Successfully reported this slideshow.
1. NURUL MIZA SHASHEIHA BINTI ABDUL MUTALIB
2. NURUL HUSNA BINTI MURYADI
3. WAN FATHIAH NASUHA BT WAN NUSDRI
4. NURFATIN A...
INTRODUCTION
• WHAT IS TERATOGEN ?
• TERATOGENIC DRUG
• FDA PREGNANCY CATEGORIES
• GENERAL MECHANISMS OF ACTION OF
TERATOG...
TERATOGEN
• Is an agent that can
disturb the
development of the
embryo or fetus
• Teratogens halt the
pregnancy or
produce...
FDA PREGNANCY CATEGORIES
CATEGORY A
• failed to
demonstrat
e a risk to
the fetus in
the first
trimester of
pregnancy
• no ...
POSSIBLE SITES OF
ACTION OF TERATOGEN
DIRECT
TOXIC
ACTION
• FETUS:
-Direct toxicity.
-Metabolites toxic.
-Indirectly toxic...
TERATOGENIC MECHANISMS OF
MEDICAL DRUGS
• Folate antagonism
• Neural crest cell disruption
• Endocrine disruption
• Oxidat...
•Analgesic
•Anticonvulsant
•Anticoagulant
•Antidepressant
•Antithyroid
•Vitamin A
•Metal toxic
•Sedative/ hypnotics
•Amino...
• Gastroschisis
• Decrease prostaglandin  decrease uterine
contraction delayed onset of labor & prolonged
period of preg...
• Fetal hydantoin syndrome :
 cranio facial malformation:
-Cleft lip and palate
-Broad nasal bridge
-Ocular hypertelorism...
• Fetal wafarin syndrome:
-Nasal hypoplasia
-Bone stippling
-Bilateral optic atrophy
-Mental retardation
• Respiratory dis...
• Cleft palate
• Defect in abdomen
• Adrenal hypoplasia
• Cardiovascular defect
• Fetal goiter
• Cranio-facial dysmorphism
• Cleft palate
• Thymic aplasia
• Neural tube defect ( spina bifida cystic )
• Hypotonia
• Cyanosis
• Lethargy
• Poor respiratory
• Cleft lip and palate
• Inguinal hernia
• Congenital heart disease
• Pyloric stenosis
• Breathing difficulties
• Congenital deafness
• Ototoxicity
TERATOGENIC
DRUGS IN SECOND
TRIMESTER OF
PREGNANCY
ACE INHIBITORS
DIAZEPAM
1) ACE INHIBITOR
MECHANISM OF ACTIONS
Produce vasodilatation by
1-inhibitting formation of
angiotensin 11
2- breakdown bra...
PHARMACOLOGICAL ACTION
 Mixed vasodilator
 In cases of heart failure, cardiac output is
maintained / even increase
 Inc...
THERAPEUTIC USES
USED IN
 Hypertension
 Heart failure
 Myocardial infarction
SIDE EFFECTS
 IF USED IN 2ND – 3RD TRIMESTER OF PREGNANCY
1- fetal hypotension
2- renal failure
3- oligohydromnios
4- dea...
2) DIAZEPAM
 Centrally acting spasmolytic drug
 It facilitates action of GABA in CNS
 It acts as GABA synapse and produ...
PHARMACOKINETICS
 ABSORPTION:
- Delayed and decreased when administered with a
moderate fat meal
 DISTRIBUTION
- Highly ...
 METABOLISM
N-demythylated
Diazepam N-desmethyldiazepam
further metabolised
hydroxylated
temazepam oxazepam
 Temazepam a...
ELIMINATION
 The initial distribution phase is followed by
prolonged elimination phase
SIDE EFFECTS
 RISKS OF…
1) cleft palate
2) cardiac and circulatory defects
1) TETRACYCLINE
 Protein synthesis inhibitor
 Inhibit the binding of aminoacyl-tRNA to the mRNA-
ribosomes complex
Amino...
SIDE EFFECTS
 IN PREGNANCY…..
 dental discolouration in chilren
 maternal hepatotoxicity with large parenteral doses
2) ACE INHIBITORS
 AS IN SECOND TRIMESTER
 Ace inhibitors in 2nd trimester
3) CHLORAMPHENICOL
 Bacteriostatic drug that stop bacterial growth by
inhibiting protein synthesis
 Prevent protein chai...
ADVERSE EFFECTS
 Hypotension
 Cyanosis
The condition can be prevented by using the drug at
recommended doses & monitori...
4) AMINOGLYCOSIDES
 EG: GENTAMICIN, STREPTOMYCIN
 Have several potential antibiotic mechanisms
 They interfere with the...
 Aminoglycosides are in pregnancy category D
 They may cause auditory or vestibular nerve damage
5) SULFAMETHOXAZOLE,
TRIMETHOPRIM
 Sulfonamide bacteriostatic antibiotic
 Structural analogs and competitive antagonist ...
 Trimethoprim binds to dihydrofolate redustase and
inhibit reduction of DHF to THF
 Sulfamethoxazole inhibit dihydrofola...
TERATOGENIC EFFECTS
 1) NEONATAL HAEMOLYSIS
 2)METHAEMOGLOBINAEMIA
•BE CAREFUL IN TAKING DRUGS DURING
PREGNANCY
•ALL CLINICIANS INCLUDING PHARMACISTS ARE
RESPONSIBLE TO COUNSEL PATIENTS WIT...
Teratogenic drugs
Teratogenic drugs
Teratogenic drugs
Nächste SlideShare
Wird geladen in …5
×

Teratogenic drugs

11.172 Aufrufe

Veröffentlicht am

no plagiarism, okay?
just sharing and for learning purpose..

Veröffentlicht in: Gesundheit & Medizin
  • Als Erste(r) kommentieren

Teratogenic drugs

  1. 1. 1. NURUL MIZA SHASHEIHA BINTI ABDUL MUTALIB 2. NURUL HUSNA BINTI MURYADI 3. WAN FATHIAH NASUHA BT WAN NUSDRI 4. NURFATIN AFIQAH BT MOHD BADRONDIN 5. ZATEEL FAHADA BT RUSLI 6. NURUL FIRDAUS BT HANAFEE 7. NURUL SAHIIRAH BT AHMAD ROFI 8. WAN FARAH NASUHA BT WAN MUHAMMAD HUSNI
  2. 2. INTRODUCTION • WHAT IS TERATOGEN ? • TERATOGENIC DRUG • FDA PREGNANCY CATEGORIES • GENERAL MECHANISMS OF ACTION OF TERATOGENIC DRUGS • TERATOGENIC MECHANISMS OF MEDICAL DRUGS
  3. 3. TERATOGEN • Is an agent that can disturb the development of the embryo or fetus • Teratogens halt the pregnancy or produce a congenital malformation • Include radiation, maternal infections, chemicals, and drugs. • directly or indirectly, causes a structural or functional change in the fetus or child if it is administrated to pregnant mother • If mother is taking this drug, It can be either stopped, switched or reduced to the lowest dose possible • typically during sensitive periods of fetal development • depending on the particular teratogenic process and target organ TERATOGENIC DRUG
  4. 4. FDA PREGNANCY CATEGORIES CATEGORY A • failed to demonstrat e a risk to the fetus in the first trimester of pregnancy • no evidence of risk in later trimesters CATEGORY C • shown an adverse effect on the fetus • no adequate and well- controlled studies in humans • potential benefits may warrant the use of drug despite potential risks. CATEGORY D • positive evidence of human fetal risk based on adverse reaction data • potential benefits may warrant use of the drug in pregnant women despite potential risks CATEGORY B • failed to demonstrate a risk to the fetus • no adequate and well- controlled studies in pregnant women. CATEGORY X • demonstrates fetal abnormalities • positive evidence of human fetal risk based on adverse reaction data • the risks involved in use of the drug in pregnant women CATEGORY N • FDA has not classified the drug.
  5. 5. POSSIBLE SITES OF ACTION OF TERATOGEN DIRECT TOXIC ACTION • FETUS: -Direct toxicity. -Metabolites toxic. -Indirectly toxic, e.g. anti-metabolites, anti- vitamin. -Pharmacodynamic actions, e.g. on cardiovascular system. -Endocrine balance altered • FAETOPLACENTAL UNIT: -Umbilical cord, e.g. spasm. -Amniotic fluid volume change. -Faetal or maternal placental blood flow. -Placental transfer of • MOTHER: -Nutritional changes, e.g. vitamin or mineral deficiencies. -Biochemical changes with secondary effects on the foetus, e.g. hyperglycaemia. -Endocrine balance • FATHER: -Sperm changes INDIRECT TOXIC ACTION • Cause malformation -interfering with faetal metabolism • Drugs: -folic acid antagonists -antiepileptic drugs
  6. 6. TERATOGENIC MECHANISMS OF MEDICAL DRUGS • Folate antagonism • Neural crest cell disruption • Endocrine disruption • Oxidative stress • Vascular disruption and specific receptor • Enzyme-mediated teratogenesis
  7. 7. •Analgesic •Anticonvulsant •Anticoagulant •Antidepressant •Antithyroid •Vitamin A •Metal toxic •Sedative/ hypnotics •Aminoglycosides
  8. 8. • Gastroschisis • Decrease prostaglandin  decrease uterine contraction delayed onset of labor & prolonged period of pregnancy • During delivery severe bleeding because aspirin decrease platelet aggregation
  9. 9. • Fetal hydantoin syndrome :  cranio facial malformation: -Cleft lip and palate -Broad nasal bridge -Ocular hypertelorism -Abnormal ears  congenital heart disease  limb malformation  mental and growth retardation
  10. 10. • Fetal wafarin syndrome: -Nasal hypoplasia -Bone stippling -Bilateral optic atrophy -Mental retardation • Respiratory distress syndrome • Fetal and maternal hemorrhage
  11. 11. • Cleft palate • Defect in abdomen • Adrenal hypoplasia • Cardiovascular defect
  12. 12. • Fetal goiter
  13. 13. • Cranio-facial dysmorphism • Cleft palate • Thymic aplasia • Neural tube defect ( spina bifida cystic )
  14. 14. • Hypotonia • Cyanosis • Lethargy • Poor respiratory
  15. 15. • Cleft lip and palate • Inguinal hernia • Congenital heart disease • Pyloric stenosis • Breathing difficulties
  16. 16. • Congenital deafness • Ototoxicity
  17. 17. TERATOGENIC DRUGS IN SECOND TRIMESTER OF PREGNANCY
  18. 18. ACE INHIBITORS DIAZEPAM
  19. 19. 1) ACE INHIBITOR MECHANISM OF ACTIONS Produce vasodilatation by 1-inhibitting formation of angiotensin 11 2- breakdown bradykinin
  20. 20. PHARMACOLOGICAL ACTION  Mixed vasodilator  In cases of heart failure, cardiac output is maintained / even increase  Increase renal blood flow BUT decrease glomerular filtration rate decrease glomerular hypertension
  21. 21. THERAPEUTIC USES USED IN  Hypertension  Heart failure  Myocardial infarction
  22. 22. SIDE EFFECTS  IF USED IN 2ND – 3RD TRIMESTER OF PREGNANCY 1- fetal hypotension 2- renal failure 3- oligohydromnios 4- death 3rd tri
  23. 23. 2) DIAZEPAM  Centrally acting spasmolytic drug  It facilitates action of GABA in CNS  It acts as GABA synapse and produce sedation at doses required to reduce muscles tone
  24. 24. PHARMACOKINETICS  ABSORPTION: - Delayed and decreased when administered with a moderate fat meal  DISTRIBUTION - Highly bound to plasma protein - Cross blood brain barrier - Cross placental barrier - Found in milk
  25. 25.  METABOLISM N-demythylated Diazepam N-desmethyldiazepam further metabolised hydroxylated temazepam oxazepam  Temazepam and oxazepam are largely eliminated by glucoronidation
  26. 26. ELIMINATION  The initial distribution phase is followed by prolonged elimination phase
  27. 27. SIDE EFFECTS  RISKS OF… 1) cleft palate 2) cardiac and circulatory defects
  28. 28. 1) TETRACYCLINE  Protein synthesis inhibitor  Inhibit the binding of aminoacyl-tRNA to the mRNA- ribosomes complex Aminoacyl-tRNA mRNA-ribosomes complex by binding to the 30S ribosomal subunit in mRNA translation complex
  29. 29. SIDE EFFECTS  IN PREGNANCY…..  dental discolouration in chilren  maternal hepatotoxicity with large parenteral doses
  30. 30. 2) ACE INHIBITORS  AS IN SECOND TRIMESTER  Ace inhibitors in 2nd trimester
  31. 31. 3) CHLORAMPHENICOL  Bacteriostatic drug that stop bacterial growth by inhibiting protein synthesis  Prevent protein chain elongation by inhibiting peptidyl transferase activity of bacterial chromosome  Intravenous chloramphenicol use has been associated with Gray Baby syndrome  This occur in newborn infants because they liver enzymes not yet fully developed chloramphenicol remains unmetabolised in body
  32. 32. ADVERSE EFFECTS  Hypotension  Cyanosis The condition can be prevented by using the drug at recommended doses & monitoring blood levels Gray Baby Syndrome
  33. 33. 4) AMINOGLYCOSIDES  EG: GENTAMICIN, STREPTOMYCIN  Have several potential antibiotic mechanisms  They interfere with the proofreading process increased rate of error in synthesis with premature termination  Inhibition of ribosomal translocation peptidyl tRNA moves from A-site to P- site  Disrupt the integrity of the bacterial cell membrane
  34. 34.  Aminoglycosides are in pregnancy category D  They may cause auditory or vestibular nerve damage
  35. 35. 5) SULFAMETHOXAZOLE, TRIMETHOPRIM  Sulfonamide bacteriostatic antibiotic  Structural analogs and competitive antagonist of PABA  Inhibit normal bacterial utilisation of PABA for the synthesis of folic acid  Used as a bacteriostatic antibiotic in prophylaxis and treatment of urinary tract infections
  36. 36.  Trimethoprim binds to dihydrofolate redustase and inhibit reduction of DHF to THF  Sulfamethoxazole inhibit dihydrofolate synthetase
  37. 37. TERATOGENIC EFFECTS  1) NEONATAL HAEMOLYSIS  2)METHAEMOGLOBINAEMIA
  38. 38. •BE CAREFUL IN TAKING DRUGS DURING PREGNANCY •ALL CLINICIANS INCLUDING PHARMACISTS ARE RESPONSIBLE TO COUNSEL PATIENTS WITH COMPLETE , ACCURATE AND CURRENT INFORMATION ON THE RISKS AND BENEFITS OF USING MEDICATIONS DURING PREGNANCY

×