HTN and Preeclampsia

Question 1

this hormone cuases dilation of the BV due to relaxing of the BV walls

Answer 1

elastin

Question 2

What is considered HTN?

Answer 2

SBP > 140 and/or DBP >90

2 times 4 hours apart

Question 3

4 categories of HTN

Answer 3

chronic
gestational
preeclampsia/eclampsia/HELLP
preeclampsia + CHTN

Question 4

What is HELLP?

Answer 4

HTN, elevated LFT, low platelets

Question 5

“preexisting HTN”

Answer 5

chronic HTN

Question 6

HTN presents before the 20th week of pregnancy or persists longer than 12 weeks postpartum

Answer 6

chronic HTN

Question 7

Prenatal care for chronic HTN

Answer 7

EKG, UA, urine culture, sCr, glucose, electrolytes, 24 hr urine, CMP, tests for renal disease (trying to r/o DM),

Question 8

1 cause of infant and maternal mortality

Answer 8

hemolysis

Question 9

what should mom with chronic HTN take during pregnancy?

Answer 9

low dose Aspirin (81-150 mg)

Question 10

Treatment for uncomplicated mild essential HTN

Answer 10

none → BP may decrease as pregnancy progresses

Question 11

How should you adjust your patient with CHTN whose BP is <120/80 early in pregnancy?

Answer 11

taper or discontinue

Question 12

When would you want to reinstitute or initiate therapy for a patient with CHTN?

Answer 12

15 above their baseline
> 150/>95
signs of HTN end-organ damage

Question 13

first line oral medication for chronic HTN

Answer 13

methyldopa

Question 14

second line/higher risk pt medication for chronic HTN

Answer 14

labetalol

Question 15

mild HTN without proteinuria or other signs of preeclampsia that develops after 20 weeks gestation and resolves by 12 weeks postpartum

Answer 15

gestational HTN

Question 16

what could proteinuria indicate?

Answer 16

impaired kidney function, preeclampsia, dehydration

Question 17

What is gestational HTN associated with?

Answer 17

hormones of pregnancy

Question 18

what are you concerned about gestational HTN progressing into?

Answer 18

preeclampsia

Question 19

New onset of HTN and proteinuria after 20 weeks → >140/>90, proteinuria >300 mg (24 hr urine)

Answer 19

preeclampsia

Question 20

if your patient presents with preeclampsia prior to 20 weeks what should you think is going on?

Answer 20

molar pregnancy

Question 21

occurrence of generalized convulsion and/or coma in the setting of preeclampsia without any other neurological condition

Answer 21

eclampsia

Question 22

Symptoms of preeclampsia

Answer 22

swelling of hands and face, HTN, proteinuria, edema, headache, vision changes, liver pain

Question 23

CNS dysfunction of severe preeclampsia

Answer 23

blurred vision, scotomata, alterned metnal status, severe headache

Question 24

symptoms of liver capsule distention in severe preeclampsia

Answer 24

RUQ or epigastric pain

Question 25

Serum transaminase concentration that is at least twice normal may indicate

Answer 25

hepatocellular injury

Question 26

What BP qualifies as severe preeclampsia?

Answer 26

>160/>110 2 times 15 min apart

Question 27

Thrombocytopenia, oliguria, progressive renal insufficiency, fetal growth restriction, pulmonary edema, cyanosis, CVA, HELLP

Answer 27

severe preeclampsia

Question 28

chronic HTN + new proteinuria + HTN and proteinuria prior to 20 weeks + sudden increase in BP + thrombocytopenia + elevated aminotransferase

Answer 28

preeclampsia superimposed on chronic HTN

Question 29

Definitive treatment for preeclampsia

Answer 29

deliver the baby

Question 30

what is major indicator for antihypertensive therapy in patient with preeclampsia?

Answer 30

prevent stroke (BP >160/>110)

Question 31

acute treatment for preeclampsia

Answer 31

IV labetalol or hydralazine | SR nifedipine

Question 32

long term treatment for preeclampsia

Answer 32

oral methyldopa or labetalol

Question 33

risk factors for HTN in pregnancy

Answer 33

``` nulliparity preeclampsia in prior pregnancy age >40 or < 18 FH of HTN CHTN chronic renal disease APA syndrome or inherited thrombophilia vascular or CTD DM multifetal gestations BMI > 30 male partner whos partner has preeclampsia hydrops fetalis unexplained fetal growth restriction IVF ```

Question 34

Points to include on physical when evaluating HTN in pregnancy

Answer 34

``` vitals HEENT (vision) cardiovascular respiratory abdomen (epigastric or RUQ pain) NM and extremities (reflex, clonus, edema) fetus (FM,NST) ```

Question 35

lab tests to order in evaluating HTN in pregnancy

Answer 35

``` CBC (Hgb & platelets) renal (Cr, UA, albumin) liver (AST, ALT, ALP, LDH) coagulation (PT, PTT, INR, fibrinogen) urine protein (dipstick, 24 hr) ```

Question 36

observation management for HTN in pregnancy

Answer 36

restrict activity BP monitoring s/s of preeclampsia fetal growth and well being

Question 37

acute therapy for HTN in pregnancy

Answer 37

IV labetalol or hydralazine | SR nifedipine

Question 38

expectant tehreapy for HTN in pregnancy

Answer 38

oral labetalol, methyldopa, nifedipine

Question 39

What medication can you give to prevent eclampsia?

Answer 39

MgSO4

Question 40

contraindicated antihypertensives in pregnancy

Answer 40

ACEi and ARBs

Question 41

Only cure for gestational HTN

Answer 41

delivery

Question 42

Medications for postpartum management of preeclampsia

Answer 42

aldomet, labetalol, propranolol

Question 43

what should mom avoid in the postpartum management of preeclampsia?

Answer 43

NSAID

Question 44

what antihypertensive meds are safe with breast feeding?

Answer 44

``` methyldopa labetalol propranolol low dose ACEi CCB ```

Question 45

Moms with preeclampsia are at increased lifetime risk of

Answer 45

CAD and CVA