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22 Cards in this Set
- Front
- Back
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The BP goal for a pregnant woman with Chronic Kidney dz <120/80, her HTN and proteinuria worsens. what drugs will increase the risk for fetal loss?
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ACE-I (angiotensin coverting enzyme inhibitors - category X) and ARBs (Angiotensin Receptor Blockers)
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What does it mean to be a category X drug?
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category X drugs have been shown to cause birth defects and should never be taken during pregnancy. (ie. accutane, thalidomide, DES)
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The FDA ranks drugs into categories A, B, C, D, and X. List what each category means with some examples.
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Category A: safe for pregnancy (folic acid, vitamin B6); Cat.B: used alot and don't appear to cause any major birth defects(antiboitics, tylenol, aspartame, insulin, ibuprofin; Cat. C: more likely to cause problems for mother or fetus(also includes drugs in clinical trials) sudafed, fluconazole, Ciprofloxacin); Cat. D: health risks for fetus (alcohol, lithium); Cat. X: shown to cause birth defects and should never be taken during pregnancy (Accutane, thalidomide)
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Name the drugs and categories they are in that are "safe" to treat a CKD pregnant patient.
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Non-dihydropyradine Calcium Channel blockers (Verapamil (Calan) and Diltiazem (Cardizem) - both Category C); ACE-I Alternative: Hydralazine and Isosorbide dinitrate (Bidil) - equivalent to ACEI in CHF- category C too
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Name some causes of acute renal failure in early pregnancy.
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septic abortion and HYPEREMESIS GRAVIDARUM (excessive morning sickness, pt gets dehydrated and goes into ARF, electrolyte abnormalities, lose H+, K+, tx with Fluids)
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Name some causes of acute renal failure late in pregnancy.
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PREECLAMPSIA (after 20wks gestation), placenta previa, abruptio placenta - diagnose renal failure with biopsy 6wks postpartum
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Name the preeclamptic triad in order of appearance.
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Edema -> Hypertension -> Proteinuria
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What happens to the thyroid in pregnancy?
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it gets bigger and T3 and T4 levels increase, but so does the thyroxine binding globulin, so free T3 and T4 remain unchanged
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TSH levels do what in pregnancy?
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remain normal
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How do you treat a pregnant pt. with Graves Disease?
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PTU (Propylthiouricil) is the drug of choice (it crosses the placenta, but less than methimazole; blocks fetal synthesis of thyroxine, use as low dose as possible)
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what are the indications of surgery in a hyperthyroid pregnant patient? when should it be done?
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Indication: hyperthyroid symptoms and high doses of PTU (>300mg/day); do surgery during 2nd trimester; Perform a substotal thryroidectomy; and prepare with 7 days of iodide
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List the neonates risks when a pregnant woman takes PTU to destroy thyroid tissue.
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Neonate could become hypothyroid (with excessive PTU crossing the placenta); b/c hyperthyroid (from high fetal TSH and Maternal Thyroid-releasing antibodies); Fetus could get a goiter
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Why is is difficult to diagnose maternal thyrotoxicosis?
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the diagnosis is difficult because the symptoms are very general: tachycardia, warm skin, heat intolerance (occurs in 1/500 pregnancies)
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what cardiac abnormality will occur in nearly all pregnant women?
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murmur - soft, midsystolic, along left sternal border
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When is an echocardiogram indicated in a pregnant woman?
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if she is symptomatic, has a diastolic murmur, has continous murmurs, Load systolic murmurs (3+/6); or has an abnormal EKG
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Explain Valvular Heart Diseae and Pregnancy. Causes, clinical observation, treatment.
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Mitral Regurgitation is most commonly due to MVP (mitral valve prolapse) and is generally well tolerated due to the decrease in systemic vascular resistance. Mitral Stenosis is genereally asymptomatic.
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If the mitral stenosis is severe, what can be done?
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Ideally, do a valvulotomy prior to conception, but a balloon valvuloplasty can be done; valvulotomy during pregnancy increases risk of fetal loss
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What is peripartum cardiomyopathy?
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weakened heart is diagnosed within the final month of pregnancy or within 3 months after delivery - a noninfectious inflammation (myocarditis) causes the heart to dilate - usually autoimmune, myocyte antigens from late-term uterus
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Describe the typical pt that gets peripartum cardiomyopathy.
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black, multiparous, over 30
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when does peripartum cardiomyopathy most commonly occur?
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at the time of delivery
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How should you handle a pregnant asthmatic patient?
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Aggressively treat exacerbations, hypoxia dangerous to fetus as well as mother.
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How should you treat asthma in a pregnant patient?
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Use inhaled Beta 2 agonists - they are category C durgs and can interfere with uterine contractions (examples are albuterol, salmeterol, and terbutaline); also Steroids are used - also category C
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