teratogenicity

Question 1

what is considered a major teratogen?

Answer 1

includes teratogenicity of an organ or organ system

Question 2

what is considered a minor teratogen?

Answer 2

hernias, ear tags, extra fingers/toes

Question 3

when a mother is more likely to remember each medication that she took when her child is sick vs a mother of a healthy baby

Answer 3

recall bias

Question 4

true or false: the placenta is a barrier

Answer 4

false

Question 5

what is the most common mode of transfer to the placenta?

Answer 5

passive diffusion

Question 6

what molecular weight of drugs can easily pass through the placental barrier?

Answer 6

<500 Da

Question 7

what are the 4 characteristics of medications that allow them to ross the placental barrier?

Answer 7

1. low molecular weight
2. highly lipid soluble
3. unionized
4. protein binding

Question 8

when can major teratogenicity occur?

Answer 8

week 3-8

Question 9

when can minor teratogenicity occur?

Answer 9

week 8-birth

Question 10

what is used to convert folate to its naturally active form?

Answer 10

vitamin b12

Question 11

what is the main drug class that is seen to have folate antagonism?

Answer 11

anticonvulsants

Question 12

what anticonvulsant has lower risks of birth defects?

Answer 12

keppra

Question 13

what are 3 medications that can cause neural crest cell disruption?

Answer 13

1. bosentan
2. isotretinoin
3. ketoconazole

Question 14

what must patient register with when taking isotretinoin?

Answer 14

iPLEDGE

Question 15

what are 3 requirements with ipledge?

Answer 15

1. must sign informed consent
2. must see a doctor every month
3. female patients must have a pregnancy test every month and get the prescription filled within 7 days

Question 16

what are 3 medications that can cause hormone disruption?

Answer 16

1. drugs used in fertility treatment
2. oral contraceptives
3. 5-alpha reductase inhibitors (finasteride)

Question 17

true or false: female development is more susceptible to endocrine disruption due to greater hormone dependence

Answer 17

false (males)

Question 18

true or false: finasteride is a pregnancy category x

Answer 18

true

Question 19

what are 3 medications that can cause oxidative stress?

Answer 19

1. class III antiarrhythmics
2. terbutaline
3. phenytoin
4. tetracycline
5. valproic acid
6. thalidomide

Question 20

what are 4 medications that can cause vascular disruption?

Answer 20

1. antihypertensives (ACEi/ARBs!)
2. aspirin
3. ephedrine
4. NSAIDs

Question 21

what should you tell patinets about the drugs that can cause vascular disruption?

Answer 21

requires pre-pregnancy counseling: timing is important

Question 22

when should you avoid the use of ACEi/ARBs?

Answer 22

in the second and third trimester

Question 23

when should you avoid aspirin use?

Answer 23

not recommended at any dose or trimester

Question 24

when can aspirin be used?

Answer 24

if low dose and the patient has preeclampsia or as an alternative to warfarin

Question 25

if you use regular dose aspirin close to delivery, what may happen?

Answer 25

premature closure of the ductus arteriosus

Question 26

if the ductus arteriosus is closed prematurely, what may happen?

Answer 26

hyperoxygenated blood and potential for pulmonary hypertension

Question 27

what are 2 drugs that can cause the premature closure of the ductus arteriosus?

Answer 27

1. aspirin 2. NSAIDs

Question 28

true or false: statins can be used in pregnancy since it has a category C rating

Answer 28

false (category x)

Question 29

what is needed for the normal growth patterns in embryonic tissues?

Answer 29

cholesterol

Question 30

what SSRI has the highest risk of fetal complications?

Answer 30

paroxetine

Question 31

if an SSRI needs to be used, what is recommended before the baby is born?

Answer 31

tapering and discontinuing the medication 2 weeks prior to birth

Question 32

what antipsychotics have a tendency to cause neonatal toxicity and withdrawal?

Answer 32

the first generations (haloperidol) and risperidone

Question 33

true or false: oral anticoagulants are not recommended in pregnancy

Answer 33

true

Question 34

true or false: heparins can be used in pregnancy

Answer 34

true

Question 35

what is recommended as first line in patients who need anticoagulation?

Answer 35

low molecular weight heparin

Question 36

why can heparins be used in pregnancy?

Answer 36

they do not cross the placental barrier

Question 37

what are 3 main differences with the new FDA risk classifications?

Answer 37

1. removes pregnancy letter categories 2. also includes men and fertility 3. changed labor and delivery to lactation

Question 38

the availability of a pregnancy registry can be seen where?

Answer 38

in the patient counseling information section

Question 39

what are 5 things that any medication that is contraindicated in pregnancy must have listed first in the risk summary?

Answer 39

1. risk based on human data 2. risk based on animal data 3. risk based on pharmacology 4. background risk info in general population 5. background risk info in disease population

Question 40

for pregnant women or women looking to conceive, what should they limit their caffeine intake to?

Answer 40

<200-300 mg/day

Question 41

what can occur if a patient drinks alcohol while pregnant?

Answer 41

fetal alcohol syndrome disorder

Question 42

what can the use of nicotine during pregnancy cause?

Answer 42

impaired fetal oxygenation

Question 43

what are 2 things that can be used in replacement of opioids?

Answer 43

1. methadone 2. buprenorphine

Question 44

what is is called when a neonate has a sensation of withdrawal symptoms from an opioid or opiate?

Answer 44

neonatal abstinence syndrome

Question 45

when is the risk of neonate abstinence syndrome low?

Answer 45

after 1 week of birth

Question 46

what is the treatment for a neonate experiencing NAS?

Answer 46

1. morphine 2. methadone

Question 47

when can patients use marijuana during pregnancy?

Answer 47

should not use marijuana during both pregnancy and lactation

Question 48

what can happen to the baby if the mom used cocaine during pregnancy?

Answer 48

1. preterm birth 2. low birth weight 3. small for gestational age

Question 49

true or false: amphetamines can cross the placenta barrier

Answer 49

true