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Obs & Gynae > Physiology of Pregnancy + Drugs > Flashcards

Physiology of Pregnancy + Drugs Flashcards

(78 cards)

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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
What happens to ESR
Increases so can't use
26
What happens to liver enzymes - AST / ALT / GGT
Decrease
27
What happens to alkaline phospate
Increases as produced by placenta
28
What happens to bile acid
The same
29
What happens to d-dimer
Increases so can't use for PE | Must do V/Q scan as CTPA CI
30
What happens to your thyroid?
Enlarged to trap more iodine as kidneys secrete more | If iodine deficient may develop a goitre
31
What makes morning sickness worse
Higher B-hCG Molar / twins Usually improves by 16 weeks
32
What is hyperemesis gravidrum
Severe N+V in pregnancy
33
What happens to HCO3
Increases
34
What occurs doe to reduced peristalsis
Constipation
35
What happens to drug absorption
Decreased as D+V + reduced motility | Increased IM due to increased blood flow
36
What happens to hepatic blood flow
Unchanged
37
What happens to NaCl and H20 l in kidney
Increased reabsorption
38
What happens to iron / folate / ca requirement
Increase
39
What do you need iodine for
Healthy brain + bone | Metabolism
40
What happens to breast
Increase in size and vascularity | Warm and tender
41
What are other general adaptions
Immunosuppressed as fetes foreign body Weight gain 2-10kg Increased relaxation Curvature of spine change
42
What is gravity
``` Number of times women IS or HAS been pregnant regardless of outcome Twins count as 1 Nulli = none Prim = 1st pregnancy Multi = >1 ```
43
What is parity
Number of pregnancy >24 weeks | 1+2 = 1 >24 weeks and 2 didn't make
44
What are Braxton Hicks
Non painful contractions Later on in pregnancy - 3rd trimester Irregular
45
Where do you get info about drugs in pregnancy
BNF UK tetrology Drug and lactation database
46
What are principles of prescribing in pregnancy
``` 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
How is absorption, distribution, metabolism and excretion affected by pregnancy
Absorption - N+V, decreased motility, increased IM and respiratory Distribution - decreased plasma protein Metabolism - increased Excretion - increased GFR so plasma conc may decrease
48
What happens to drugs in fetal circulation
Less protein so increased drug Little fat Reduced enzymes
49
What does placental transfer depend on
Weight - smal Polarity - non polar Lipid solubility
50
What is teratogenicity
1st trimester
51
What do folate antagonists cause
Need folate for DNA Neural tube Face and limb defects
52
What are folate antagonist
Methotrexate Trimethoprim Nitrofurantoin AED
53
What should you do for methotrexate
Stop 6 months prior
54
What should you do for trimethoprim
Do not give in 1st trimester
55
What should you do for nitrafurantoin
Not in 3rd trimester | Cause haemolytic anaemia
56
What do retinoid drugs cause
Aortic arch anomaly VSD Face malformation Oesophageal atresia LD Endocrine In-utero death
57
What do retinoids require
Contraception
58
What do anti-convulsants cause
Neural tube defect
59
What do anti-coag cause
Haemorrhage CNS MSK
60
What does ACEI cause
Renal dysgenesis | Growth
61
What does NSAID cause
Premature closure of ductus arteriosus
62
What does alcohol cause
``` SGA Pre-mature Miscarriage FAS Withdrawal ```
63
What do opioids cause
NAS | Resp depressio
64
What does cocaine cause
``` Vasoconstriction Hypertension Abruption Premature IUGR NAS ```
65
When do you avoid aspirin
Labour | Risk of bleed
66
Zika
Microcephaly
67
What does smoking cause
``` IUGR Pre-term Placental abruption Pre-eclampsia Cleft palate /lip Miscarriage Stillbirth ```
68
Thialimiide
Absent limb
69
Phenytoin / Carbamazepine
Neural tube defect | GDD
70
Tetracyclne
Yellow teeth
71
SSRI
Congenital HD | Pulmonary hypertension in 3rd
72
What is fetotoxicity
2nd / 3rd trimster insult | Functional and growth defect
73
What drugs should be avoided in breast feeding
``` Cytotoxic Immunosuppression Aspirin Amiadarone Lithium Iodine Tetracyclien / sulphonamide / quinolone ```
74
What does CVS changes cause
Ejection systolic Forceful apex 3rd HS
75
What Ax CANNOT be used in pregnancy
``` Tetracycline Aminoglycoside Sulphonamide Trimethoprim Quinolones ```
76
What other drugs should be stopped
``` ACEI Statin Warfarin Sulphonurea Retinoids Cytotoxic ```
77
Aminoglycoside
Ototoxicity
78
Lithium
Ebsteins

Obs & Gynae (23 decks)

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