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22 Cards in this Set

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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?
ACE-I (angiotensin coverting enzyme inhibitors - category X) and ARBs (Angiotensin Receptor Blockers)
What does it mean to be a category X drug?
category X drugs have been shown to cause birth defects and should never be taken during pregnancy. (ie. accutane, thalidomide, DES)
The FDA ranks drugs into categories A, B, C, D, and X. List what each category means with some examples.
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)
Name the drugs and categories they are in that are "safe" to treat a CKD pregnant patient.
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
Name some causes of acute renal failure in early pregnancy.
septic abortion and HYPEREMESIS GRAVIDARUM (excessive morning sickness, pt gets dehydrated and goes into ARF, electrolyte abnormalities, lose H+, K+, tx with Fluids)
Name some causes of acute renal failure late in pregnancy.
PREECLAMPSIA (after 20wks gestation), placenta previa, abruptio placenta - diagnose renal failure with biopsy 6wks postpartum
Name the preeclamptic triad in order of appearance.
Edema -> Hypertension -> Proteinuria
What happens to the thyroid in pregnancy?
it gets bigger and T3 and T4 levels increase, but so does the thyroxine binding globulin, so free T3 and T4 remain unchanged
TSH levels do what in pregnancy?
remain normal
How do you treat a pregnant pt. with Graves Disease?
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)
what are the indications of surgery in a hyperthyroid pregnant patient? when should it be done?
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
List the neonates risks when a pregnant woman takes PTU to destroy thyroid tissue.
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
Why is is difficult to diagnose maternal thyrotoxicosis?
the diagnosis is difficult because the symptoms are very general: tachycardia, warm skin, heat intolerance (occurs in 1/500 pregnancies)
what cardiac abnormality will occur in nearly all pregnant women?
murmur - soft, midsystolic, along left sternal border
When is an echocardiogram indicated in a pregnant woman?
if she is symptomatic, has a diastolic murmur, has continous murmurs, Load systolic murmurs (3+/6); or has an abnormal EKG
Explain Valvular Heart Diseae and Pregnancy. Causes, clinical observation, treatment.
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.
If the mitral stenosis is severe, what can be done?
Ideally, do a valvulotomy prior to conception, but a balloon valvuloplasty can be done; valvulotomy during pregnancy increases risk of fetal loss
What is peripartum cardiomyopathy?
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
Describe the typical pt that gets peripartum cardiomyopathy.
black, multiparous, over 30
when does peripartum cardiomyopathy most commonly occur?
at the time of delivery
How should you handle a pregnant asthmatic patient?
Aggressively treat exacerbations, hypoxia dangerous to fetus as well as mother.
How should you treat asthma in a pregnant patient?
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