Medical Disease Flashcards
how does congenital hypothyroidism present?
low birth weight and neuropsychological impairment
what will labs reveal in hypothyroidism
high TSH
low T4
treatment for hypothyroid
levothyroxine
changes in pregnancy associated with thyroid
more RBCs, increased estrogen and thyroglobulin proteins
why do the changes in thyroid hormones matter?
euthyroid non-pregnant women with thyroid disease become relatively hypothyroid as she gets more and more pregnant
important considerations in hypothyroidism in pregnancy
may require increasing levothyroxine in pregnancy
- usually requires 25% increase
- requires TSH to be assessed regularly (q4-6wks)
how to diagnose hypothyroidism in pregnancy
TSH and free T4
Ultrasound
NO RADIOACTIVE IODINE ABLATION (RAIU)
labs in hyperthyroidism
low TSH
high free T4
diagnosis of hyperthyroid in pregnancy
TSH and free T4
surgery in 2nd trimester
PTU in pregnancy
treatment of hyperthyroidism prior to pregnancy
surgical resection or radioactive iodine ablation
considerations for hyperthyroid diagnosis in pregnancy
nothing radioactive can be used
- surgery can still be performed in the 2nd trimester and only in extreme cases
- PTU in pregnancy
mechanism of action of propylthiouracil (PTU)
partially blocks conversion of T4->T2
treatment of hypothyroid disease in pregnancy
frequent TSH assessment
adjust dose of levothyroxine based on TSH
valproate in pregnancy
cardiac abnormalities, neural tube defects, craniofacial abnormalities
what epileptic drugs to avoid in pregnancy?
valproate, phenytoin, and carbamazapine
what are phenytoin and carbamazapine associated with in pregnancy
cleft palate/craniofacial abnormalities, cardiac abnormalities, and developmental delay
what med is a reasonable choice in pregnancy?
levetiracetam
what should every pregnant patient on anticonvulsants receive?
folate supplementation
asymptomatic screen of bacteriuria
YES
are pregnant patients with asymptomatic bacteriuria treated?
YES
first line treatment for asymptomatic bacteriuria
empiric coverage of UTIs:
- oral amoxicillin OR IV ceftriaxone
back-up treatment for asymptomatic bacteriuria if penicillin allergy?
nitrofurantoin
what is found in asymptomatic bacteriuria
leukocyte esterase positive nitrite positive WBCs bacteria no symptoms
treat asymptomatic bacteriuria
oral abx
what is found in cystitis
urgency, frequency, and dysuria
leukocyte esterase positive
nitrite positive
treatment of cystitis
amoxicillin
what is found in pyelonephritis
urgency, frequency, and dysuria, high fevers, and costovertebral angle tenderness
leukocyte esterase positive
nitrite positive
WBC casts
treatment of pyelonephritis
IV ceftriaxone
obtain ultrasound to rule out abscess
meds that are not safe in pregnancy
ACE inhibitors (-prils)
ARBs (-artan)
lithium
retinoic acid
oral diabetes medications (metformin may be ok)
anticonvulsants (valproate, phenytoin, carbamazapine)
meds that are almost always safe
α-methyl-dopa labetalol hydralazine insulin amoxicillin ceftriaxone nitrofurantoin
what is pregnancy safety category A
no risk in controlled human studies
what is pregnancy safety category B
no risk in animal studies, but no human data OR risk in animal studies, but no risk in human studies
what is pregnancy safety category C
risk not ruled out, benefits may outweigh risk
what is pregnancy safety category D
evidence of risk in humans, but still might be worth it if the thing they treat is really bad
what is pregnancy safety category X
never use in pregnancy
what is pregnancy safety category N
not classified
what med to select for HTN pregnancy
α-methyldopa
what med to select for HTN in pregnancy if α-methyldopa is not available
hydralazine or labetalol
first line treatment for diabetes in patients looking to become pregnant
dietary modification and lifestyle modifications
- meet with a nutritionist
mainstay of therapy of DM in pregnancy
insulin
what are birth defects associated with GDM mom?
macrosomia, premature delivery, transposition of the great vessels
