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Obs & Gynae > Physiology of Pregnancy + Drugs > Flashcards

Physiology of Pregnancy + Drugs Flashcards

1
Q

What happens to blood volume, RBC and flow in pregnancy and what does this lead too

A

Increases
RBC increase by up to 40%
Produces physiological anaemia

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2
Q

What happens to systemic vascular resistance

A

Decreases

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3
Q

What happens to BP in pregnancy and why

A

Drops due to drop in resistance + relaxation due to progesterone
Usually returns to normal by 3rd trimester

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4
Q

What happens to CO

A

Increases due to drop in afterload and increase in SV + HR

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5
Q

What happens to after load, SV + HR

A

Afterload drops due to drop in resistance

SV and HR increases due to increased O2 demand

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6
Q

What position for pregnant women in resus?

A

Left lateral

Lying supine reduces CO. by 25% as IVC squashed

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7
Q

Why does 02 demand increase

A

Increased metabolism

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8
Q

What happens to TV and RR

A

Increases as increased O2 demand
SOB due to increased RR = physiological but careful of PE
Can lead to mild alkalosis on blood - also due to increased HCO3

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9
Q

What happens to PEFR and FEV1

A

Unchanged

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10
Q

What does progesterone do

A

Causes bronchodilator

Asthmatic have less problems in pregnancy

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11
Q

What happens to gut motility and peristalsis and what does this increase risk of

A

Decreases
Due to smooth muscle relaxation by progesterone
GORD

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12
Q

What happens to intra-abdominal pressure

A

Increases

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13
Q

What happens to GFR

A

Increases as increased CO

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14
Q

What happens to creatinine and urea

A

Increased clearance

Lower levels in pregnancy suggest renal failure

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15
Q

What happens to protein

A

Increased excretion causing oedema

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16
Q

What happens to ureters

A

Dilatation and hydronephrosis

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17
Q

Why are pregnant women prone to UTI

A

Short urethra
Stasis by progesterone
Can cause pre-term labour
Microscopic haematuria common in pregnancy

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18
Q

What happens to urate

A

Urate increases the same as no of weeks gestation

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19
Q

Why is glycosuria common in pregnancy

A

Pregnancy is anti-insulin

If that is only symptom the n don’t worry

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20
Q

What happens to iron requirements

A

Increase

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21
Q

What happens to WCC

A

Increase but doesn’t mean infection

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22
Q

What happens to platelets

A

Decrease

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23
Q

What happens to Hg, Hcrit and RBC

A

Decrease

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24
Q

What happens to CRP

A

Stays the same so use as marker of infection

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25
Q

What happens to ESR

A

Increases so can’t use

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26
Q

What happens to liver enzymes - AST / ALT / GGT

A

Decrease

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27
Q

What happens to alkaline phospate

A

Increases as produced by placenta

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28
Q

What happens to bile acid

A

The same

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29
Q

What happens to d-dimer

A

Increases so can’t use for PE

Must do V/Q scan as CTPA CI

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30
Q

What happens to your thyroid?

A

Enlarged to trap more iodine as kidneys secrete more

If iodine deficient may develop a goitre

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31
Q

What makes morning sickness worse

A

Higher B-hCG
Molar / twins
Usually improves by 16 weeks

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32
Q

What is hyperemesis gravidrum

A

Severe N+V in pregnancy

33
Q

What happens to HCO3

A

Increases

34
Q

What occurs doe to reduced peristalsis

A

Constipation

35
Q

What happens to drug absorption

A

Decreased as D+V + reduced motility

Increased IM due to increased blood flow

36
Q

What happens to hepatic blood flow

A

Unchanged

37
Q

What happens to NaCl and H20 l in kidney

A

Increased reabsorption

38
Q

What happens to iron / folate / ca requirement

A

Increase

39
Q

What do you need iodine for

A

Healthy brain + bone

Metabolism

40
Q

What happens to breast

A

Increase in size and vascularity

Warm and tender

41
Q

What are other general adaptions

A

Immunosuppressed as fetes foreign body
Weight gain 2-10kg
Increased relaxation
Curvature of spine change

42
Q

What is gravity

A 
Number of times women IS or HAS been pregnant regardless of outcome
Twins count as 1 
Nulli = none
Prim = 1st pregnancy 
Multi = >1
43
Q

What is parity

A

Number of pregnancy >24 weeks

1+2 = 1 >24 weeks and 2 didn’t make

44
Q

What are Braxton Hicks

A

Non painful contractions
Later on in pregnancy - 3rd trimester
Irregular

45
Q

Where do you get info about drugs in pregnancy

A

BNF
UK tetrology
Drug and lactation database

46
Q

What are principles of prescribing in pregnancy

A 
Avoid unneccesary
Use drugs with best safety 
Avoid new drugs
Use lowest dose for shortest time
Avoid 1st 10 weeks
Stop or reduce before delivery
If safe in<2 should be safe in breast
Choose highly protein bound
47
Q

How is absorption, distribution, metabolism and excretion affected by pregnancy

A

Absorption - N+V, decreased motility, increased IM and respiratory
Distribution - decreased plasma protein
Metabolism - increased
Excretion - increased GFR so plasma conc may decrease

48
Q

What happens to drugs in fetal circulation

A

Less protein so increased drug
Little fat
Reduced enzymes

49
Q

What does placental transfer depend on

A

Weight - smal
Polarity - non polar
Lipid solubility

50
Q

What is teratogenicity

A

1st trimester

51
Q

What do folate antagonists cause

A

Need folate for DNA
Neural tube
Face and limb defects

52
Q

What are folate antagonist

A

Methotrexate
Trimethoprim
Nitrofurantoin
AED

53
Q

What should you do for methotrexate

A

Stop 6 months prior

54
Q

What should you do for trimethoprim

A

Do not give in 1st trimester

55
Q

What should you do for nitrafurantoin

A

Not in 3rd trimester

Cause haemolytic anaemia

56
Q

What do retinoid drugs cause

A

Aortic arch anomaly
VSD
Face malformation
Oesophageal atresia

LD
Endocrine
In-utero death

57
Q

What do retinoids require

A

Contraception

58
Q

What do anti-convulsants cause

A

Neural tube defect

59
Q

What do anti-coag cause

A

Haemorrhage
CNS
MSK

60
Q

What does ACEI cause

A

Renal dysgenesis

Growth

61
Q

What does NSAID cause

A

Premature closure of ductus arteriosus

62
Q

What does alcohol cause

A 
SGA
Pre-mature
Miscarriage 
FAS
Withdrawal
63
Q

What do opioids cause

A

NAS

Resp depressio

64
Q

What does cocaine cause

A 
Vasoconstriction
Hypertension
Abruption
Premature
IUGR 
NAS
65
Q

When do you avoid aspirin

A

Labour

Risk of bleed

66
Q

Zika

A

Microcephaly

67
Q

What does smoking cause

A 
IUGR
Pre-term
Placental abruption 
Pre-eclampsia 
Cleft palate /lip 
Miscarriage
Stillbirth
68
Q

Thialimiide

A

Absent limb

69
Q

Phenytoin / Carbamazepine

A

Neural tube defect

GDD

70
Q

Tetracyclne

A

Yellow teeth

71
Q

SSRI

A

Congenital HD

Pulmonary hypertension in 3rd

72
Q

What is fetotoxicity

A

2nd / 3rd trimster insult

Functional and growth defect

73
Q

What drugs should be avoided in breast feeding

A 
Cytotoxic
Immunosuppression
Aspirin
Amiadarone
Lithium 
Iodine
Tetracyclien / sulphonamide / quinolone
74
Q

What does CVS changes cause

A

Ejection systolic
Forceful apex
3rd HS

75
Q

What Ax CANNOT be used in pregnancy

A 
Tetracycline
Aminoglycoside
Sulphonamide
Trimethoprim 
Quinolones
76
Q

What other drugs should be stopped

A 
ACEI 
Statin
Warfarin
Sulphonurea
Retinoids
Cytotoxic
77
Q

Aminoglycoside

A

Ototoxicity

78
Q

Lithium

A

Ebsteins

Obs & Gynae (23 decks)

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