NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
NU661 Primary Care Childbearing Woman FINAL
Exam 2024/2025 verified questions and answers
graded A+
Causes of Secondary HTN
-Renal: Glomerular disease, polycystic kidneys, renal artery stenosis
-Collagen Vascular Disease: scleroderma, SLE, periarteritis nodosa
-Endcrinopathy: DM, thyrotoxicosis, hyperaldosteronism, Cushing's Disease, pheochromocytoma
-Vascular disease: Coarctation, vasculitis
Gestational HTN
-Dx'd after 20th week gestation
-No proteinuria
(Note: this terminology replaces "Pregnancy Induced Hypertension as of year 2000)
Pre-eclampsia
-Elevated BP with proteinuria and/or edema
-Eclampsia
-HELLP
-Other severe pre-eclampsia
,NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
Chronic HTN (in pregnancy)
-Dx'd prior to 20th week gestation
-Elevated BP prior to conception
BP In Pregnancy
-Decreases normally in 2nd trimester, returns to pre-pregnancy level in 3rd trimester
-Mild HTN in pregnancy: 140-179/90-109
-Severe HTN in pregnancy: >/= 180/110
Perinatal Risks of Chronic HTN in Pregnancy
-PTL (66% chance of PTB)
-Pre-eclampsia
-Abruption
-IUGR (30% chance)
-Fetal demise
-C-section delivery
End Organ Evaluation
-EKG
-24 hour urine collection for proteinuria
-Ophthalmic evaluation
,NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
-Renal disease results in worse prognosis (GFR, BUN, Creatinine)
Management of Mild HTN in Pregnancy
-Most do fine w/o medications
-One RCT showed no decrease in IUGR, abruption, superimposed HTN or perinatal mortality (Tx'd by
placebo, Aldomet, Labetolol)
HTN Medications Used in Pregnancy
-ACE-Inhibitors
-Aldomet
-Labetolol
-Nifedipine
-Diuretics
Antenatal Management of HTN in Pregnancy
Pre-Pregnancy:
-ID secondary cause (if present)
-Switch to safe meds PRN
Antenatal:
-Baseline LFTs, CBC, BUN, Creatinine
-Baseline 24hr urine for protein, creatinine clearance
-2nd trimester visits q2weeks
-3rd trimester visits q weekly
, NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
-Baseline U/S 18-20 weeks, then q4weeks for EFW, AFI, doppler studies
-Weekly NST beginning 32 weeks
-Deliver by 39weeks
(Note: No consensus on management)
Pharmacologic:
-Keep BP </=140/90
-Aldomet, Nifedipine, Labetolol
-Watch for superimposed HTN and aggressively treat
Aldomet
-Most popular anti-HTN used in pregnancy
-Centrally acting: reduces sympathetic outflow by stimulating a2-adrenoreceptor
-Reduces systemic vascular resistance w/o effecting Cardiac Output
-S/Es: Dry mouth, lethargy, LFT changes, postural hypotension
-Dosage: 1gm loading dose, then up to 3gm in divided doses
-Limited effects on uteroplacental flow
-Safety data present for pregnancy and breastfeeding
Labetolol
-Chronic and/or gestational HTN management
-Beta-blocker with some alpha action
-Good for pre-eclampsia d/t alpha action that helps reduce vasospasm
-S/Es: HA, tremor
NU661 Primary Care Childbearing Woman FINAL
Exam 2024/2025 verified questions and answers
graded A+
Causes of Secondary HTN
-Renal: Glomerular disease, polycystic kidneys, renal artery stenosis
-Collagen Vascular Disease: scleroderma, SLE, periarteritis nodosa
-Endcrinopathy: DM, thyrotoxicosis, hyperaldosteronism, Cushing's Disease, pheochromocytoma
-Vascular disease: Coarctation, vasculitis
Gestational HTN
-Dx'd after 20th week gestation
-No proteinuria
(Note: this terminology replaces "Pregnancy Induced Hypertension as of year 2000)
Pre-eclampsia
-Elevated BP with proteinuria and/or edema
-Eclampsia
-HELLP
-Other severe pre-eclampsia
,NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
Chronic HTN (in pregnancy)
-Dx'd prior to 20th week gestation
-Elevated BP prior to conception
BP In Pregnancy
-Decreases normally in 2nd trimester, returns to pre-pregnancy level in 3rd trimester
-Mild HTN in pregnancy: 140-179/90-109
-Severe HTN in pregnancy: >/= 180/110
Perinatal Risks of Chronic HTN in Pregnancy
-PTL (66% chance of PTB)
-Pre-eclampsia
-Abruption
-IUGR (30% chance)
-Fetal demise
-C-section delivery
End Organ Evaluation
-EKG
-24 hour urine collection for proteinuria
-Ophthalmic evaluation
,NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
-Renal disease results in worse prognosis (GFR, BUN, Creatinine)
Management of Mild HTN in Pregnancy
-Most do fine w/o medications
-One RCT showed no decrease in IUGR, abruption, superimposed HTN or perinatal mortality (Tx'd by
placebo, Aldomet, Labetolol)
HTN Medications Used in Pregnancy
-ACE-Inhibitors
-Aldomet
-Labetolol
-Nifedipine
-Diuretics
Antenatal Management of HTN in Pregnancy
Pre-Pregnancy:
-ID secondary cause (if present)
-Switch to safe meds PRN
Antenatal:
-Baseline LFTs, CBC, BUN, Creatinine
-Baseline 24hr urine for protein, creatinine clearance
-2nd trimester visits q2weeks
-3rd trimester visits q weekly
, NU661 Primary Care Childbearing Woman FINAL Exam 2024/2025
-Baseline U/S 18-20 weeks, then q4weeks for EFW, AFI, doppler studies
-Weekly NST beginning 32 weeks
-Deliver by 39weeks
(Note: No consensus on management)
Pharmacologic:
-Keep BP </=140/90
-Aldomet, Nifedipine, Labetolol
-Watch for superimposed HTN and aggressively treat
Aldomet
-Most popular anti-HTN used in pregnancy
-Centrally acting: reduces sympathetic outflow by stimulating a2-adrenoreceptor
-Reduces systemic vascular resistance w/o effecting Cardiac Output
-S/Es: Dry mouth, lethargy, LFT changes, postural hypotension
-Dosage: 1gm loading dose, then up to 3gm in divided doses
-Limited effects on uteroplacental flow
-Safety data present for pregnancy and breastfeeding
Labetolol
-Chronic and/or gestational HTN management
-Beta-blocker with some alpha action
-Good for pre-eclampsia d/t alpha action that helps reduce vasospasm
-S/Es: HA, tremor
