All the following drugs are teratogenic EXCEPT:
ANSWER: (D) MetoclopramideREF: KDT 6th edition, page 909, internet resourcesSee APPENDIX-32 below for list of "Teratogens"FDA pregnancy category B lists Metoclopramide is not expected to be harmful to an unborn babyFDA lists phenytoin in Pregnancy Category DUnited States FDA Pharmaceutical Pregnancy CategoriesPregnancy Category AAdequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).Pregnancy Category BAnimal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and w'ell-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.Pregnancy Category CAnimal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.Pregnancy Category DThere is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.Pregnancy Category XStudies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.Following are few category-X drugs:ANTIEMETIC: DomperiodoneANALGESIC: MorphineANTIBIOTICS: Fluoroquinolones, Tetracycline, Doxycycline, Chloramphenicol, streptomycin, Kanamycin, TobramycinANTITUBERCULAR: StreptomycinANTIAMOEBIC: TinidazoleANTIMALARIAL: Quinine, Sulfadoxine, PrimaquineANTIHELMINTHIC: Mebendazole, DECANTIFUNGAL: Amphotericin -B, Itraconazole, Ketoconazole, GriesofulvinANTIVIRAL: Ganciclovir, Foscarnet, Amantadine, <2-interferonANTIHYPERTENSIVE: ACE inhibitors, Angiotensin antagonistANTIDIABETIC: Sulfonylurea, Acarbose, Metformin . ANTICOAGULANT: WarfarinOTHERS: Thalidomide, Alcohol, Radioactive iodine, Isotretinoin, Cytotoxic drugs APPENDIX - 32TeratogensTeratogenGroupCritical periodEffectThalidomidesedative34-51 days after LMPExternal ear deformity (earliest), PHOCOMELIA (MC- four groups: 4-limb phocomelia, Upper limb phocomelia, Predominantly Upper-limb phocomelia, Predominantly lower limb defects), Facial Hemangioma, Esophageal atresia, TOF, Renal agenesisRetinoic AcidVitamin3-5 weekcranio-facial abnormalitiesMicrotia/Anotia (deafness)Missing jaw or one that is too smallDisorders of jaw formation (split jaw)Disorders of formation of aortic archThymic aplasia/hvpoplasiaDeformities in the CNS (mc-hydrocephalus)Diethvlstil-boestrolHormone vaginal adenosis, erosions of the cervix and transversal cleavages in the vaginaAlcohol {fetal alcohol syndrome)Recreational LBW, microcephaly, maxillary hypoplasia, flat nasal bridge, micrognathia, microphthalmia, hypoplastic upper lip, broad lower lip.CocaineRecreational/Narcotic addiction in the child, retarded growth, to malformations of the circulatory systemLithiumAntipsychotic3-8 -weeksEbstein anomaly (me), cleft palate in experimental animalsStreptomycinAminoglycosides4-8 weeksdamage of the 8th cerebral nerve- deafnessWarfarinAnticoagulant1st trimesterHypoplastic nasal bridge , chondrodysplasia 2nd trimesterCNS malformation 3rd trimesterRisk of bleedingRubellaViral1st trimestercardiac defects, cataracts and deafnessCytomegalovirusViralspontaneous miscarriage in 1st trimester, anomalies from 2nd trimesterRetarded growth, changes in the CNS (microcephaly, cerebral atrophy, hydrocephaly, cerebellar hypoplasia, chorioretinitis, atrophy of the eyes) and hepatosplenomegalyHerpes SimplexViralAs a rule, HSV occurs in late pregnancyMental deficiency, Microcephaly, Myocardiopathy, Spasticity, Retinal dysplasiaVaricellaViralOnly up to the 20th week.muscle atrophy, hypoplasia of the limbs and fingers, abnormalities of the eyes and the brain (mental deficiency)Toxoplasmosis(ToxoplasmaGondi.)intracellularparasite cerebral calcification, microcephaly, microphthalmia, chorioretinitis, microphthalmia, hydrocephalusCongenitalSyphilis Mental deficiency, hydrocephalus, deafness, blindness, bone malformations, Hutchinson's teeth (pathognomic)Critical Period:Before the 14th day an insult (injury) to the embryo will not cause an abnormality because the embryo either repairs the damage or dies (spontaneous miscarriage)Embryonic period, during which numerous mitotic divisions and organogenesis occur, the embryo is very vulnerable and most congenital abnormalities happen thenFetopathies are the abnormalities that occur after the 8th week and up to delivery. The sensibility to injurious substances is clearly reduced in the last two trimesters of pregnancy.In infectious etiology critical period might not coincide with the effects they cause as there critical period might be different from the incidence of infection in the pregnancy trimester.
Alcohol
Phenytoin
Warfarin
Metoclopramide
Pregnancy