Neonatal Flashcards
(43 cards)
What are the most used maternal drugs that effect the fetus?
Antibiotics
Do most drugs cross the placenta?
Yes… nearly all. Short and long term effects to fetus possible.
What types of drugs usually cross placenta?
Lipophilic Non-ionized Low Molecular weight Non-protein bound free Unmetabolized
What is the molecular weight cut off for placental crossing?
1000 will not cross
What is variable in placental drug exposure?
genetic polymorphisms
How does the placenta metabolize drugs?
Aromatic oxidation:
hydroxylation
alkylation
methylation
What percent of fetal blood goes directly into fetal liver?
40-60%
What 6 ways can drug cause teratogenicity?
- folate
- neural crest
- endocrine
- ROS
- vascular
- receptor/enzymes
* NSAIDS
* SSRIs
What does thalidomide cause?
phocomelia (seal limbs)
What must a drug show to be called a teratogen?
- classic defined effects
- stage of effect
- dose dependency
What percent of US pregnancies are unplanned?
50%
What percent of births have some defect?
4% - not all from drugs though
What is of utmost importance in teratagenicity?
Timing of exposure
What do earlier exposures cause? later?
Early: organs
Late: psychologic
What two species are drugs usually tested in?
Rat
Rabbit
What are SSRIs used to treat? Does this cause problems?
Depression: chronic lipophilic drug can cause problems
What are pregnancy exposure registries?
Women can volunteer their experiences with any drug in pregnancy
What can a retrospective cohort study not establish?
Causality: can only show associations
Bias and time-elapsed recall are problems
What can show causality?
Case control study
What did the 2007 FDA act do?
Post marketing surveillance
What is a major teratogen in acne treatment?
Isotretinoin: ignorant women ignore labels!
What does SSRIs cause in fetus?
Pulmonary artery HTN
What is Cat A? B? C? D? X?
A: no effect in animals and women
B: animals ok, women untested. OR animals effected, women unaffected
C: Animal positve, women untested (or neither)
D: Risk to fetus: balance need
X: risk to fetus outweighs benefit to mother
What is Cat A?
No effect in animals or women in 1st trimester
No evidence of 2nd or 3rd trimester effect
