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EM Tintinallis > 99 Comorbid disorders in pregnancy > Flashcards

99 Comorbid disorders in pregnancy Flashcards

1
Q

Sugar goals in pregnant diabetics

A

less than 95 fasting and less than 120 postprandial

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2
Q

preffered tx for diabetes in preganncy

A

NPH insulin

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3
Q

up and coming treatemnts in prengnat diabetics?

A

Detemir (levemir) long acting insulin, insulin lispro and aspart for post prandial hyperglyecmia control

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4
Q

insulin dose for pregnant diabetics

A

.7 units/kg/day in early pregancy, 1 unit/kg/day in late pregancny

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5
Q

indications for metformin in pregnant patients

A

PRICE, decline, or unable to self administer insulin

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6
Q

Why glyburides are not recommended

A

PROVEN to be inferior in efficacy to insulin

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7
Q

When do you screen pregnant diabetics for DKA

A

at sugar level above 180

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8
Q

hypoglemia/DKA risk in pregnancy

A

risk of hypoglyemia is 3 to 5 times higher in pregnancy. DKA happens at lower levels of sugar

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9
Q

Cause of transient hyperthyroidism of hyperemesis gravidarum?

A

Thyrotropin receptor stimulation from BHCG. acts like TSH

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10
Q

difference between hyperthryodism of hyperemesis and normal hyperthyroidism on labs?

A

TSH is suppressed in both and eleveated T4. but T3 is not as elevated as in normal hyperthyroidism.

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11
Q

Treatment for hyperthyroidism in pregnancy?

A

In first trimester, give PTU, in second and third give methimazole. Methimazole is a teratogen and PTU causes liver damage.

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12
Q

how to treat unstable dysrrhythmia in pregnant patient?

A

same as any other. synchronized cardioversion 50J to 200J.

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13
Q

only class D beta blocker

A

atenolol

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14
Q

most common non sinus tachy of pregnancy?

A

PSVT

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15
Q

how to treat Afib in pregnancy?

A

rate and rhythm control with CCB’s and BB as usual. but anticoagulate with LMWH or Unfractionated heparin.

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16
Q

Drugs to use and not use for wide complex tachycardia?

A

You can use procainamide or lidocaine, but NOT amiodarone. It crosses the placenta and is class D

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17
Q

What serious cardiac conditions are morE common in pregnancy?

A

AD, ACS, and cardiomyopathy

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18
Q

3 most common causes of ACS in pregnancy?

A

coronary artery dissection (most common), coronary vasospasm, and coronary emboli.

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19
Q

risk of thrombolytics in pregnancy in addition to the usual?

A

placental abruption and maternal hemorrhage.

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20
Q

two ccardiac considerations for edema in pregnancy?

A

peripartum cardiomyopathy (dilated) and sympathetic crashing pulmonary edema.

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21
Q

leading cause of maternal morbidity and mortality?

A

vte

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22
Q

location of DVT’s in pregnancy

A

More likely to be left sided, and proximal iliofemoral. can commonly be in the pelvic veins as well.

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23
Q

Chan’s left prediction tool?

A

tool to predict DVT.
L-left leg
e-edema asymmetry >2mm
ft-first trimester

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24
Q

at what location is US most sensitive in diagnosis DVT?

A

above the knee

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25
Q

2 biggest differences in diagnosis and tx of DVT in pregnant patients?

A
  1. D-dimer is useless

2. always treat a DVT. in nonpregnant patients, there is debate on whether or not to treat.

26
Q

how to evaluate pelvic vein thrombosis in pregnancy?

A

MRV or noncontrast MRI.

27
Q

preferred imaging modality for PE in pregnant patients?

A

CT angio

28
Q

how to treat stable DVT/PE in pregnancy?

A

LMWH. alternatively, Unfractionated heparin

29
Q

tx of life threatening PE in prenancy?

A

recombinant TPA. has rates of maternal death of 1-6% and fetal demis of 2-5%

30
Q

most common medical disease in pregnancy?

A

asthma

31
Q

only asthma medicain that you don’t give to pregnant patients?

A

epi. risk of placental vasoconstriction and insufficiency

32
Q

tx for asthma?

A

Maintain oxygen saturation >95%, administer repetitive or continuous inhaled β2-agonist (albuterol/salbutamol); give inhaled ipratropium and systemic corticosteroids; give IV magnesium; monitor maternal response to therapy; and monitor the fetus for signs of distress.64 Terbutaline sulfate, 0.25 milligram every 20 minutes,

33
Q

treatment for asymptomatic bacteruria and cystitis in pregnancy?

A

First-line treatment for asymptomatic bacteriuria and simple cystitis is either amoxicillin, 500 milligrams PO two to three times daily for 3 to 7 days, or cephalexin, 500 milligrams two to four times daily for 3 to 7 days.71

34
Q

what’s the problem with Bactrim during pregnancy?

A

Trimethoprim causes neural tube defects in first trimester, sulfas cause kernicterus in 3rd trimester

35
Q

most common cause for sponataneous intracrainal hemorrhage in pregnancy?

A

hypertension

36
Q

timeline for increased risk of cerebral hemorrhage in pregnancy?

A

pregnancy until 6 weeks postpartum

37
Q

majority of strokes in pregnancy happen during

A

3rd trimester

38
Q

what conditions you have to consider before giving tpa for stroke?

A

hemorrhage and eclampsia

39
Q

timeline for central venous thrombosis in pregnancy?

A

second and third trimester and up to 4 weeks postpartum

40
Q

what meds you can and can’t give for migraines in pregnancy?

A

can’t give ergot alkalids. Give Reglan or phenothiazines.

41
Q

most effective migraine treatment?

A

Compazine 10mg IV +/- diphenhydramine 25-50mg

42
Q

treatment for central venous thrombosis?

A

low molecular weight heparin

43
Q

Do any GERD medications have any teratogenic effects?

A

No.

44
Q

What is the most common surgical emergency in pregnancy?

A

Appendicitis.

45
Q

What is the best test to diagnose appendicitis and pregnancy?

A

Noncontrast MRI without gadolinium as recommended due to recent concerns of fetal effects from exposure

46
Q

Alternative testing modality for appendicitis and pregnancy

A

Focal appendiceal city

47
Q

Why is Doppler with color not enough to exclude the diagnosis of torsion

A

Because it may be intermittently twisting and re-twisting I may be more of a chronic condition. Does clinical diagnosis is most important

48
Q

What are the class D antiepileptics in pregnancy

A

Valproic acid, phenytoin, carbamazepine

49
Q

Recommended anti-epileptic during pregnancy

A

Mono therapy with Leviteracetam and lamotrigine

50
Q

Why are opioids a problem during pregnancy

A

Other than maternal risk of overdose, hope your withdrawal can cause hypoxia, preterm labor, and fetal demise

51
Q

What is the best test to diagnose appendicitis and pregnancy?

A

Noncontrast MRI without gadolinium as recommended due to recent concerns of fetal effects from exposure

52
Q

Alternative testing modality for appendicitis and pregnancy

A

Focal appendiceal city

53
Q

Why is Doppler with color not enough to exclude the diagnosis of torsion

A

Because it may be intermittently twisting and re-twisting I may be more of a chronic condition. Does clinical diagnosis is most important

54
Q

What are the class D antiepileptics in pregnancy

A

Valproic acid, phenytoin, carbamazepine

55
Q

Recommended anti-epileptic during pregnancy

A

Mono therapy with Leviteracetam and lamotrigine

56
Q

Why are opioids a problem during pregnancy

A

Other than maternal risk of overdose, hope your withdrawal can cause hypoxia, preterm labor, and fetal demise

57
Q

What is the only difference in the management of alcoholism and pregnancy?

A

Do not use disulfiram or Antabuse because there’s a potential teratogen

58
Q

When is the classic

Teratogenic. And pregnancy

A

2 to 15 weeks of gestation

59
Q

What did you not give NSAIDs during pregnancy

A

I can cost oligohydramnios, and construction of a fetal ductus arteriosus

60
Q

What are the acceptable limits of radiation during pregnancy

A

Definitely less than 50 MGy or 5 rads, But probably under 100 is OK to

61
Q

Describe the possible Tourette’s agenic affects above 10 rd by gestational age,?

A

0 to 2 weeks represents a possible spontaneous abortion, 3 to 15 weeks are possible malformations or mental development defects with increasing dose, over 16 weeks are probably no detectable problems

EM Tintinallis (12 decks)

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