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RNC OB > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the definition of Gestational Hypertension?

A

Blood Pressure >139/89 after 20 weeks of pregnancy and does not progress to Pre-eclampsia and is normotensive by 12 weeks postpartum.

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1
Q

What is the definition of Chronic Hypertension?

A

Blood pressure >139/89 present and observable before pregnancy or diagnosed before 20 weeks of pregnancy.

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2
Q

What is the definition of Pre-Eclampsia?

A

At least two blood pressures of >139/89 at least 4 hours apart with the addition of proteinuria or an MAP >105.

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3
Q

What is the definition of Severe Pre-Eclampsia?

A

Blood Pressure >159/109
Platelets <100,000
Serum Creatinine >1.1
Elevate AST and ALT (twice the normal limit)

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4
Q

What is the proteinuria level to diagnose Pre-Eclampsia?

A

300 mg

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5
Q

What is the definition of HELLP syndrome?

A

Hemolysis (Elevated LDH, elevated bilirubin)
Elevated Liver Enzymes
Low Platelets

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6
Q

What is the definition of eclampsia?

A

The onset of a grand mal seizure in a woman diagnosed with pre-eclampsia and no previous neurologic conditions

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7
Q

What are the two stages of Pre-Eclampsia?

A
  1. Encompassing poor placentation
  2. New onset of hypertension and proteinuria
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8
Q

Why is swelling a concern in Pre-Eclampsia?

A

This can lead to hemoconcentration and increase the risk of pulmonary edema or cerebral edema.

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9
Q

Why is Magnesium Sulfate given in the diagnosis of Pre-Eclampsia?

A

For seizure prevention

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10
Q

What is the target Magnesium Levels?

A

4.8-8.4 mg/dL (normal is 1.5-2)

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11
Q

What is the medication that is given for Magnesium toxcitiy?

A

Calcium Gluconate.

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12
Q

What are symptoms of Magnesium Toxicity?

A

decreased urine output, depressed respirations, decreased myocardial contractility

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13
Q

What is the dosage of hydralazine?

A

5 mg given over 2 minutes
Max dose: 25 mg/ 24hours

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14
Q

What is the dosage of labetalol?

A

10 or 20 mg given over 2 minutes. This can be given as 20, 40, or 80 mg.
Max dose of oral: 2400 mg
Max dose IV: 220-300 mg/ 24 hours

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15
Q

What is the dosage of Nifedipine?

A

10 or 20 mg immediate release or 30 mg extended-release.
Max XL dose: 120 mg/day
Max immediate release: 180 mg/day

16
Q

What are Neurologic symptoms of Pre-E?

A
  1. Headache (unrelieved with Tylenol)- this is indicative of cerebral edema and vasoconstriction.
  2. Visual disturbances- optic nerve ischemia and fluid build-up behind the eyes
  3. Seizures- NOT FROM HIGH BPs!!!!! This is from fluid accumulation that puts intense pressure on the brain.
  4. Hyperreflexia
17
Q

What are Heart/Lung symptoms of Pre-E?

A
  1. Left ventricular failure
  2. Oliguria- all the fluid is in the interstitial spaces and not in the vasculature to be filtered out by the kidneys
  3. Pulmonary edema- THE HEART FAILED FIRST!
18
Q

What are Liver symptoms of Pre-E?

A
  1. RUQ pain- this is from vasospasms and ischemia
  2. Elevated labs- LFTs, Bilirubin, LDH
19
Q

What are the normal ranges for AST and ALT?

A

AST: 8-48
ALT: 7-55

20
Q

What are Kidney symptoms of Pre-E?

A
  1. Protein loss- protein is a large molecule and should not be lost from the kidneys, this is because the filter is broken
  2. Increase in Creatinine- the kidneys are working harder in general
21
Q

What are Blood symptoms of Pre-E?

A
  1. Low platelets- this is because of hemolysis
  2. Albumin loss- this leads to 3rd spacing
22
Q

What are Fetal effects of Pre-E?

A

IUGR, abruption, placental insufficiency, Preterm delivery, and oligohydramnios

23
Q

What are patients with Chronic Hypertension at risk for?

A

Stroke (intracranial bleed)

24
Q

Why should ACE inhibitors and ARBS be avoided in pregnancy?

A

They are fetotoxic, cause fetal anomalies and kidney damage

25
Q

When are the platelets the lowest after delivery with HELLP?

A

24 hours post delivery- it is going to get worse before it gets better.

26
Q

When are you at highest risk for a seizure?

A

Within 24 hours of delivery.

27
Q

Magnesium is a hypertonic solution, what does that mean?

A

This pulls fluid out of the interstitial spaces and back into the vasculature.

28
Q

What are three conditions to not give Magnesium in and one to watch with?

A
  1. Myasthenia gravis
  2. Heart failure
  3. Pulmonary edema
  4. Watch kidney function- mag is excreted through the kidneys
29
Q

True or False: Magnesium is a Calcium antagnoist?

A

True: As magnesium goes up, Calcium goes down.

30
Q

What is a contraindication for IV labetalol?

A

Asthma- this is non-selective to both beta receptors-this can cause bronchospasm

31
Q

What is a caution to know when giving IV labetalol?

A

Diabetics- this can impair the autonomic response to hypoglycemia

32
Q

When should you hold giving labetalol?

A

When the pulse is under 60 bpm

33
Q

What are side effects of hydralazine?

A

Hypotension and tachycardia.

34
Q

How does Procardia work?

A

This dilates the coronary arteries (relaxes smooth muscle) which increases renal perfusion

35
Q

What are three side effects of Procardia?

A
  1. Red cheeks
  2. Headache
  3. rebound tachycardia
36
Q

What should not be given with Procardia?

A

Grapefruit or grapefruit juice- this can impair the absorption

37
Q

True or False: after a patient is stabilized from a seizure, the safest route is to deliver vaginally?

A

True: a patient can rapidly dilate with a seizure

38
Q

When do blood pressures peak after delivery?

A

3-6 days

RNC OB (21 decks)

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