99 Comorbid disorders in pregnancy Flashcards
Sugar goals in pregnant diabetics
less than 95 fasting and less than 120 postprandial
preffered tx for diabetes in preganncy
NPH insulin
up and coming treatemnts in prengnat diabetics?
Detemir (levemir) long acting insulin, insulin lispro and aspart for post prandial hyperglyecmia control
insulin dose for pregnant diabetics
.7 units/kg/day in early pregancy, 1 unit/kg/day in late pregancny
indications for metformin in pregnant patients
PRICE, decline, or unable to self administer insulin
Why glyburides are not recommended
PROVEN to be inferior in efficacy to insulin
When do you screen pregnant diabetics for DKA
at sugar level above 180
hypoglemia/DKA risk in pregnancy
risk of hypoglyemia is 3 to 5 times higher in pregnancy. DKA happens at lower levels of sugar
Cause of transient hyperthyroidism of hyperemesis gravidarum?
Thyrotropin receptor stimulation from BHCG. acts like TSH
difference between hyperthryodism of hyperemesis and normal hyperthyroidism on labs?
TSH is suppressed in both and eleveated T4. but T3 is not as elevated as in normal hyperthyroidism.
Treatment for hyperthyroidism in pregnancy?
In first trimester, give PTU, in second and third give methimazole. Methimazole is a teratogen and PTU causes liver damage.
how to treat unstable dysrrhythmia in pregnant patient?
same as any other. synchronized cardioversion 50J to 200J.
only class D beta blocker
atenolol
most common non sinus tachy of pregnancy?
PSVT
how to treat Afib in pregnancy?
rate and rhythm control with CCB’s and BB as usual. but anticoagulate with LMWH or Unfractionated heparin.
Drugs to use and not use for wide complex tachycardia?
You can use procainamide or lidocaine, but NOT amiodarone. It crosses the placenta and is class D
What serious cardiac conditions are morE common in pregnancy?
AD, ACS, and cardiomyopathy
3 most common causes of ACS in pregnancy?
coronary artery dissection (most common), coronary vasospasm, and coronary emboli.
risk of thrombolytics in pregnancy in addition to the usual?
placental abruption and maternal hemorrhage.
two ccardiac considerations for edema in pregnancy?
peripartum cardiomyopathy (dilated) and sympathetic crashing pulmonary edema.
leading cause of maternal morbidity and mortality?
vte
location of DVT’s in pregnancy
More likely to be left sided, and proximal iliofemoral. can commonly be in the pelvic veins as well.
Chan’s left prediction tool?
tool to predict DVT.
L-left leg
e-edema asymmetry >2mm
ft-first trimester
at what location is US most sensitive in diagnosis DVT?
above the knee
2 biggest differences in diagnosis and tx of DVT in pregnant patients?
- D-dimer is useless
2. always treat a DVT. in nonpregnant patients, there is debate on whether or not to treat.
how to evaluate pelvic vein thrombosis in pregnancy?
MRV or noncontrast MRI.
preferred imaging modality for PE in pregnant patients?
CT angio
how to treat stable DVT/PE in pregnancy?
LMWH. alternatively, Unfractionated heparin
tx of life threatening PE in prenancy?
recombinant TPA. has rates of maternal death of 1-6% and fetal demis of 2-5%
most common medical disease in pregnancy?
asthma
only asthma medicain that you don’t give to pregnant patients?
epi. risk of placental vasoconstriction and insufficiency
tx for asthma?
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,
treatment for asymptomatic bacteruria and cystitis in pregnancy?
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
what’s the problem with Bactrim during pregnancy?
Trimethoprim causes neural tube defects in first trimester, sulfas cause kernicterus in 3rd trimester
most common cause for sponataneous intracrainal hemorrhage in pregnancy?
hypertension
timeline for increased risk of cerebral hemorrhage in pregnancy?
pregnancy until 6 weeks postpartum
majority of strokes in pregnancy happen during
3rd trimester
what conditions you have to consider before giving tpa for stroke?
hemorrhage and eclampsia
timeline for central venous thrombosis in pregnancy?
second and third trimester and up to 4 weeks postpartum
what meds you can and can’t give for migraines in pregnancy?
can’t give ergot alkalids. Give Reglan or phenothiazines.
most effective migraine treatment?
Compazine 10mg IV +/- diphenhydramine 25-50mg
treatment for central venous thrombosis?
low molecular weight heparin
Do any GERD medications have any teratogenic effects?
No.
What is the most common surgical emergency in pregnancy?
Appendicitis.
What is the best test to diagnose appendicitis and pregnancy?
Noncontrast MRI without gadolinium as recommended due to recent concerns of fetal effects from exposure
Alternative testing modality for appendicitis and pregnancy
Focal appendiceal city
Why is Doppler with color not enough to exclude the diagnosis of torsion
Because it may be intermittently twisting and re-twisting I may be more of a chronic condition. Does clinical diagnosis is most important
What are the class D antiepileptics in pregnancy
Valproic acid, phenytoin, carbamazepine
Recommended anti-epileptic during pregnancy
Mono therapy with Leviteracetam and lamotrigine
Why are opioids a problem during pregnancy
Other than maternal risk of overdose, hope your withdrawal can cause hypoxia, preterm labor, and fetal demise
What is the best test to diagnose appendicitis and pregnancy?
Noncontrast MRI without gadolinium as recommended due to recent concerns of fetal effects from exposure
Alternative testing modality for appendicitis and pregnancy
Focal appendiceal city
Why is Doppler with color not enough to exclude the diagnosis of torsion
Because it may be intermittently twisting and re-twisting I may be more of a chronic condition. Does clinical diagnosis is most important
What are the class D antiepileptics in pregnancy
Valproic acid, phenytoin, carbamazepine
Recommended anti-epileptic during pregnancy
Mono therapy with Leviteracetam and lamotrigine
Why are opioids a problem during pregnancy
Other than maternal risk of overdose, hope your withdrawal can cause hypoxia, preterm labor, and fetal demise
What is the only difference in the management of alcoholism and pregnancy?
Do not use disulfiram or Antabuse because there’s a potential teratogen
When is the classic
Teratogenic. And pregnancy
2 to 15 weeks of gestation
What did you not give NSAIDs during pregnancy
I can cost oligohydramnios, and construction of a fetal ductus arteriosus
What are the acceptable limits of radiation during pregnancy
Definitely less than 50 MGy or 5 rads, But probably under 100 is OK to
Describe the possible Tourette’s agenic affects above 10 rd by gestational age,?
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
