Hypertension Flashcards
What is the definition of Gestational Hypertension?
Blood Pressure >139/89 after 20 weeks of pregnancy and does not progress to Pre-eclampsia and is normotensive by 12 weeks postpartum.
What is the definition of Chronic Hypertension?
Blood pressure >139/89 present and observable before pregnancy or diagnosed before 20 weeks of pregnancy.
What is the definition of Pre-Eclampsia?
At least two blood pressures of >139/89 at least 4 hours apart with the addition of proteinuria or an MAP >105.
What is the definition of Severe Pre-Eclampsia?
Blood Pressure >159/109
Platelets <100,000
Serum Creatinine >1.1
Elevate AST and ALT (twice the normal limit)
What is the proteinuria level to diagnose Pre-Eclampsia?
300 mg
What is the definition of HELLP syndrome?
Hemolysis (Elevated LDH, elevated bilirubin)
Elevated Liver Enzymes
Low Platelets
What is the definition of eclampsia?
The onset of a grand mal seizure in a woman diagnosed with pre-eclampsia and no previous neurologic conditions
What are the two stages of Pre-Eclampsia?
- Encompassing poor placentation
- New onset of hypertension and proteinuria
Why is swelling a concern in Pre-Eclampsia?
This can lead to hemoconcentration and increase the risk of pulmonary edema or cerebral edema.
Why is Magnesium Sulfate given in the diagnosis of Pre-Eclampsia?
For seizure prevention
What is the target Magnesium Levels?
4.8-8.4 mg/dL (normal is 1.5-2)
What is the medication that is given for Magnesium toxcitiy?
Calcium Gluconate.
What are symptoms of Magnesium Toxicity?
decreased urine output, depressed respirations, decreased myocardial contractility
What is the dosage of hydralazine?
5 mg given over 2 minutes
Max dose: 25 mg/ 24hours
What is the dosage of labetalol?
10 or 20 mg given over 2 minutes. This can be given as 20, 40, or 80 mg.
Max dose of oral: 2400 mg
Max dose IV: 220-300 mg/ 24 hours
What is the dosage of Nifedipine?
10 or 20 mg immediate release or 30 mg extended-release.
Max XL dose: 120 mg/day
Max immediate release: 180 mg/day
What are Neurologic symptoms of Pre-E?
- Headache (unrelieved with Tylenol)- this is indicative of cerebral edema and vasoconstriction.
- Visual disturbances- optic nerve ischemia and fluid build-up behind the eyes
- Seizures- NOT FROM HIGH BPs!!!!! This is from fluid accumulation that puts intense pressure on the brain.
- Hyperreflexia
What are Heart/Lung symptoms of Pre-E?
- Left ventricular failure
- Oliguria- all the fluid is in the interstitial spaces and not in the vasculature to be filtered out by the kidneys
- Pulmonary edema- THE HEART FAILED FIRST!
What are Liver symptoms of Pre-E?
- RUQ pain- this is from vasospasms and ischemia
- Elevated labs- LFTs, Bilirubin, LDH
What are the normal ranges for AST and ALT?
AST: 8-48
ALT: 7-55
What are Kidney symptoms of Pre-E?
- Protein loss- protein is a large molecule and should not be lost from the kidneys, this is because the filter is broken
- Increase in Creatinine- the kidneys are working harder in general
What are Blood symptoms of Pre-E?
- Low platelets- this is because of hemolysis
- Albumin loss- this leads to 3rd spacing
What are Fetal effects of Pre-E?
IUGR, abruption, placental insufficiency, Preterm delivery, and oligohydramnios
What are patients with Chronic Hypertension at risk for?
Stroke (intracranial bleed)
Why should ACE inhibitors and ARBS be avoided in pregnancy?
They are fetotoxic, cause fetal anomalies and kidney damage
When are the platelets the lowest after delivery with HELLP?
24 hours post delivery- it is going to get worse before it gets better.
When are you at highest risk for a seizure?
Within 24 hours of delivery.
Magnesium is a hypertonic solution, what does that mean?
This pulls fluid out of the interstitial spaces and back into the vasculature.
What are three conditions to not give Magnesium in and one to watch with?
- Myasthenia gravis
- Heart failure
- Pulmonary edema
- Watch kidney function- mag is excreted through the kidneys
True or False: Magnesium is a Calcium antagnoist?
True: As magnesium goes up, Calcium goes down.
What is a contraindication for IV labetalol?
Asthma- this is non-selective to both beta receptors-this can cause bronchospasm
What is a caution to know when giving IV labetalol?
Diabetics- this can impair the autonomic response to hypoglycemia
When should you hold giving labetalol?
When the pulse is under 60 bpm
What are side effects of hydralazine?
Hypotension and tachycardia.
How does Procardia work?
This dilates the coronary arteries (relaxes smooth muscle) which increases renal perfusion
What are three side effects of Procardia?
- Red cheeks
- Headache
- rebound tachycardia
What should not be given with Procardia?
Grapefruit or grapefruit juice- this can impair the absorption
True or False: after a patient is stabilized from a seizure, the safest route is to deliver vaginally?
True: a patient can rapidly dilate with a seizure
When do blood pressures peak after delivery?
3-6 days
