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Online Med Ed - Obstetrics > Medical Disease > Flashcards

Medical Disease Flashcards

1
Q

how does congenital hypothyroidism present?

A

low birth weight and neuropsychological impairment

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2
Q

what will labs reveal in hypothyroidism

A

high TSH

low T4

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3
Q

treatment for hypothyroid

A

levothyroxine

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4
Q

changes in pregnancy associated with thyroid

A

more RBCs, increased estrogen and thyroglobulin proteins

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5
Q

why do the changes in thyroid hormones matter?

A

euthyroid non-pregnant women with thyroid disease become relatively hypothyroid as she gets more and more pregnant

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6
Q

important considerations in hypothyroidism in pregnancy

A

may require increasing levothyroxine in pregnancy

  • usually requires 25% increase
  • requires TSH to be assessed regularly (q4-6wks)
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7
Q

how to diagnose hypothyroidism in pregnancy

A

TSH and free T4
Ultrasound
NO RADIOACTIVE IODINE ABLATION (RAIU)

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8
Q

labs in hyperthyroidism

A

low TSH

high free T4

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9
Q

diagnosis of hyperthyroid in pregnancy

A

TSH and free T4
surgery in 2nd trimester
PTU in pregnancy

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10
Q

treatment of hyperthyroidism prior to pregnancy

A

surgical resection or radioactive iodine ablation

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11
Q

considerations for hyperthyroid diagnosis in pregnancy

A

nothing radioactive can be used

  • surgery can still be performed in the 2nd trimester and only in extreme cases
  • PTU in pregnancy
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12
Q

mechanism of action of propylthiouracil (PTU)

A

partially blocks conversion of T4->T2

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13
Q

treatment of hypothyroid disease in pregnancy

A

frequent TSH assessment

adjust dose of levothyroxine based on TSH

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14
Q

valproate in pregnancy

A

cardiac abnormalities, neural tube defects, craniofacial abnormalities

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15
Q

what epileptic drugs to avoid in pregnancy?

A

valproate, phenytoin, and carbamazapine

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16
Q

what are phenytoin and carbamazapine associated with in pregnancy

A

cleft palate/craniofacial abnormalities, cardiac abnormalities, and developmental delay

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17
Q

what med is a reasonable choice in pregnancy?

A

levetiracetam

18
Q

what should every pregnant patient on anticonvulsants receive?

A

folate supplementation

19
Q

asymptomatic screen of bacteriuria

A

YES

20
Q

are pregnant patients with asymptomatic bacteriuria treated?

A

YES

21
Q

first line treatment for asymptomatic bacteriuria

A

empiric coverage of UTIs:

- oral amoxicillin OR IV ceftriaxone

22
Q

back-up treatment for asymptomatic bacteriuria if penicillin allergy?

A

nitrofurantoin

23
Q

what is found in asymptomatic bacteriuria

A 
leukocyte esterase positive
nitrite positive
WBCs
bacteria
no symptoms
24
Q

treat asymptomatic bacteriuria

A

oral abx

25
Q

what is found in cystitis

A

urgency, frequency, and dysuria
leukocyte esterase positive
nitrite positive

26
Q

treatment of cystitis

A

amoxicillin

27
Q

what is found in pyelonephritis

A

urgency, frequency, and dysuria, high fevers, and costovertebral angle tenderness
leukocyte esterase positive
nitrite positive
WBC casts

28
Q

treatment of pyelonephritis

A

IV ceftriaxone

obtain ultrasound to rule out abscess

29
Q

meds that are not safe in pregnancy

A

ACE inhibitors (-prils)
ARBs (-artan)
lithium
retinoic acid
oral diabetes medications (metformin may be ok)
anticonvulsants (valproate, phenytoin, carbamazapine)

30
Q

meds that are almost always safe

A 
α-methyl-dopa
labetalol
hydralazine
insulin
amoxicillin
ceftriaxone
nitrofurantoin
31
Q

what is pregnancy safety category A

A

no risk in controlled human studies

32
Q

what is pregnancy safety category B

A

no risk in animal studies, but no human data OR risk in animal studies, but no risk in human studies

33
Q

what is pregnancy safety category C

A

risk not ruled out, benefits may outweigh risk

34
Q

what is pregnancy safety category D

A

evidence of risk in humans, but still might be worth it if the thing they treat is really bad

35
Q

what is pregnancy safety category X

A

never use in pregnancy

36
Q

what is pregnancy safety category N

A

not classified

37
Q

what med to select for HTN pregnancy

A

α-methyldopa

38
Q

what med to select for HTN in pregnancy if α-methyldopa is not available

A

hydralazine or labetalol

39
Q

first line treatment for diabetes in patients looking to become pregnant

A

dietary modification and lifestyle modifications

- meet with a nutritionist

40
Q

mainstay of therapy of DM in pregnancy

A

insulin

41
Q

what are birth defects associated with GDM mom?

A

macrosomia, premature delivery, transposition of the great vessels

Online Med Ed - Obstetrics (19 decks)

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