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AHN 548 Unit 5 > CH 33 Nervous System and Autoimmune Disorders of Pregnancy > Flashcards

CH 33 Nervous System and Autoimmune Disorders of Pregnancy Flashcards

1
Q

CVA causes

A

insufficiency (arteriosclerosis, cerebral embolism, vasospasm from HTN), and bleeding into the cerebral cortex (arteriovenous malformarion, ruptured aneurysm)

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2
Q

What happens during CVA

A

brain becomes infarcted from lack of blood flow, or intracranial bleeding results in space occupying lesion. Severity affected by blood pressure, 02 sat, hypoglycemia, and adequacy of circulation Usually happens in last trimester or immediately postpartum

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3
Q

CVA causes exclusive to pregnancy

A

eclampsia, choriocarcinoma, and amniotic fluid embolism

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4
Q

Most common aneurysm

A

Saccular (berry) variety, which protrudes from the major arteries in the circle of Willis

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5
Q

Clinical findings of CVA

A

Headaches, visual disturbances, syncope, and hemiparesis

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6
Q

Use of CT and MRI for CVA

A

used to increase delineation of CVA involvement

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7
Q

Arteriography in CVA

A

definitive if surgical intervention is being considered because it can more precisely localize the involved area

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8
Q

Labs for CVA

A

coagulation profile, ANA, lupus anticoagulant, factor V Leiden, homocysteine, anticardiolipin, proteins C and S, antithrombin III, plasminogen levels

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9
Q

CVA treatment, what should be done

A

Manage supportively, and use surgery for some aneurysms. Anticoagulation with heparin. Tissue plasminogen activator is contraindicated in pregnancy. Normalize blood pressure, resp support, treat metabolic complications and coagulopathies or cardiac abnormalities

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10
Q

CVA meds for cerebral edema

A

Dexamethasone, hyperventilation, mannitol, phenobarbital to induce coma, and monitor ICP.

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11
Q

CVA surgical intervention for pregnancy

A

do surgery without disturbing fetus, unless fetal maturity allows for c section before intervention. If vaginal delivery must be done, use forceps and regional anesthesia to reduce cerebral pressure associated with Valsava maneuver

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12
Q

Migraines during pregnancy

A

decrease during pregnancy in 50-80% of patients

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13
Q

Migraine clinical findings

A

usually has a history, described as pounding and may settle in the eyes, temporal region or occiput; Associated with GI complaints (N/V/D), or systemic symptoms (vertigo, syncope), photophobia, sonophobia, aura. Sleep may abort attack.

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14
Q

Tension and caffeine withdrawal HA

A

associated with bandlike pressure pain

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15
Q

Migraine differentials

A

Rule out Meniere’s disease if there is vertigo; If there is vertigo associated with ataxia or gait r/o head trauma, brain tumors, seizure disorders and multiple sclerosis

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16
Q

Migraine treatment (environmental)

A

Identify triggers (missing meals, stress, aged cheese, sausage, chocolate, citrus fruits, wine, monosodium glutamate, strong odors or lights, inadequate sleep)

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17
Q

Migraine treatment, abortive meds

A

acetaminophen, acetaminophen with codeine, narcotics, magnesium. Not preferred during pregnancy: butalbital, isometheptene, caffeine, aspirin, naproxen, ibuprofen, and triptans. Don’t give NSAIDs in 3rd trimester..it’ll lead to oligohydramnios

18
Q

Migraine treatment, prophylactic meds

A

beta mimetic blockers, low dose tricyclic antidepressants, CCBs, magnesium, riboflavin, and topiromate. DONT fgve valporic acid or divalproate during pregnancy.

19
Q

MS pathogenesis

A

autoimmune demyelinating process in white matter of CNS. Affects women twice as much. Cause not known

20
Q

MS clinical findings

A

weakness in extremities, sensory loss, difficulty with coordination, visual problems, increased reflexes, spasticity, bladder control problems

21
Q

Differential diagnosis for MS

A

R/O myasthenia gravis by doing anticholinesterase (neostigmine) challenge and acetylcholine receptor antibody testing. R/o Guillian-Barre if there is hx of recent viral infection

22
Q

Labs for MS

A

Check serum for Vitamin B 12, Lyme, human T cell lymphotrophic virus type 1, erythrocyte sedimentation rate, ANA, rheumatoid factor. Elevated IgG in cerebrospinal fluid is diagnostic

23
Q

Imaging for MS

A

MRI would reveal lesions in white matter of the brain and spinal cord. Active plaques will enhance with contrast

24
Q

MS treatment

A

Interferon beta 1a, interferon beta 1b, glatiramer. Give glatiramer if trying to conceive then discontinue when pregnancy is established. Treat exacerbations with IVIG and corticosteroids postpartum

25
Q

Myasthenia Gravis, what is it

A

chronic disorder of the neuromuscular junction of striate muscles as result of acetylcholine receptor dysfunction. Antibodies to acetylcholine will be present. Occurs more commonly in females than males and in the 30s.

26
Q

Myasthenia gravis clinical findings

A

fatigued small muscles (especially ocular causing double vision), weakness increases, easily diagnosed later in the day. may have difficulty swallowing and with speech.

27
Q

Myasthenia gravis diagnosis

A

administer edrophonium (tensilon) to assess improvement in muscular weakness. Perform radioimmunoassay for acetylcholine receptor antibody. Repetitive nerve stimulation would show decrement greater than 15%

28
Q

Myasthenia gravis complications of pregnancy

A

exacerbation in 1/3 of pts. Doesn’t affect uterus since it is smooth muscle. Length of labor not affected but 2nd stage may be harder due to maternal fatigue. Exacerbations most common postpartum. Monitor fetal kicks with US, monitor for pulmonary issues and polyhydramnios. Neonate transient symptoms last around 3 weeks.

29
Q

Myasthenia Gravis treatment

A

Anticholinesterases (neostigmine) must be given more frequently during pregnancy. May also use thymectomy, steroids, plasma exchange, and IVIG. Give anticholinesterase parenterally during labor. AVOID aminoglycoside antibiotics, mag sulfate, and chloroform

30
Q

Rheumatoid arthritis parthenogenesis

A

chronic autoimmune disease characterized by symmetric inflammatory synovitis

31
Q

Clinical findings of rheumatoid arthritis

A

insidious with prodrome of fatigue, weakness, generalized joint swelling and myalgias.

32
Q

Diagnosis of Rheumatoid arthritis

A

made when patient is found to have inflammatory arthritis involving 3 or more joints. rheumatoid factor, elevated c reactive protein, elevated ESR, duration of symptoms for more than 6 weeks. Assess morning stiffness and number of joints involved

33
Q

Abnormal labs in rheumatoid arthritis

A

mild leukocytes, elevated ESR, positive rheumatoid factor.

34
Q

Treatment of rheumatoid arthritis

A

Rest, anti-inflammatory drugs, splints, PT, well balanced diet, joint movement. Low dose corticosteroids, hydroxychloroquine, sulfasalazine. Relapse may occur within 6 months postpartum. May need to terminate breastfeeding so that mother can take full range of pharmacologic therapy.

35
Q

Meds to avoid for Rheumatoid arthritis in pregnancy

A

AVOID Cyclooxygenase inhibitors to avoid premature closure of ductus arteriosus and oligohydramnios. Avoid tumor necrosis factor inhibitors, penicillamine, gold, and methotrexate. Monitor Ro/SS-a and La/SS-b to determine feral risk of heart block

36
Q

Systemic Lupus Erythematosus (SLE) pathogenesis

A

chronic inflammatory dz that affects many organs. cause is unknown.

37
Q

SLE clinical findings

A

need to meet 4 of these criteria: malar rash, discoid rash, photosensitivity, oral ulcers, serositis, renal disorders, neuro disorders, hematologic disorders (anemia, leukopenia, thrombocytopenia), immunological disorders (anti DNA, anti Sm, false positive venereal dz research lab test), or abnormal ANA titer

38
Q

Differential diagnosis SLE

A

rheumatoid arthritis, drug induced SLE symptoms, polyarteritis, chronic active hepatitis, and preeclampsia

39
Q

Complications of SLE

A

preeclampsia, fetal growth restriction, risk of lupus flare, preterm delivery, may have deterioration of renal function

40
Q

SLE treatment

A

Corticosteroids (may cause facial cleft, PROM, preterm delivery), hydroxychloroquine and azathioprine. Daily baby aspirin and heparin for those diagnosed with antiphospholipid antibody syndrome.

41
Q

SLE monitoring during pregnancy

A

serial US for fetal growth, antenatal testing to ensure fetal well being. Deliver at 39 weeks. Uterine artery doppler at midgestation to predict fetal growth restriction

42
Q

Drugs to avoid for SLE during pregnancy

A

Mycophenolate mofetil, cyclophosphamide, methotrexate, warfarin

AHN 548 Unit 5 (14 decks)

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