teratogens

Question 1

teratogens effects according to period

Answer 1

before week 3 –> all-or-none
3-8 weeks (embryonic period - most suscpetible)
after 8 weeks –> growth and function affected

Question 2

Antibiotics to avoid in pregnancy (and why)

Answer 2

1. Sulfonamides –> Kernicterus
2. Amniglycosides –> Ototoxicity
3. Fluoroquinolones –> Cartilage damage
4. macrolides –> embryotoxic
5. tetracyclines –> DIscolored teeth, inhibiton of growth
6. Chloramphenicol –> Gray babe syndrome
7. Griseofluvin –> teratogenic
8. Ribavirin (antiviral)

Question 3

drugs and substance that affect pregnancy (beside antibiotics) (14)

Answer 3

1. ACE inhibitors 2. Alkylating agents 3. Antiepileptics
2. Diethylstibestrol 5. Folate antagonists
3. Isotretinoin 7. Lithium 8. Methimazol
4. Thalidomide 10. Warfarin 11. Alcohol 12. Cocaine
5. Smoking (nicotine, CO) 14. others factors

Question 4

Alkylating agents - effects on fetus

Answer 4

1. absence of digits

2. multiple anomalies

Question 5

Warfarin - effects on fetus

Answer 5

1. bone deformities
2. fetal hemorrhage
3. abortion
4. opthalmologic abnormalities

Question 6

Methimazole - effects on fetus

Answer 6

aplasia cutis congenita

Question 7

thalidomide - effects on fetus

Answer 7

limb defects (phocomelia, micromelia - flipper limbs)

Question 8

phocomelia

Answer 8

a rare congenital deformity in which the hands or feet are attached close to the trunk, the limbs being grossly underdeveloped or absent.

Question 9

micromelia

Answer 9

limb is abnormally shortened

Question 10

isotretinoin (13-cis retinoic acid) - effects on fetus

Answer 10

multiple severe birth defects (contraception mandatory)

Question 11

Folate antagonists - effects on fetus / drugs?

Answer 11

neural tube defects

1. TMP
2. Methotrexate
3. antiepileptic drugs

Question 12

Complications of DES daughters

Answer 12

1. clear cell adeno of vagina + cervic
2. stractureal anomalies of the reproductive syystem
3. pregnancy problems
4. infertility

Question 13

antiepileptic drugs - effects on fetus

Answer 13

1. neural tube defects
2. cardiac defects
3. cleft palate
4. skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism)

Question 14

antiepileptic drugs that affect fetus - which drugs Most commonly

Answer 14

1. carbamazepine
2. phenobarbital
3. phenytoin
4. valproate

Question 15

antiepileptic drugs - co-administration with

Answer 15

high dose of follate acid

Question 16

substance abuse that affects fetus

Answer 16

1. Alcohol
2. cocaine
3. Smoking (nicotine, CO)

Question 17

alchohol abuse - effects on fetus

Answer 17

1. common cause of birth defects and intellectual disability
2. fetal alcohol syndrome

Question 18

cocaine abuse - effects on fetus

Answer 18

1. low birth weight
2. preterm birth
3. Intrauterine growth restriction (IUGR)
4. placental abruption

Question 19

smoking - effects on fetus

Answer 19

1. Low birth weight (leading cause in developed countries)
2. preterm labor
3. placental problems
4. Intrauterine growth restriction (IUGR)
5. SIDS

Question 20

iodine (lack or excess) - effect on fetus

Answer 20

congenital goiter or hypothiroidism (cretinism)

Question 21

Methylmercury - effect on fetus / found

Answer 21

NEUROTOXICITY

1. swordfish
2. shark
3. tilefish
4. king mackerel

Question 22

Vitamin A excess - effect on fetus

Answer 22

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac)

Question 23

X-rays - effect on fetus

Answer 23

1. Microcephaly

2. intellectual disability

Question 24

Leading cause of low body weight in in developed countries

Answer 24

smoking

Question 25

Leading cause of intellectual disability in USA / mechanism

Answer 25

Fetal alcohol syndrome --> failure of cell migration

Question 26

newborns of alcohol consumption mothers have increased incidence of congenital abnormalities, including

Answer 26

1. pre and postnatal developmental retardation 2 2. microcephaly 3. facial abnormalities 4. limb disolocation 5. heart defects 6. heart-lung fistulas 7. holoprosencephaly

Question 27

Fetal alcohol syndrome - Most severe form

Answer 27

1. heart-lung fistulas | 2. holoprosnecephaly

Question 28

Fetal alcohol syndrome - facial abnormalities

Answer 28

1. smooth philtrum 2. thin vermilion border (upper lip) 3. small palpebras fissures

Question 29

drugs that affect bone/limbs of fetus (and how)

Answer 29

1. Warfarin (bone deformities) 2. tetracyclines (inhibited bone growth) 3. thalidomide (limb defects (phocomelia, micromelia - flipper limbs)) 4. alcohol (limb disolocation) 5. antiepileptics (skeletal abnormalities (phalanx/nail) hypoplasia, facial dysmorphism)

Question 30

Males exposed to DES in the utero - complciations

Answer 30

cryptorchidism microphallus hyposadias testicular hypoplasia

Question 31

azathiprine in pregnancy

Answer 31

safe

Question 32

lithium exposure during pregnancy

Answer 32

1st trimester: Ebstein anomaly | 2nd and 3rd trimester: goiter and neonatal neuromuscular dysfunction

Question 33

woman under lithium becomes pregnant --> ....

Answer 33

slow tapering lithium | no abrupt stopping

Question 34

inhale steroids during pregnancy

Answer 34

ok

Question 35

fetal hydantion syndrome

Answer 35

small body size, microcephali, digital hypoplasia, nail hypoplasia, hirsutism, cleft palate, rib abnormalities - phenytoin, carbamazepine