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OB > HTN Disorders > Flashcards

HTN Disorders Flashcards

1
Q

Chronic vs gestational HTN

A

Both have SBP >140 and DBP > 90
Onset with chronic is prior to pregnancy or less than 20 weeks
Onset with gestational is 20 weeks
ACEI not used for chronic (fetal renal failure, oligohydramnios, and pulm hypoplasia)
Chronic lasts past 12 weeks PP and gestational resolves by 12 weeks PP
Gestational starts at 37 weeks or after
Chronic HTN increased risk for preeclampsia

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2
Q

Pathogenesis of HTN in OB patients

HTN is associated with what physiological cause

A

Failure of 2nd trophoblastic invasion (14-16 weeks)

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3
Q

What complicated vascular proteins are involved with HTN in OB patients

A

PGs, TXs, endothelin, endothelium derived relaxing factor

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4
Q

Associated with alterations in immune response and occurs in presence of placental issue

A

HTN

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5
Q

Platelet dysfunction

A

HTN

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6
Q

Severe HTN criteria and goal

A

Criteria >160-170/105-110
Goal 140-155/90-105
Greater reduction = decrease UPP

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7
Q

Which antihypertensives are contraindicated in pregnancy

A

ACEI

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8
Q

Management of refractory HTN

A

Infusions of labetalol, NTG, or nipride
A-line for severe cases
Treat HTN from DL

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9
Q

Risk of pulmonary HTN and stroke are greatest when

A

PP

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10
Q

S/S of pre-eclampsia

A

HTN and proteinuria after 20th week

Sbp >140
DBP > 90
300 mg or more of proteinuria in 24 hours

Nondependent edema no longer included

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11
Q

Pre-eclampsia has deficiency in

A

Prostacyclin and thromboxane

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12
Q

Increased Prostacyclin and smaller increase of thromboxane does what

A

Vasodilation, decreased platelet aggregation and decreased uterine tone

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13
Q

In pre-eclampsia which hormone dominates

A

Thromboxane (increased platelet aggregation, increased uterine tone, vasoconstriction)
Prostayclin decreases

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14
Q

What causes vasoconstriction in pre-eclampsia

A

Increased prostaglandin, interleukin and endothelins

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15
Q

What happens when uterine spiral arteries cannot dilate in pre-eclampsia

A

Placental ischemia

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16
Q

Pre-eclampsia has an increased or decreased response to vasoactive substances

A

Increased

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17
Q

Placenta releases _____ that causes endothelial dysfunction throughout body

A

Cytokines

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18
Q

Pre-eclampsia has a deficiency in _____ causing increased oxidative stress from free radicals

A

Antioxidants

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19
Q

Prostayclin does what

A

Increases UPBF

Decreases platelet aggregation, vasoconstriction, uterine atony

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20
Q

Thromboxane does what

A

Decreases UPBF

Increases platelet aggregation, vasoconstriction, uterine activity

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21
Q

Cardiovascular physiologic response of pre-eclampsia

A

Hypersensitive to vasoactive hormones
Vascular spasm, decrease in blood volume
Increased SVR
Sustained HTN

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22
Q

Pulmonary physiologic response to pre-eclampsia

A 
Pharyngolaryngeal edema
Pulmonary edema
Colloid oncotic pressure is reduced 
Antepartum 18 normal is 22
Postpartum 14 and normal is 17
Decreased colloid oncotic pressure and increased vascular permeability = loss of fluid and protein into tissues leading to edema
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23
Q

Neurological s/s from pre-eclampsia

A 
HA
Visual disturbances
CNS hyperexcitability
Hyperreflexia
Seziures
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24
Q

Renal s/s from pre-eclampsia

A

Glomerulopathy
GFR decreased by 25%
Proteinuria
Oliguria

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25
Q

Hepatic s/s from pre-eclampsia

A

Increased transaminases

Subcostal/RUQ pain - liver swelling, periportal hemorrhage, subcapsular hematoma, hepatic rupture

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26
Q

Hematologic s/s from pre-eclampsia

A

Hypercoagulability
Fibrinolysis
Platelet activation - thrombocytopenia
DIC esp with placental abruption

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27
Q

Risk factors for pre-eclampsia

A 
Previous diagnosis
Multipara
Pre existing HTN DM
Renal vascular CT diseases
BMI > 35
African american
Age >40
Lupus
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28
Q

Symptoms of pre-eclampsia

A 
U/o 30-50ml/hr
Mild HA
Blurred impaired vision
NV abdominal pain
Chest pain
Depression of patellar reflexes
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29
Q

Lab values found in pre-eclamptic patients

A 
Plts 50k-100k
Ast/alt 1-2x normal
IUGR
Creat 0.9-1
Proteinuria
30
Q

Pre-eclampsia severe symptoms diagnostic critieria

A

BP >160 DBP >110
Persistent oliguria <500/daily
Progressive renal insufficiency

31
Q

Pre-eclampsia severe symptoms lab values

A

Plt <100k
AST/ALT 2X normal
HEELP syndrome

32
Q

Severe symptoms with pre-eclampsia

A 
Unrelenting HA
Partial blindness or blind spots
Epigastric / RUQ pain
Pulmonary edema
U/O <30 ML/hr
33
Q

Category 3 symptoms of pre-eclampsia

A 
Creatinine > 1.2
Proteinuria > 500mg/daily
NV abdominal pain
Chest pain 
RR <12
34
Q

Eclampsia s/s

A 
Pre-eclampsia with seizures
HTN encephalopathy
Loss of cerebral autoregulation
Vasospasm
Microinfarctions, punctate hemorrhages
Thrombosis
Cerebral edema
35
Q

What is feared with eclampsia

36
Q

HELLP syndrome s/s

A

Upper abdominal tenderness/epigastric pain

Hemolysis
Elevated liver enzymes
Low platelets <100k

37
Q

Definitive treatment of HELLP and pre-eclampsia

A

Delivery of baby

38
Q

What are HELLP patients at risk for

A

DIC, intra-abdominal bleeding from liver

39
Q

Prophylaxis with ASA =

A

No change in fetal outcomes

40
Q

37 weeks or signs of deterioration in pre-eclampsia

A

Labor induced or CS urgent

41
Q

When symptoms become severe or fetal distress ensues in pre-eclampsia

A

Immediate delivery

42
Q

Treat BP when it exceeds _______ to prevent CVA, MI, placental abruption

43
Q

Mag sulfate is used for

A

Seizure prophylaxis

44
Q

MOA of mag sulfate

A

Centrally via NMDA receptor antagonism

Increases prostacyclin release

45
Q

Mag sulfate dose

A

4g bolus over 20 min then 1-2g/hr
4-6 meq/l is therapeutic range
Continued in PP

46
Q

Benefits of mag

A

Decreases SVR
Increases CI
Improved UPBF
Tocolysis of labor

47
Q

Disadvantages of mag

A

Narrow therapeutic window, toxic effects
Increased bleeding and hypotension with hemorrhage
Decreased uterine contractility (oxytocin may be required for induction of labor, increased risk of uterine atony)

48
Q

Antidote for mag toxicity

A

1g calcium gluconate or 300mg calcium chloride

49
Q

Loss of DTR =

50
Q

Mag level with Respiratory depression =

51
Q

Mag level with respiratory arrest

52
Q

Mag level with cardiac arrest

53
Q

Treatment of eclamptic seizure

A

Small doses of barbs or benzos (midaz 1-2mg) O2 by mask
If seizure persists or patient not breathing - RSI and extubate when completely awake and recovered from neuromuscular blockade and mag sulfate has been administered

54
Q

Pre-anesthetic management for preeclamptic patient
Volume status
Airway eval
Lab values you should have and want

A

Volume status - hypovolemic (give 250-500 prior to epidural), more prone to pulmonary edema with boluses, central line, PA catheters for resuscitation
Airway eval - edema gets worse with labor and pushing
Lab values you should have - HCT, platelet 70-100k, PT/PTT, TEG indicates platelet function, BUN Cr
Lab values you should want- TEG, ABG, CXR if SOB (pulm edema)

55
Q

What labor analgesia is preferred for pre-eclamptic patients

A

Epidural for decreased catecholamines, BP control, improved intervillous blood flow

Avoid hypotension non glucose IV fluids
Ephedrine!

56
Q

Increased ICP in pre-eclampsia = which anesthetic plan

57
Q

Anesthesia considerations for CS for pre-eclampsia

A 
Coagulation, airway, hemodynamics
Fetal status
Epidural preferred
3% 2chloro for emergency 
Severe: avoid epi with test dose
Spinal not advised bc of severe sympathectomy
Avoid GA
Mag increases sensitivity to NMB
Don’t decrease sux
58
Q

Indications for GA with pre-eclamptic patients

A

Sustained fetal bradycardia

Maternal coagulopathy, hemorrhage or refusal of regional

59
Q

True or false consider awake fiberoptic with pre-eclamptic GA patients

60
Q

Which drug should be avoided for GA pre-eclamptic patients

61
Q

During GA for pre-eclamptic patients what drugs are used to control HTN

A

Hydralazine, labetalol, remi, HTG, emolol for DL

A-line for severe HTN (risk of CVA)

62
Q

Best med to prevent and treat eclampsia

63
Q

MOA of cocaine abuse

A

Ester LA

Inhibits NE reuptake in presynaptic SNS = increased SNS tone

64
Q

Risks with cocaine abuse

A

Tachy, dysrhythmias, coronary vasoconstriction, MI

Cerebral vasoconstriction, ischemia, seizures, stroke

65
Q

Fetus implications for cocaine abuse

A

Spontaneous abortion
Premature labor
Placental abruption
Lower APGAR scores

66
Q

Decrease or increase MAC with cocaine abuse

A

Chronic - decreased MAC

Acute - increased MAC

67
Q

What happens with blocking beta 1 and 2 receptors with cocaine abuse patients

A

heart failure if patient has elevated SVR

68
Q

Antihypertensive used for cocaine abuse

A

Labetalol for alpha action

Vasodilators can cause tachy

69
Q

Why can’t you use ephedrine for hypotension in cocaine abuse

A

Due to catecholamine depletion

Phenylephrine !

70
Q

Chronic abuse of cocaine is associated with

A

Thrombocytopenia

Check platelets before regional

OB (10 decks)

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