Hypertensive Disorders Flashcards
PRES
definition
Sxs
Vision loss or deficit
Seizure
Headache
Altered sensorium
Diagnosed by imaging: vasogenic edema posterior aspect of brain on MRI
PRES diagnosis
Vasogenic edema and hyperintensities on the posterior aspect of the brain on MRI
LFTS
AST is dominant transaminase released in PreE and will be higher than ALT
Abnormal coags may develop with significant liver dysfunction
Delivery timing
SEVERE FEATURES
34w
Contraindications to magnesium sulfate
Myasthenia gravis
Hypocalcemia
Moderate to severe renal failure
Cardiac ischemia, heart block, myocarditis
No IV access?
Mag can be injected intramuscularly, 10 g loading those followed by 5 g every four hours.
Rate of adverse effects is higher
Adverse effects
Antidote
DTRs lost at 9 mg/dL
Respiratory depression at 12
Cardiac arrest at 30
Calcium gluconate 1g
IV Antihypertensives
Dosing
Adverse effects
Onset of action
Labetalol
10-20 mg then 20-80 q10 min. Max 300 mg in 24 hrs
Avoid in patients with asthma decompensated cardiac function, heart block and bradycardia
1 to 2 minutes
Hydralazine
5 mg then 5 to 10 mg every 20 minutes, maximum 20 milligrams
AEs: maternal hypotension, headaches, FHT abn
10 minutes
Nifedipine
10 mg orally then 20 mg every 20 min to Maximum 180 mg
Reflex tachycardia and headache
10 minutes
Indication for baby aspirin
High risk factors (1)
Moderate risk factors(Need 2)
History of preeclampsia diabetes Auto immune disease such as a APAS or lupus Multi fetal gestation Chronic hypertension Renal disease
Age more than 35 years Nulliparity Obesity African-American Low socioeconomic status FH of preE Hx of SGA OR low BW >10 yrs since previous pregnancy
Alternatives to magnesium sulfate for seizure prophylaxis
Phenytoin 300 mg IV
Requires EKG monitoring
Diazepam 5mg IV
May require intubation
Secondary causes of chronic hypertension
Coarctation of the aorta Primary hyperaldosteronism Cushing disease Pheochromocytoma Sleep apnea Methamphetamine or cocaine use Renal disease or renal artery stenosis
Preferred oral agents for treatment of chronic hypertension in pregnancy
Labetalol up to 2400 mg divided into 2 to 3 doses
Nifedipine up to 120 mg once per day
Methyldopa up to 300 mg divided into 2 to 3 doses
HCTZ can be continued in pregnancy
Ace inhibitors are contraindicated in pregnancy
New criteria for hypertension
Normal blood pressure less than 120/80
Elevated blood pressure 120 to 129 and diastolic less than 80
Stage 1 130-139/80-89
Stage 2 >140/90
White classification
A1 diet controlled gestational
A2 drug therapy
B onset >age 20, <10 yrsduration
C onset 10-20 duration 10-20 yrs
D onset <10 duration >20 yrs
F nephropathy
H CAD
R retinopathy
Maternal risk of chronic hypertension in pregnancy
Death Stroke Pulmonary edema Renal failure MI Preeclampsia Abruption Postpartum hemorrhage Gestational diabetes
