism, goiter
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| Lithium | 1st trimester 3rd trimester | cardiac defects newborn toxicity | Various heart defects
Ebstein's anomaly (downward displacement
of triscuspid valve to right ventricle)
Toxic effects: cyanosis, hypotonia, bradycardia, atrial flutter, Twave
inversion, cardiomegaly, GI bleed, sz, diabetes insipudius,
shock, hepatom
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| Methylene blue | 2nd - 3rd trimester | 20% jejunal-ileal astresias | Fetus: jejunal-ileal astresias --> death
Newborn: hyperbilil, hemolytic anemia,
methemoglobinemia
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| Methimazole Carbimazole | Up to 9 weeks after LMP | Low | Pattern of rare defects --> Scalp or patchy hair defects, choanal atresia, esophageal
atresia w/ fistula, minor facial anomalies, hypoplast/absent
nipples, hypothyroidism, goiter
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| Misoprostol | 1st trimester (esp 6-8wk) | 7x for Mobius syndrome | Abortion, Mobius syndrome, defects of
cranium/scalp, oral cleft, etc
Mobius: 6th and 7th nerve palsies
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| Mycophenolate | 1st trimester | SAB (spont.abortion)- 45% Defects -22% | Defcts of external ear, face, oral clefts,
heart, kidney, esophagus, distal limbs
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| NSAID | 1st trimester > 32 weeks | SAB, ASD/VSD Patent ductus Arteriosus, renal toxicity | SAB, cardiac tox, renal tox
Premature closure DA - reversible
Patent DA - irreversible
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| Penicillamine | Unknown | <5% | Cutis laxa
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| SSRI's | 1st trimester >20 weeks | --> SAB/PPHN: 2-6% --> neonatal withdrawal: 30% | Birth defects, SAB
Withdrawl, PPHN (persistent
HTN of newborn)
Cardiac toxicity, SAB, carniosynostosis, omphalocele,
anencephaly, gastroschisis, low birth weight, PPHN,
neurobehavior defcts
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| Trimethoprim | 1st trimester | Unknown | Cardiovascular
Can also cause oral cleft, urinary tract, and neural tube defect
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| Thalidomide | 35-40 days after 1st day of LMP [50-100mg/d] | 20-30% | Defects of limbs, skeletal defects,
craniofacial, CNS, major organs
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| Vitamin A (Acitretin- Etretinate, Accutane) | 15 days after conception to end of 1st trimester | 30-50% | SAB, CNS, craniocial, cardiovascular, thymus
gland, miscellaneous
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| Warfarin | 6th - 9th week - throughout | --> fetal warfarin syndrome 5-10% --> CNS defects 4-5% | Fetal warfarin syndrome, CNS, optic, cardiac, IUGR
(warfarin has very long half life)
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| Alcohol | Throughout | NO SAFE DOSE!!! Can cause fetal alcohol syndrome, disruption of NTs (Glutamate, GABA) | IUGR + MR + Facial anomalies=classical triad
Microcephaly, long term neurobehavioral
abnormalities
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| Cigarette smoking | 1st trimester 2nd - 3rd trimester | -> Malformations, SAB -> growth |
Cleft lip, club foot, cardiac defects,
carniosynostosis, Poland syndrome,
transverse limb reduction
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| Toluene | Unknown | Unknown | Similar to FAS
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| Cocaine | Unknown | Unknown | Causes vascular disruption -- SAB, stillbirths,
IUGR, preterm delivery, etc
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| ACE-I, ARBs | 2nd - 3rd trimester | Dose / duration dependent | Renal failure, IUGR, hypocalvaria, hypotension
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| Androgenic hormones | 8-13th week 2nd - 3rd trimester | Unknown | Masculinization of female fetus
(labial fusion, and clitoral hypertrophy)
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