Teratology , Drugs And Medication Flashcards
(139 cards)
0
Q
This refers to agents that produces STRUCTURAL ABNORMALITIES
A
Teratogen
1
Q
Teratogen is derived from Greek word teratos which means?
A
Monsters
2
Q
Most of the major structural abnormalities are easily seen at ___ and an association with a specific ___ exposure is likely to be suspected
A
Birth
Prenatal
3
Q
Agent that interferes with normal MATURATION and FUNCTION of an organ
A
Hadegen
4
Q
This refers to an agent that alters growth
A
Trophogen
5
Q
Criteria for proof of human teratogenicity: (7)
A
- Careful delineation of clinical cases
- Rare environment exposure associated with rare defect with at least three reported cases
- Proof that agents acts on embryo or fetus, direct or indirectly
- Proven exposure to agent at critical times in prenatal development
- Association must be biologically plausible
- Consistent findings by two or more epidemiological studies of high quality
- Teratogenicity in experimental animals especially primates
6
Q
This is the period of 2 weeks from fertilization to implantation
A
Preimplantation period
7
Q
This is called the “all or none” period
A
Preimplantation period
8
Q
Teratogens in the preimplantation period in animals can produce a ___ dependent diminution in ___ or ____
A
Dose dependent
Body length and size
9
Q
This is the critical period from the 2nd to the 8th week following conception
A
Embryonic period
10
Q
This is the most crucial with regard to structural malformations
A
Embryonic period
11
Q
This pertains to the 9th week to term, in which functional maturation may be involved
A
Fetal period
12
Q
Alteration in the cardiac blood flow can result in ___ an example of which involves (2)
A
Deformations
Hypoplastic left heart or aortic coarctation
13
Q
Category of drugs that shows studies in pregnant women have not shown an increased risk for fetal abnormalities
A
Category A
14
Q
This category of drugs if administered during the first, second, and third trimester of pregnancy the possibility of fetal harm appears remote
A
Category A
15
Q
Fewer than __ percentage of all medication are within the category A
A
1
16
Q
Examples of category A drug
A
Levothyroxine
Potassium supplementation
Prenatal multivitamins
17
Q
This category shows that animal reproduction studies have shown adverse effect but adequate and well controlled studies in pregnant women have failed to demonstrate a risk to the fetus during the first trimester and in the later trimesters
A
Category B
18
Q
Drugs under the category B
A
Antibiotics: Penicillins, Macrolides, Cephalosporins
19
Q
This category shows that animal reproduction studies have shown that this medication is TERATOGENIC or EMBRYOCIDAL or Adverse effect and there are no adequate and well controlled studies in pregnant woman
A
Category C
20
Q
Examples of drugs under category C
A
Albuterol Zidovudine Lamivudine Beta blocker Calcium channel blocker
21
Q
Category of this medication causes fetal harm when administered to pregnant woman
A
Category D
22
Q
If this drug categories is used during pregnancy or if a woman becomes pregnant while taking this medication, she would be apprised to the potential hazard to the fetus
A
Category D and X
23
Q
This category of drugs usually contains medications used to treat potentially life threatening medical conditions
A
Category D
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Examples of category D
```
Systemic corticosteroids
Azathioprine
Phenytoin
Carbamazepine
Lithium
Valproic acid
```
25
This category of medication is contraindicated in women who are or may become
Category X
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An example of a category X medications
Rubella vaccines
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List the possible disturbances of specific pathogenic processes
Cell death
Altered tissue growth
Abnormal cellular differentiation
Abnormal development
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Folic acid metabolism can cause the following:
Neural tube defects
Cardiac defects
Cleft lip and palate
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Drugs that can interfere with folic acid metabolism
Hydration
Phenobarbital
Valproic acid
Carbamazepine
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Treatment for folic acid metabolism distrubances
Folic acid supplementation
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The mutations of this gene can cause neural tube defects
Tetrahydrofolate reductase 677C
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Hydantoin can cause a homolozygous gene mutation of low ____
Epoxied hydroxylase activity
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Cigarette smoking and cleft palate cause the polymorphism in the gene of __
Transforming growth factor alpha-1
34
This are regulatory genes that encodes nuclear proteins to control the expression of other developmentally important genes
Homeobox genes
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Retinoic acid can prematurely activate the homeobox gene that can cause _____
Severe hindbrain and limb abnormalities
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Valproic acids activates the homeobox genes that regulates the ___ skeletal patterning in turns causes ___ in the ___
Axial
Neural tube defects
Lumbosacral region
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Paternal exposure may either involve:
Genetic mutation or chromosomal anomaly in the sperm
| Drug in the seminal fluid can expose the fetus during intercourse
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Drugs that can cause changes in the gene expression and imprinting in the paternal exposure
```
Ethyl alcohol
Cyclophosphamide
Lead
Opiates
Mercury
Solvents
Pesticide
Anesthetic gases
Hydrocarbons
```
39
Fetal alcohol syndrome diagnostic criteria
Dysmorphic facial feature
Prenatal and/or postnatal growth impairment
CNS abnormalities
40
Dysmorphic facial features in fetal alcohol syndrome involves:
Small palpebral fissure
Thin vermilion border
Smooth philtrum
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Women ingesting ___ or more drinks of alcohol per day throughout pregnancy have a ____ risk of fetal alcohol syndrome
8
| 30-50%
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Most frequent abnormalities brought about by anticonvulsant ingestion:
Orzo facial clefts
| Congenital heart defects
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This drug's teratogenicity is strongly influenced by genetic make up of low activity of fetal epoxied hydroxylase
Phenytoin
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The used of phenytoin will show 7-10% have sufficient features of the ______ and one third show ____ and ____ anomalies
Fetal hydantoin syndrome
Minor craniofacial
Digital anomalies
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Features of a fetal hydantoin syndrome
```
Upturned nose
Mild midfacial hyplasia
Longer upper lip
Thin vermillion border
Lower distal digital hyplasia
```
46
Used to be considered as the epileptic drug of choice during pregnancy, teratogenic potential unclear
Carbamazepine
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High potential for teratogenicity, abnormalities characteristic of anticonvulsant embryopathy
Trimethadone
| Paramethadone
48
This drug when given in the 1st trimester exposure has a 1-2% risk of spina bifida in the lumbosacral region, also acts directly in the homeobox gene governing caudal structure development
Valproic acid
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This drug when given in the first trimester there will be no structural abnormalities, usually occurs during the fetal period
ACE inhibitors
50
Examples of ACE inhibitors
Enalapril
Captopril
Lisinopril
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ACE inhibitors causes anomalies as a result from prolonged fetal ___ and ____
Hypotension
| Hypoperfusion
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This drug is associated with conjoined twins, and in animal studies shows CNS and Skeletal anomalies
Griseofulvin
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This anti fungal drug is used in immune compromised patients and several reports shows congenital malformation associated with this
Fluconazole
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Fluconazole is associated with this syndrome:
Antley Bixler syndrome
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Antley Bixler syndrome is composed of the following:
Skull abnormalities
Cleft palate
Humoral radial fusion and other arm abnormalities
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Itraconzole is associated with this defect
Limb defects
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In the exposure of exogenous sex hormones prior to ____ completed weeks of gestation has no effect on external structures
7
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The exposure of exogenous sex hormone between ___ to ___ weeks can result to full masculinization of the female fetus and partial effects and genital ambiguity thereafter up to about ___
7-12
| 20
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Hormonal influence on behavior occurs much ___ than on the ____ genitalia and the degree if behavioral alteration is _____ to the ___ and _____ of exposure
```
Later
External
Proportional
Dose
Length
```
60
This disease has an enzymatic deficiency that causes the inability to hydroxylase cortisol precursors which eventually cause female masculinization
Congenital adrenal hyperplasia
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This drug cause the virilization of female fetus wherein there is labioscrotal fusion after first trimester exposure and phallic enlargement later
Testosterone
| Anabolic steroids
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The presence of this drug and specifically this metabolite can cause the virilization of the female fetus and slight increased risk for cardiac defects
Androgenic progestin
| Medroxyprogesterone Acetate
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Weak androgen that may cause female fetus virilization such as CLITOROMEGALY, FUSED LABIA, UROGENITAL SINUS MALFORMATIONS
Danazol
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Virilization of Danazol
Clitoromegaly
Fused labia
Urogenital sinus malformations
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Virilization of the female fetus by Testoterone and Anabolic steroids
Labioscrotal fusion
| Phallic enlargement
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Both a carcinogen and teratogen used to vaginal and cervical clear cell adenocarcinoma in prenatally exposed women
Diethystilbestrol
67
The anomalies associated with Diethylstilbestrol
```
Muller own structural anomalies
Epididymal cysts
Microphallus
Cryptochordism
Testicular hypoplasia
```
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Category of corticosteroids and in animal studies causes ____
Category
Cleft palate
Facial clefts
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Mycophenolate mofetil has this enzyme inhibitor
Inosine monophosphate dehydrogenase inhibitors
70
This drug is used to prevent rejection in kidneys recipients and treatment of autoimmune disease
Mycophenolate mofetil
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The use of Mycophenolate mofetil will increased the risk of the following:
Spontaneous abortions
Ear bilateral microtia
Antonia
Atresia of external auditory canals
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Category of Mycophenolate mofetil
Category D
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To drug is used to treat thyroid malignancies that can ablate the fetal thyroid which increase risk of childhood thyroid carcinoma
Radioactive iodine 131
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This is a known teratogen which the it's effect can hinders the development of the nervous system
Methyl mercury
75
Prenatal exposure to methyl mercury can appear yo cause a disturbance in the neuronal cell division and migration which results to range of defects from:
Developmental delay
Mild neurological abnormalities
Microcephaly and severe brain damage
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This psychiatric medications can cause Ebstein anomaly
Lithium
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Lithium can cause transient neonatal toxicity such as:
```
Hypothyroidism
Diabetes insipidus
Cardiomegaly
Bradycardia
ECG abnormalities
Cyanosis
Hypotonia
```
78
This psychoactive drug can cause cardiovascular anomalies, omphalocele, craniosynostosis, and anacephaly
Paroxetine
| Fluoxetine
79
Neonatal behavioral syndrome includes the following:
```
Jitteriness
Shivering
Increased muscle tone
Feeding or digestive distrubances
Irritability or agitation
Respiratory distress
```
80
Maternal use of SSRI can cause persistent _____ in newborn
Persistent pulmonary hypertension
81
Two forms of vitamin A
Beta carotene
| Retinol
82
A precursor of provitamin A found in fruits and vegetables and has never been shown to cause birth defects
Beta carotene
83
Preformed vitamin A uncertain whether a high dose of vitamin A are teratogenic
Retinol
84
Constriction of the fetal ductus arteriosus and persistent fetal circulation and pulmonary hypertension in neonate
Indomethacin and other PGI
85
With prolonged used of Indomethacin and other PGI, this will ___ urine output and amniotic fluid volume
Decreased
86
NSAIDS are not considered teratogenic but may have reversible fetal effects during the ___ trimester
3rd
87
These are the greatest risk if infant is born within 48 hours after starting the NSAID therapy
Intraverntricular hemorrhage
Pulmonary dysplasia
Necrotizing enterocolitis
88
This can precipitate as neonate withdrawal syndrome
Narcotic analgesic
89
Butorphanol can cause the following:
Respiratory distress
| Neonatal withdrawal with sinusoidal heart pattern
90
Exposure during pregnancy is generally brief and not at toxic levels
Local analgesia and anesthesia
91
This is a pyrimidine synthesis inhibitor used in the treatment of RA
Leflunomide
92
Leflunomide is contraindicated in pregnancy because this shows ___ in animal experiments
Hydrocephalus
Eye anomalies
Skeletal abnormalities
Fetal death
93
Valuable as the first line anti malarial treatment and for chemoprophylaxis
Chloroquine
94
This is reserved for severely ill women and chloroquine resistant malaria
Quinine and quinidine
95
Are there any occurrence of congenital anomalies in mothers using anti malarial drugs in therapeutic dose?
None
96
Daily use of chloroquine for lupus and connective tissue disease has been shown to cause ___
Maternal retinopathy
97
This is used for a symptomatic malaria treatment
Mefloquine
98
This is associated with a five fold increased risk for STILLBIRTH
Mefloquine
99
Dose exposure to quinine and quinidine can cause
CNS anomalies
Limb and Urogenital anomalies
Induce abortions
100
This can cause yellowish discolorization of the deciduous teeth
Tetracycline
101
This drug can cause deposition in the fetal long bones
Tetracyclines
102
This drug can cause CN 8 damage
Streptomycin
103
This drug has a 1-2% risk of having ototoxicity
Streptomycin
104
Hyperbilirubinemia if used near delivery of a preterm infant
Sulfonamide
105
Alkylating agent that cause cell death or heritable DNA alterations in surviving cells
Cyclophosphamide
106
This is commonly reported in cyclophosphamide used:
Hypoplastic digits on hands and feet
107
Cyclophosphamide can be given during ___ but not during ___
2nd and 3rd trimester
| 1st trimester
108
Anomalies seen in cyclophosphamide:
```
Cleft palate
Single coronary artery
Imperforated anus
Fetal growth restriction
Microcephalic
```
109
What is the Methotrexate and Amniopterin syndrome:
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Growth restriction
Failure of calvarial ossification
Craniosynostosis
Hypoplastic supra orbital ridges
Small posteriorly of rotated ears
Micrognathia
Severe limb anomalies
```
110
Antiviral drug used as an inhalational agent for RSV infection in children
Ribavirin
111
Ribavirin is contraindicated in pregnancy because it can cause
Hydrocephalus
| Limb deformities
112
This is an endothelin receptor antagonist used to treat pulmonary hypertension
Boss tan
113
Bosentan cause abnormalities in the ___, ____ and _____
Head
Face
Large coronary artery
114
Dose higher than the recommended daily allowance of ___ of vitamins A should be avoided
5000 IU
115
An anti-acne medication considered one of the most POTENT teratogen in common use
Isotretinoin
116
1st trimester the exposure to isotretinoin can cause craniofacial anomaly: _____ and cardiac anomaly: _____, CNS: _____, Thymus:____
- bilateral, symmetrical microtia, anotia, agenesis, stenosis of external ear canal
- conotruncal
- hydrocephalus
- agenesis, aplasia, hypoplasia of the thymus
117
An antipsoriatic drug similar anomalies to isotretinoin but does so even when conception occurs after drug discontinuation
Eat retinae
118
It is recommended that woman stop the use of etretinate for at least ___ years prior to attempting conception
2 years
119
This is an all trans retinoids acid usually prepared in gel treatment of acne vulgaris
Tretinoin
120
Anxiolytics and sedative agent that is notorious teratogen producing limb reduction defects
Thalidomide
121
Thalidomide affect structures derived from the mesodermal layer this includes:
Limbs
Ear
Cardiovascular system
Bowel musculature
122
Days of upper limb phocomelia
Day 27-30
123
Days of lower limb phocomelia
Days 30-33
124
Warfarin exposure during this age will cause warfarin embryopathy
6-9th week
125
What is the components of warfarin embryopathy
Nasal hypoplasia
| Stippled vertebral and femoral epiphyses
126
Mechanism of warfarin embryopathy:
No posttranslational carboxylation of coagulation protein
127
Warfarin exposure at 2nd and 3rd trimester can cause:
```
Dorsal midline CNS dysplasia
Micropthalmia
Optic atrophy
Blindness
Developmental delay and mental retardation
```
128
Sympathomimetic agent associated with symmetrical growth restriction, minor congenital anomalies
Amphetamines
129
This drug has vasoactive and hypertensive effect
Cocaine
130
Risk of vascular interruption is highest after 1st trimester can cause placental abruption
Cocaine
131
Miscellaneous drugs that can manifest with jitteriness, tremors, and irritablity
Phenycyclidine
132
Miscellaneous drug that can cause chromosomal breakage
Lysergic Acid Diethylamide
133
This drug is best documented reproductive effect that cause fetal growth restriction
Tobacco
134
Preterm fetuses exposed to this drug can cause gray baby syndrome
Chloramphenicol
135
This drug when used in the 1st trimester has been associated limb defects and fetal cardiac depression and arrest
Verapamil
136
This drug is associated with neonatal thrombocytopenia, bleeding and electrolyte disturbance
Thiazides diuretics
137
This may stimulate renal PGE2 production that cause patent ductus arteriosus
Furosemide
138
Maternal therapy associated with neonatal hematologic abnormalities such as fatal pancytopenia
Azathioprine
