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AY Reproduction > Medical problems & prescribing in pregnancy > Flashcards

Medical problems & prescribing in pregnancy Flashcards

1
Q

How does pregnancy affect maternal BP?

A

Vasodilation so BP falls in early pregnancy till 22-24 weeks then steady rise

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2
Q

How is gestational hypertension defined?

A

Hypertension (>140/90) in the second half of pregnancy that resolves <6 weeks post birth
No proteinuria or oedema

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3
Q

What is pre-eclampsia?

A

Hypertension + oedema + proteinuria (>0.3g/24hr)

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4
Q

Symptoms of pre-eclampsia

A 
Headache
Visual disturbance
Rapid progressive oedema 
Nausea/vomiting 
Epigastric/RUQ pain
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5
Q

What is the prophylaxis for pre-eclampsia?

A

Low dose aspirin from 12 weeks if high risk

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6
Q

What efect does pregnancy have on renal diseas?

A

Decreased GFR
Increased serum uric acid
Increased creatinine/potassium/urea

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7
Q

What is HELLP syndrome?

A

Haemolysis Elevated Liver enzymes Low Platelets

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8
Q

How is HELLP treated?

A 
Steroids + delivery 
Seizure prevention (magnesium sulphate)
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9
Q

What is the most common liver disease of pregnancy?

A

Intrahepatic cholestasis of pregnancy

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10
Q

What are the clinical features of intrahepatic cholestasis of pregnancy?

A

Pruritis (hands & soles of feet)
No rash
Jaundice
Raised bilirubin

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11
Q

How is intrahepatic cholestasis of pregnancy managed?

A

Urso for symptomatic relief

Typically induced at 37 weeks

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12
Q

What are the clinical features of acute fatty liver of pregnancy?

A 
Abdo pain 
Jaundice 
Nausea &amp; vomiting
Headache
Hypoglycaemia
Elevated ALT
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13
Q

What hypertensives are used to treat in pregnancy?

A

Labetalol

Methyldopa

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14
Q

Which anti-hypertensives should be avoided in pregnancy?

A

Diuretics + ACE inhibitors

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15
Q

What type of seizure presents in eclampsia?

A

Tonic-clonic seizure

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16
Q

What is the main cause of death in eclampsia?

A

Pulmonary oedema

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17
Q

Which diabetic medication is not safe in pregnancy and should be changed to insulin?

A

Sulphonylureas

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18
Q

How does diabetics antenatal care differ from a regular person?

A

etinal screening every trimester

37-38 weeks delivery

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19
Q

What blood glucose range should be aimed for with pregnant diabetics?

A

BM 4-6

HbA1c <6%

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20
Q

How is a DVT diagnosed in pregnancy?

A

D-dimer NOT used

Duplex US of the lower limb

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21
Q

How are women at high risk of VTE treated?

A

LMW Heparin prophylaxis (continue 3 months after delivery or 6 months after treatment)

22
Q

How long before delivery should warfarin therapy be stopped?

A

6 weeks

23
Q

Is warfarin ok in breast feeding?

A

Yes

24
Q

How is hypothyroidism managed in pregnancy?

A

Increase levothyroxine by 25-50mcg in 1st trimester

25
Q

What effect does pregnancy have on existing hyperthyroidism?

A

Worse in 1st trimester (due to HCG)

Improves 2nd & 3rd trimester

26
Q

Are carbimazole & PTU safe in pregnancy?

A

Yes

27
Q

What effect can the increased RR have on ABG’s in pregnancy?

A

Resp alkalosis (increased pH, decreased pCO2, decreased bicarb)

28
Q

Which anti-epilapticscancause NTD?

A

Valproate

Carbmazepine

29
Q

Which anti-epileptic can cause orofacial defects?

A

Phenytoin

30
Q

Which anti-epileptics can cause heart defects?

A

Phenytoin

Valproate

31
Q

Why is there an increased risk of seizures in the 1st trimester?

A

Hyperemesis & haemodilution

32
Q

What should be prescribed if a pregnan patient is taking hepatic enzyme inducing anti-epileptics?

A

Vit K from 36 weeks

33
Q

What should epileptics be prescribed in pregnancy to minimise foetal problems?

A

Folic acid - 12 weeks prior to conception & throughout pregnancy

34
Q

If either parent has epilepsy what is the chance of the kid having it?

A

5%

35
Q

If both parents have epilepsy what is the chance of the kid having it?

A

15-20%

36
Q

What should be avoided when treating anxiety in pregnancy?

A

Benzos (cleft, neonatal withdrawal)

37
Q

What problems can lamotrigine cause if taken whilst breast feeding?

A

Steven-Johnson syndrome (NEC)

38
Q

Is lithium contraindicated in breast feeding?

A

Yes

39
Q

Which anti-psychotic are safe to treat schizophrenia with in pregnancy?

A

Typical anti-psychotics

40
Q

Which depression drugs are contraindicated in pregnancy?

A

Venlafaxine

Paroxetine

41
Q

Why should cooked liver be avoided in pregnancy?

A

High levels of vitamin A

42
Q

What should be used to treat nausea & vomiting in pregnancy?

A

Cyclizine

43
Q

What should be used to treat UTI’sin pregnancy?

A

Nitrofuratoin (1st & 2nd trimester)

Trimethoprim (3rd trimester)

44
Q

What drug is safe for treatment of pain in pregnancy (e.g. headache)?

A

Paracetamol

45
Q

Which drug if taken when breastfeeding can cause neonatal hypoethyroidism?

A

Amiodarone

46
Q

Which drugs if taken while breastfeeding can cause the baby to be drowsy?

A

Benzos

47
Q

Which drug suppresses lactation if taken when breast feeding?

A

Bromocriptine

48
Q

What issues can methotrexate cause if taken in pregnancy?

A

Skeletal defects

49
Q

What problems can warfarin cause if taken in pregnancy?

A

Limb & facial defects

50
Q

What problems can ACE inhibitors/ARBs cause if taken in pregnancy?

A

Renal hypoplasia

AY Reproduction (23 decks)

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