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Cardio > Pregnancy and lactation > Flashcards

Pregnancy and lactation Flashcards

1
Q

Drug therapy for HTN in pregnancy is mainly for

A

Maternal safety. Lack of data to support improvement in fetal outcome

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2
Q

Is hydrochlorothiazide safe in lactation

A

Yes. In doses less than 50mg. Intense diuresis will reduce Breast milk

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3
Q

Labetolol and lactation precaution

A

Nursing a preterm baby other agents may be preferred. Ok for other infants

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4
Q

Amlodipine and lactation

A

An alternate drug may be preferred. If used infants should be carefully observed for adverse effects

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5
Q

A beta blocker other than labetolol which can be used in lactation

A

Metoprolol-No special precaution required

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6
Q

4 safe drugs for HTN in lactation

A

Metoprolol
Labetolol
Nifedipine
Hydrochlorothiazide

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7
Q

Atenolol in lactation

A

Should be avoided

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8
Q

Acceptable alternatives to Labetolol in pregnancy

A

Pindolol and LONG ACTING METOPROLOL are acceptable alternatives though less well studied

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9
Q

Definition of normal BP in pregnancy

A

<140/90

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10
Q

Definition of severe HTN in pregnancy

A

160/110 or more

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11
Q

Benefit of treatment of mild to moderate HTN in pregnancy

A

No proven fetal or maternal benefits

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12
Q

Benefits of treatment of Severe HTN in pregnancy

A

Reduces maternal stroke

Also heart failure & Renal failure

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13
Q

Chronic use of Hydralazine more than ——should be avoided to prevent ——-

A

100 mg /day ; to prevent SLE in mother

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14
Q

4 drugs which can be used in HTN in pregnancy

A

Labetolol, Nifedipine long acting, Alpha methyl dopa, Hydrallazine(4th choice)

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15
Q

Moderate HTN in pregnancy is

A

150/100 or more

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16
Q

Treatment of FH in pregnancy

A
  1. Stop statins 3 months prior to attempting to conceive
  2. Do not check cholesterol during pregnancy as no therapy is indicated
  3. Breast feeding ok but no cholesterol medicines except probably bile acid binding resins

NICE 2008

17
Q

Criteria for HETEROZYGOUS FH

A 
Dutch Lipid Clinic Network Criteria 
Definite-9 points
Probable-6 points
Possible-3 points
2 or less - unlikely
18
Q

Corneal Arcus and FH

A

If less than 45 yrs FH possible

19
Q

Ascending Aorta diameter and pregnancy

A

If > 45. Spontaneous dissection at 3 rd trimester esp with BAV

20
Q

Can moderate AS be pregnant

A

Pregnancy is well tolerated in moderate AS

ALL women with SYMPTOMATIC AS should have valve intervention prior to pregnancy

During pregnancy symptoms- medical mng- if refractory- valvuloplasty or AVR

21
Q

Maternal risk of Severe AS

A

A/w 10% maternal mortality ( although rare)

Severe AS preferable to do intervention before pregnancy

Cleveland clinic

22
Q

Effect of lowering BP on Pre eclampsia

A

Does not affect the course of pre eclampsia

As primary abnormality is that of placental vasculature resulting in placental underperfusion

23
Q

Uptodate consensus on treating HTN in pre eclampsia

A

150/100 or more

24
Q

Pre eclampsia is after

A

20 wks of pregnancy

25
Q

By 8 weeks of pregnancy cardiac output

A

increases by 20%

26
Q

Why there is 40% increase in cardiac output during pregnancy

A

Peripheral vasodilation leads to 25-30% fall in Peripheral Vascular resistance . To compensate for this CO increases

27
Q

Maximum cardiac output during pregnancy is at

A

20-28 weeks of gestation

28
Q

Blood pressure changes in pregnancy

A

Reduces-1st and 2nd trimester

3rd trimester- Reaches pre pregnant levels

29
Q

Most of the cardiac murmurs in pregnancy occur by

A

10-12 weeks

30
Q

Most common SVT in pregnancy

A

AVNRT

31
Q

Best first trimester antihypertensive

A

Labetolol and Methyl dopa

32
Q

Can u give beta blockers in lactation

A

Yes
If indicated- Propranolol, Metoprolol And Labetolol - In all these infant dose is less than 2%

Atenolol-STRICT NO

Carvedilol, Bisoprolol- Not preferred. No data

33
Q

CCBs considered safe in breast feeding

A

Nifedipine, Diltiazem, Verapamil

Amlodipine can But may be avoided

Uptodate

34
Q

Use of ACE/ARB in breastfeeding mothers

A

Captopril and Enalapril May be used . Very less excretion in milk. Take hemodynamic status of infant into account before starting

No data on ARB

35
Q

Role of Hydralazine in breastfeeding mothers in HTN

Methyldopa?

A

Both safe

But use others as first line

36
Q

Grading of hypertension in pregnancy

A

Normal- upto 139/89
Mild to Moderate- upto 159/109
Severe-160/110 or more

Moderate is 150-159/ 100-109

37
Q

BP goal in pregnant patients on anti Hypertensives

A

130-150/80-100

Uptodate

38
Q

Normal. BP response in pregnancy

A

Starts falling by 6weeks.
Nadir at 16-20 weeks
Then starts raising to prepregnancy levels

Uptodate

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