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Medical Disease (Thyroid (Epilepsy (HTN (Goals are stricter <140/<…

- - - - Dx: TSH
        
        Hyperthyroid: low TSH (confirm w/ FT4: high)
        
        Hypothyroid: high TSH (confirm w/ FT4: low)
        
        non pregnant medical pt: ~~RAIU scan~~
        
        not possible if :pregnant_woman::skin-tone-4: :radioactive_sign:
        
        Tx Hyperthyroidism in 1st Tri
        :pencil2:3rd Tri, mom is big :pregnant_woman::skin-tone-4: and anesthesia is difficult.
        
        Rx: PTU
        
        ~~Methimazole~~? probably safe, though
        
        ~~Radiation~~ :radioactive_sign:
        
        surgery
        
        ~~RAI~~ :radioactive_sign:
        
        Tx Hypothyroidism
        
        Levothyroxine & check response w/ TSH
        
        f/u check TSH q4wks (normally q6m)
        
        f/u: ↑ in proteins ( :pregnant_woman::skin-tone-4:) leads to ↑ demand of Levothyroxine in hypothyroidism
        
        33% of :female_sign: need 25% incr
  - - - Pt: Knows before hand she has epilepsy, (unlike ecclampsia)
        
        Dx: clinical hx
        
        Tx:
        :pencil2: "L drugs are safe"
        
        Leviteracitam
        
        Lamotrigine
        
        ~~Valproate~~ class C
        
        ~~Phenytoin~~ class D
        
        ~~Carbamazepine~~ class D
        
        :pencil2:Real life: balance risk of teratogen and seizure risk
        
        1st Tri is where most damage occurs
        
        Closer baby is to delivery, more likely mom needs antiseizures
        
        If mom is not having seizures in late pregnancy, may take off Rx
        
        Seizures happening?
        
        Phenobarbitals :barber: are safe
        
        Folic acid for mom's taking antiepileptics (essential)
        
        FDA categories link
    - - Goals are stricter
        
        <140/<80
        
        Pt: Already getting Rx for HTN
        
        ID meds she can use, avoiding teratogens
        
        Safe Meds
        
        alpha methyl DOPA (right answer)
        
        labetalol
        
        hydralazine
        
        Dangerous common HTN meds:
        
        ~~ACEi~~ :spades: (worst)
        
        ~~BBlockers~~ :trumpet:
        
        ~~CCB~~ :icecream:
        
        ~~diuretics~~
        
        Elevated BP is a sign of Ecclampsia
        
        need tighter screening for ecclampsia
        
        more freq UA (looking for protein)
        
        rising BP could be Rx noncompliance or ecclampsia, raise index of suspicion
      - actual DM :candy:
        
        Actual diabetes (before gestation) ≠ GDM
        
        Same management as DM:
        
        A1c <7%
        
        diet & exercise LSM
        
        Use meds: Change PO to insulin
        :pencil2:Glyburide and Metformin are safe, but this is clinical, not answer on test
        
        Using insulin has tighter targeting of glucose than other Rx.
        
        incr insulin requirement for :pregnant_woman: due to hormones
        
        Basal bolus strategy
        
        Target postprandial sugars
        :warning: can't use A1c anymore, need minute to minute blood glucose
        
        massive reduction in insulin requirements
        
        Day 1 post delivery, lower insulin to prevent hypoglycemia
        
        :pencil2:Complications of poor glycemic control
        
        ↑↑ glucose early pregnancy: Transposition of the great vessels :<3::
        
        ↑↑ glucose during pregnancy: Macrosomic baby, Shoulder dystocia, C section
- - - - Dx: UA
        
        Asx, :check: pos. UA
        
        Asx bacteriuria
        
        we care in pregnancy/procedure related
        
        Tx: Amoxacillin
        
        Nitrofurantoin (if PCN :pencil2: allergy)
        
        ~~TMP-SMX~~ : teratogen :spider:
        
        ~~Cipro~~ :teratogen :spider:
        
        f/u Rescreen: repeat UA
        
        after UTI
        
        retreat if still :check: UA
        
        U/F/D & :check: pos. UA
        
        Cystitis
        
        Tx: Amoxacillin
        * Nitrofurantoin (if PCN :pencil2: allergy)
        
        ~~TMP-SMX~~ : teratogen :spider:
        
        ~~Cipro~~ :teratogen :spider:
        
        f/u Rescreen: repeat UA
        
        after UTI
        
        retreat if still :check: UA
        
        Pyelo s/s (U/F/D, :fire:, CVA tend.) & :check: pos. UA
        
        ±WBC casts in sediment
        
        :warning:much sicker pt :biohazard_sign:
        
        Tx: Admit inpatient
        
        Ceftriaxone
        
        ~~Cipro ambulatory care~~
        
        f/u: few days later, reassess
        
        :check:Improved!
        
        just Pyelo
        
        Tx w/ 10day Abx
        
        :green_cross: No improvement
        
        worry about perinephric abscess
        
        Tx: 14day Abx
        
        need to see to drain abscess
        
        CT (nope :radioactive_sign: :pregnant_woman::skin-tone-2:)
        
        US
        
        1 more item...
        
        :pencil2:What's a :check: UA?
        
        Nitrites :check:
        
        Leuk Esterase :check:
        
        WBC (any)
        
        bacteria
        
        ~~epithelial cells~~: contaminant, since cells have bacteria on it
        
        Cx/Sensitivities: >100,000 colonies