Teratogens

Question 1

def. teratogen

Answer 1

an agent that may have a negative effect on the baby

Question 2

5 possible teratogen effects

Answer 2

1. preg. loss
2. congenital malformations
3. neurobehavioral
4. IUGR
5. long term carcinogen

Question 3

2 classes of malformation

Answer 3

1. major - require intervention

2. minor - traits with no serious or cosmetic consequence

Question 4

** what is baseline risk of malformation

Answer 4

1-3%

Question 5

2 major risk for malformation

Answer 5

1. unknown
2. genetic
   drugs are 1%

Question 6

what is all or none period

Answer 6

time after fert and before implantation (12 days after ovulation)
- either kills or is fine

Question 7

when is are most structures developed by and 2 exception

Answer 7

done by end of T1 except brain and eye

Question 8

when does placenta play a role

Answer 8

5 weeks

- won;t let some drugs through

Question 9

4 mechs. of teratology

Answer 9

1. control of cell division
2. apop
3. gene expression
4. cell metabolism

Question 10

6 mech of toxicity

Answer 10

1. hyperthermia
2. hypoxia
3. acid base
4. reduced uterine flow
5. elevated cortisol
6. def. of zinc

Question 11

4 maternal conditions that are teratologic

Answer 11

1. diabetes - hyperglycemia - cardiac, neural tube, macrosomia
2. hypothyroidism - decrease IQ
3. chronic renal failure - oligohydro
4. conditions with antibodies -SLE, graves

Question 12

5 major maternal infections

Answer 12

Toxoplasmosis
Other (syph, varicella)
Rubella
Cytomegalovirus
Herpes simplex

Question 13

6 bad drugs

Answer 13

1. accutane - miscarriage and malformations
2. thalidomide - flippers (phocomegaly)
3. warfarin 6-9 weeks
4. anticonvulsants
5. ACEi
6. lithium

Question 14

when is warfarin risk

Answer 14

6-9 weeks - facial defects

Question 15

4 anticonvulsants and their risks

Answer 15

1. carbamazepin - 1% risk of NTD
2. lamotragine - no effects
3. valproic acid - 2% risk of NTD, others possible
4. phenytoin (dilantin) - craniofacial, impaired growth - 10%

Question 16

when is ACEi effect and what

Answer 16

back in T2-3

- oligouria, low BP - polyhydramnios

Question 17

what is effect of lithium

Answer 17

ebsteins abnormality

Question 18

5 classes of FDA

Answer 18

A - no risk human studies
B - no risk in human studies, but yes in animals
C- animals studies bad - no human studies
D- poor quality studies
x- contraindicated

Question 19

2 probs with FDA

Answer 19

1. not always updated

2. need RCTs which preg women are excluded from

Question 20

how to anticoagulate a preg. woman

Answer 20

heparin - large and can’t pass

Question 21

what to use for asthma

Answer 21

1. bronchdilator - safe
2. inhaled steroids - safe
3. systemic steroid - some probs

Question 22

what is radiation principle

Answer 22

ALARA - need 5-15rads to cause prob- all are way below 5

Question 23

2 env. exposures

Answer 23

1. organic solvents

2. mercury - avoid big fish and 1 can tuna/week

Question 24

traid of FAS

Answer 24

1. growth retard
2. dysmorphic features
3. decreased IQ and behav issues

Question 25

3 prevention strategies

Answer 25

1. folic acid before preg - high dose if high risk 2. multivitamin throughout 3. US at 18 weeks

Question 26

what is breastfeeding reccomendation

Answer 26

generally safe - keep to 10% of maternal dose