Hypertension

Question 1

What is the definition of Gestational Hypertension?

Answer 1

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

Question 1

What is the definition of Chronic Hypertension?

Answer 1

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

Question 2

What is the definition of Pre-Eclampsia?

Answer 2

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

Question 3

What is the definition of Severe Pre-Eclampsia?

Answer 3

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

Question 4

What is the proteinuria level to diagnose Pre-Eclampsia?

Answer 4

300 mg

Question 5

What is the definition of HELLP syndrome?

Answer 5

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

Question 6

What is the definition of eclampsia?

Answer 6

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

Question 7

What are the two stages of Pre-Eclampsia?

Answer 7

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

Question 8

Why is swelling a concern in Pre-Eclampsia?

Answer 8

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

Question 9

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

Answer 9

For seizure prevention

Question 10

What is the target Magnesium Levels?

Answer 10

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

Question 11

What is the medication that is given for Magnesium toxcitiy?

Answer 11

Calcium Gluconate.

Question 12

What are symptoms of Magnesium Toxicity?

Answer 12

decreased urine output, depressed respirations, decreased myocardial contractility

Question 13

What is the dosage of hydralazine?

Answer 13

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

Question 14

What is the dosage of labetalol?

Answer 14

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

Question 15

What is the dosage of Nifedipine?

Answer 15

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

Question 16

What are Neurologic symptoms of Pre-E?

Answer 16

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

Question 17

What are Heart/Lung symptoms of Pre-E?

Answer 17

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!

Question 18

What are Liver symptoms of Pre-E?

Answer 18

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

Question 19

What are the normal ranges for AST and ALT?

Answer 19

AST: 8-48
ALT: 7-55

Question 20

What are Kidney symptoms of Pre-E?

Answer 20

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

Question 21

What are Blood symptoms of Pre-E?

Answer 21

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

Question 22

What are Fetal effects of Pre-E?

Answer 22

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

Question 23

What are patients with Chronic Hypertension at risk for?

Answer 23

Stroke (intracranial bleed)

Question 24

Why should ACE inhibitors and ARBS be avoided in pregnancy?

Answer 24

They are fetotoxic, cause fetal anomalies and kidney damage

Question 25

When are the platelets the lowest after delivery with HELLP?

Answer 25

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

Question 26

When are you at highest risk for a seizure?

Answer 26

Within 24 hours of delivery.

Question 27

Magnesium is a hypertonic solution, what does that mean?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

True or False: Magnesium is a Calcium antagnoist?

Answer 29

True: As magnesium goes up, Calcium goes down.

Question 30

What is a contraindication for IV labetalol?

Answer 30

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

Question 31

What is a caution to know when giving IV labetalol?

Answer 31

Diabetics- this can impair the autonomic response to hypoglycemia

Question 32

When should you hold giving labetalol?

Answer 32

When the pulse is under 60 bpm

Question 33

What are side effects of hydralazine?

Answer 33

Hypotension and tachycardia.

Question 34

How does Procardia work?

Answer 34

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

Question 35

What are three side effects of Procardia?

Answer 35

1. Red cheeks 2. Headache 3. rebound tachycardia

Question 36

What should not be given with Procardia?

Answer 36

Grapefruit or grapefruit juice- this can impair the absorption

Question 37

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

Answer 37

True: a patient can rapidly dilate with a seizure

Question 38

When do blood pressures peak after delivery?

Answer 38

3-6 days