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Final study guide

Teratogen Any environmental agent sucha s a drug, chemical infection or pollutant which potentially harms the developing fetus
FDA Guidelines only apply to... pregnant women
FDA Guidelines A Adequate studies in pregnant women have not demonstrated risk
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
FDA Guidelines C Animal studies show risk but there are no human studies OR there are no studies in humans or laboratory animals
FDA Guidelines D Evidence of human risk but benefits may make use acceptable
FDA Guidelines X Studies show risk; risk of use clearly outweighs any possible benefit
Dangers of relying on FDA Pregnancy Categories 1. Prevent quality clinical assessment of original studies 2. Only useful for prescribing, not retrospective risk assessment
What do you need to utilize other resources? 1. Known teratogenic exposure 2. Complicated inquiry 3. Patient anxiety 4. Conflicting opinions
Strategies to Reduce Risk for previous ONTD mg of folic acid prior to and during pregnancy
What plays into the effects of a teratogenic exposure? 1. Route 2. Timing (critical period) 3. Dosage 4. Duration 5. genotype of fetus
Background risk for a baby to have a congenital anomaly is 3%
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.
Anticonvulsants: Worst one... Depakote, Dilatin, Phenobarbatal
Chemotherapeutic agents 1. Malformations 2. IUGR 3. Pancytopenia 4. CNS damage 5. Pregnancy loss 6. Cardiomyopathy 7. Prematurity 8 MR 9 Limb anomalies
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
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
Anticonvulsants... potential risks 1. Malformations 2. OB complications 3. hemorrhage and other problems in the newborn, 4 developmental delays 5. behaviorial problems
Anticonvulsant embryopathy 1. Broad depressed nasal bridge 2. short nose with anteverted nares 3. Long philtrum 4. Maxillary hypoplasia 5. fingernail hypoplasia
Androgenic hormones Masculinization of the female fetus, dose-dependent and critical period 8-13 weeks (labial fusion) later in pregnancy (clitoral hypertrophy)
DES critical period of development (andro. hormone) up to 20 weeks gestation, highest risk for adenocarcinomas between weeks 10 and 13
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
Retinoids Isotretinoin, etretinate, tretinoin, dietary vitamin A, Patterns of malformations: CNS anomalies, ear anomalies, cardiovascular defects, thymus anomalies, intellectual deficiency
Critical period for isotretinoin/Retinoids 15th day following conceptions through the end of the first trimester of pregnancy.
Tetracycline increased risk for defects of primary teeth beyond the 4th month ofpregnancy, (binds to calcium)
Streptomycin hearing loss (damage to the 8th nerve)
Thalidomide Phocomelia, amelia, heart defects, renal and genitourinary anomalies, oral clefts, anomalies of the eyes and external ears
Warfarin stippled epiphyses (between 6 and 9 weeks gestation)
Critical period for NTDs 4-6 weeks
Critical period for MR 7-16 weeks
less critical period for CNS 32-38 weeks
Critical period for TA, ASD, and VSD 3/5 through 6 weeks
less critical period for heart 6 2/3rd through 8 weeks
Critical period for amelia/meromelia 4 weeks to 6 weeks
Less critical period for upper limb 6 weeks to 9 weeks
Less critical period for lower limb 6 weeks to 9 weeks
Critical period for cleft lip weeks 5 and 6
less critical period for upper lip weeks 7 and 8
Low-set malformed ears and deafness weks 4 through 9
less critical period ears weeks 9 through 16
Critical period for microhthalmia, cataracts and glaucoma weeks 4 through 8
less critical period for eyes weeks 8 through birth
critical period for enamal hypoplasia and staining weeks 7 and 8
less critical period for teeth weeks 9 through birth
critical period for cleft palate weeks 7 and 8
less critical period and palate week 9
critical period for masculinization of female genitalia weeks 7, 8 and 9
less critical period for external genitalia weeks 16 and 38
What drugs are associated with clefting? glucocorticoids and anticonvulsants
Chemotherapeutic agents critical period 8-10 weeks gestation
ACE Inhibitors critical period Second and third trimester
Androgenic hormones critical period 8-13 weeks gestation
Created by: KChatham
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