2025 – PAGE 247 – PHARMACOLOGY & DRUG PEARLS

VALPROIC ACID EXPOSURE

Valproic acid exposure can lead to a small mouth, a small chin, epicanthal folds, midface hypoplasia, and SPINA BIFIDA.

MNEMONIC: Imagine what types of trophies a serial killer would have on his “VALL” of prized possessions: definitely a BIFURCATED SPINE and possibly a skull with a small chin and small mouth.

CARBAMAZEPINE EXPOSURE

The presentation is similar to that of VALproic acid exposure: spinal and facial deformities. Spinal deformities from carbamazepine exposure include spina bifida.

MNEMONIC: Car-Bam-azepine. Imagine a CAR that goes “BAM!” as it slams into a serial killer’s VALL!

ETHANOL EXPOSURE

Ethanol exposure causes FETAL ALCOHOL SYNDROME (FAS). Problems include small for gestational age (SGA), midface hypoplasia, thin upper lip, a smooth philtrum, a small 5^th fingernail, 5^th finger clinodactyly (curved), ASD, and VSD.

• PEARL: Many of the symptoms overlap with those of anticonvulsant exposure. If you see SGA, ASD or VSD, consider choosing FAS over antiseizure medication exposure.
• MNEMONIC: Ever heard of WINE PINKY?
  • www.pbrlinks.com/ETHANOLEXPOSURE1 Mnemonic image of WINE PINKY
  • www.pbrlinks.com/ETHANOLEXPOSURE2 Mnemonic image of Dr. Evil + Wine Pinky + Philtrum + Lips.
  • www.pbrlinks.com/ETHANOLEXPOSURE3 Mnemonic image of Dr. Evil + Pinkies + Mini-Me to help you also remember SGA
• MNEMONIC: Imagine your favorite, or the most memorable, bottle of alcohol. Now imagine a child is born with two mini, flight-sized bottles sticking out of his or her chest and pointing towards either flank. One bottle is in an ASD, and the other in a VSD.
• MNEMONIC: FAS = 3 letters, just like ASD and VSD.
• IMAGE: www.pbrlinks.com/ETHANOLEXPOSURE4 (GREAT IMAGES. Don’t read! Just look and move on!)

VITAMIN A (AKA RETINOL) EXPOSURE

Supplementation of Vitamin A during pregnancy is associated with Transposition of the Great Vessels (AKA Transposition of the Great Arteries, or TGA, or TOGA).

MNEMONIC: Ever heard of Retin-A®? AKA tretinoin? Now try to associate this WHITE acne cream with a WHITE TOGA (TGA).

ISOTRETINOIN EXPOSURE

Isotretinoin exposure is associated with small ears, small eyes, small head, small jaw, and small thymus; also associated with cardiac defects (such as Tetralogy of Fallot, truncus arteriosus, transposition of the great vessels) and CNS problems (like hydrocephalus).

MNEMONIC: ISOTRETINOIN not only SHRINKS PIMPLES, but it also shrinks the HEAD, EARS, EYES, and THYMUS!