Obstetrics and Gynecology Quiz on Preeclampsia

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Questions and Answers

What is the primary use of alpha-methyl norepinephrine?

Management of chronic hypertension during pregnancy (correct)

Prevention of seizures

Treatment of eclampsia

Induction of labor

Which of the following is NOT a side effect of methyldopa?

Increased appetite (correct)

Bone marrow suppression

Orthostatic hypotension

Bradycardia

What characterizes preeclampsia?

Elevated BP above 130/90 mm Hg with proteinuria (correct)

Seizures occurring after the 20th week of gestation

Severe abdominal pain and low BP

Elevated BP above 140/90 mm Hg and proteinuria

What is the definitive treatment for severe preeclampsia?

Delivery of the fetus Signup and view all the answers

Which drug is the drug of choice for lowering blood pressure in severe preeclampsia?

Labetalol Signup and view all the answers

What is the primary role of magnesium sulfate in managing eclampsia?

Prevent seizures Signup and view all the answers

Which of the following is a risk associated with preeclampsia for the fetus?

Premature birth Signup and view all the answers

What happens to blood pressure after the intravenous injection of clonidine?

It initially rises then decreases Signup and view all the answers

Which of the following drugs primarily acts as a peripheral arteriolar dilator and is also used in hypertensive emergencies?

Fenoldopam Signup and view all the answers

What is a significant complication associated with the use of Minoxidil?

Hirsutism Signup and view all the answers

Sodium Nitroprusside is primarily used for which of the following conditions?

Hypertensive emergencies Signup and view all the answers

What is a common side effect of using Fenoldopam?

Headache Signup and view all the answers

Which of the following actions does Sodium Nitroprusside perform in the absence of heart failure?

Decreases vascular resistance Signup and view all the answers

Which condition should prompt caution when administering Fenoldopam?

Glaucoma Signup and view all the answers

What is the mechanism of action of Hydralazine?

Releases nitric oxide Signup and view all the answers

What serious toxicity is associated with Sodium Nitroprusside?

Cyanide accumulation Signup and view all the answers

What is the primary mechanism of action for thiazide diuretics?

Inhibition of Na+ sodium reabsorption in the distal tubule Signup and view all the answers

Which of the following is a common side effect of loop diuretics?

Hypocalcemia Signup and view all the answers

In which situation are loop diuretics considered first-line treatment?

Severe hypertension and kidney failure Signup and view all the answers

What is the primary function of potassium-sparing diuretics?

Prevent potassium excretion Signup and view all the answers

What condition may thiazide diuretics exacerbate through their side effects?

Diabetes mellitus Signup and view all the answers

Which adrenergic blocking drug decreases CNS sympathetic outflow?

Methyldopa Signup and view all the answers

What is a significant side effect of the potassium-sparing diuretic spironolactone?

Gynecomastia Signup and view all the answers

Which mechanism is responsible for the long-term regulation of blood pressure?

Renin-angiotensin system Signup and view all the answers

What effect does clonidine have on sympathetic and parasympathetic tone?

Reduces sympathetic and increases parasympathetic tone Signup and view all the answers

Which side effect is commonly associated with clonidine?

Dry mouth Signup and view all the answers

What is a consequence of abruptly withdrawing clonidine after prolonged use?

Life-threatening hypertensive crisis Signup and view all the answers

Which of the following is NOT a common side effect of alpha blockers?

Hyperkalemia Signup and view all the answers

Which beta blocker is known for being a selective beta-1 blocker?

Atenolol Signup and view all the answers

Which medication class is indicated as a first-line treatment for hypertension combined with heart failure?

ACE inhibitors Signup and view all the answers

Which condition is a contraindication for the use of ACE inhibitors?

Pregnancy Signup and view all the answers

What is a side effect specifically associated with non-dihydropyridine calcium channel blockers?

Bradycardia Signup and view all the answers

Which medication class is known to inhibit angiotensin II receptors?

Angiotensin II receptor blockers (ARBs) Signup and view all the answers

Which of the following is a common side effect of using calcium channel blockers?

Drowsiness Signup and view all the answers

Study Notes

Hypertension Medications

Hypertension medications are used to treat high blood pressure.
Various terms are used to describe different stages and severities of high blood pressure.
Normotension: SBP < 120 and DBP < 80
Prehypertension: SBP > 120 but < 140 or DBP > 80
Stage 1 Hypertension: SBP > 140 but < 160 or DBP > 90 but < 100
Stage 2 Hypertension: SBP > 160 or DBP > 100
Hypertensive Urgency: Markedly elevated hypertension with no evidence of end-organ involvement
Hypertensive Emergency: Hypertension with evidence of end-organ involvement

Blood Pressure Regulation

Two mechanisms regulate blood pressure:
Baroreceptor: acts quickly
Renin-angiotensin: acts in the long term

Classification of Diuretic Drugs

Diuretic drugs are used in renal disorders.
Categorized based on whether they modify salt excretion or water excretion
PCT, TAL, DCT, CCT, Osmotic diuretics, ADH agonists, ADH antagonists, Loop diuretics, Carbonic anhydrase inhibitors, Thiazides, K+-sparing diuretics.

Diuretics (Thiazides)

Examples: Hydrochlorothiazide, Chlorthalidone, Metolazone
Mechanism of action: Inhibit Na+ sodium reabsorption in the distal tubule

Thiazides in Hypertension

First-line treatment for postmenopausal women or those with osteoporosis.
Potential side effects: Hyponatremia, Hypokalemia, Hyperglycemia, Hyperuricemia, Hyperlipidemia, Hypercalcemia

Loop Diuretics

Examples: Furosemide, Bumetanide, Torsemide, Etacrynic acid
Mechanism of action: Inhibits sodium reabsorption in the ascending loop of Henle
Third-line treatment for severe hypertension, including cases with kidney failure or abdominal/pulmonary edema

Loop Diuretics - Side Effects

Hypokalemia (hypokalemic metabolic alkalosis)
Hyperuricemia
Hypocalcemia
Hypomagnesemia
Ototoxicity
Allergic reactions

Potassium-Sparing Diuretics

Aldosterone antagonist: Spironolactone
Non-antagonists of aldosterone: Amiloride, Triamterene
Mechanism of action: Reduces sodium reabsorption in the collecting ducts, reducing potassium release
Do not affect blood pressure
Prevent potassium excretion in loop diuretic and thiazide use
Potential side effects: Hyperkalemia, Gynecomastia, Women's menstrual disorders, Inflammation and kidney stones (Triamterene)

Inhibitors of the Adrenergic System

Centrally acting adrenergic blocking drugs
Ganglion blocking drugs (Mecamylamine)
Adrenergic neuron blocking drugs (Reserpine)
Adrenergic receptor antagonists (alpha or beta blockers)

Central Adrenergic Blocking Drugs (Methyldopa)

Decreases central (CNS) sympathetic outflow
Stimulates central alpha-2 receptors controlling the vasomotor center of the medulla
L-dopa analog; produces alpha-methyl norepinephrine
Used in chronic hypertension during pregnancy
Potential side effects: Sedation, depression, sleep disturbance, nightmare, orthostatic hypotension, increased prolactin secretion, bone marrow suppression, bradycardia, headache, tolerance

Preeclampsia & Eclampsia

Multisystem disorder characterized by elevated blood pressure (above 130/90 mm Hg) and proteinuria (300 mg or more in 24 hours) after the 20th week of pregnancy.
Eclampsia: Preeclampsia with seizures.
Serious risks for both the fetus and mother, including intrauterine growth restriction, premature birth, and death.

Preeclampsia & Eclampsia - Management

Management depends on gestational duration
Near term and certain fetal maturity: induction of labor advised
Earlier gestational stage: bed rest, prolonged hospitalization, antihypertensive drugs, anticonvulsant prophylaxis
Severe cases: delivery is the definitive intervention
Postponed delivery: labetalol is the drug of choice for lowering blood pressure IV bolus

Preeclampsia & Eclampsia - Prophylaxis

Because severe preeclampsia can turn into eclampsia
Magnesium sulfate is the preferred drug for seizure control
Initial dose: 4-6 gm IV loading followed by 5 gm IM every 4 hours or continuous IV infusion (1-2 gm/hr)

Central Adrenergic Blocking Drugs (Clonidine)

After IV injection, clonidine briefly increases then more prolonged hypotension
Acts on alpha adrenoceptors in arterioles
After oral usage, reduces sympathetic and increases parasympathetic tone resulting in BP lowering and bradycardia
Binds to imidazoline receptors to mediate antihypertensive effects.
- Side effects: Dry mouth, sedation
- Should not be used in people at risk for mental depression.
- Withdrawn if depression occurs during therapy.
- Concomitant treatment with tricyclic antidepressants can block antihypertensive effects -Withdrawal after prolonged high dosage can cause life-threatening hypertensive crisis.
- Omitting doses can result in nervousness, tachycardia, headache, and sweating.

Adrenergic Receptor Antagonists - Alpha Blockers

Prazosin and terazosin: selective alpha-1 antagonists
Labetolol
Decreased peripheral vascular resistance (vasodilation) in arteries and veins
Sodium and water retention
Third line of HTN
HTN + benign prostate hyperplasia

Alpha Blocker Side Effects

Reflex tachycardia
Orthostatic hypotension
Nasal congestion (increased nasal mucus volume)
Miosis
Other side effects of alpha-receptor blocking

Adrenergic Antagonists - Beta Blockers

Beta-1 blockers: Atenolol, Metoprolol
Non-selective beta-1 and -2: nadolol, propranolol, Timolol, pindolol
Inhibits beta-1 receptors in the heart, reducing cardiac output
Inhibits beta receptors of brain, kidney; inhibiting renin
Second line of HTN treatment
HTN + MI, migraine, stable angina

Beta Blockers - Side Effects

Bradycardia
AV Block
CNS effects (sleep disorders, depression, nightmares)
Worsening of asthma
Impaired lipid profile
Covering symptoms of hypoglycemia

Angiotensin Synthesis Inhibitors

Captopril, Enalapril, Lisinopril
Inhibits angiotensin-converting enzyme (ACE) that hydrolyzes angiotensin I to angiotensin II.
Inhibit enzyme that destroys bradykinin (dilator)
First-line treatment for hypertension
HTN + MI, HF, Diabetes

ACE Inhibitors - Complications

Dry cough
Angioedema
Hyperkalemia
Blood pressure reduction (first use)
Acute kidney failure
Prohibited in pregnancy

Angiotensin II Receptor Blockers (ARBs)

Valsartan, Saralasin, losartan
Inhibits angiotensin II receptors.
Similar side effects to ACE inhibitors without dry cough
Increased possibility of fetal malformations in pregnancy

Calcium Channel Blockers

Dihydropyridine (nifedipine, amlodipine)
Non-Dihydropyridine (verapamil, diltiazem)
Blocks calcium entry into smooth muscle of arteries (vasodilation)
Decreased heart rate and contractility
First-line treatment
- HTN + angina, asthma, supraventricular arrhythmia, hypertensive urgency

Calcium Channel Blockers - Side Effects

Headache, hypotension, reflex tachycardia, ankle edema
Dihydropyridine: facial flushing, drowsiness
Non-dihydropyridine: bradycardia, weakening of the heart, heart failure, AV block, constipation

Vasodilators - Mechanisms

Release of nitric oxide
Reduction of calcium influx
Hyperpolarization of cell membranes (opening of potassium channels)
Activation of dopamine receptors

Vasodilators

Oral: Hydralazine, Minoxidil (long-term outpatient high blood pressure)
Injectable: Nitroprusside, Fenoldopam (hypertensive emergencies)
Calcium channel blockers
Nitrates (ischemic heart disease, sometimes hypertensive emergencies)

Vasodilators - Minoxidil & Hydralazine

Minoxidil: releases NO; opens ATP-dependent potassium channels; third line of treatment, hairiness, fluid accumulation around the heart
Hydralazine: lupus-like syndrome (idiosyncratic), positive Coombs test; first six months of treatment

Vasodilators - Sodium Nitroprusside

Treatment for hypertensive emergencies and severe heart failure.
Releases nitric oxide (activates guanylyl cyclase).
In the absence of heart failure: lowers blood pressure via decreased vascular resistance
Light-sensitive, needs preparation before use, covered with opaque foil
Most serious toxicity: cyanide accumulation
Treatment with sodium thiosulfate and hydroxycobalamin
Thiocyanate toxicity (weakness, disorientation, psychosis, muscle spasms, seizures)

Vasodilators - Fenoldopam

Peripheral arteriolar dilator for emergencies and postoperative hypertension.
Agonist of dopamine D1 receptors; dilates peripheral arteries and causes natriuresis.
Short half-life (10 minutes); continuous IV infusion
Side effects: Reflex tachycardia, headache, and flushing
Avoid in patients with glaucoma (increases intraocular pressure)

Vasodilators - Diazoxide

Effective, long-acting potassium channel opener; causes hyperpolarization in smooth muscle and pancreatic β cells.
Arteriolar dilating property, formerly used parenterally for emergency cases
High dose (300 mg rapid injection)
Inhibits insulin release from the pancreas
Oral dosage for hypoglycemia: 3-8 mg/kg/day in 3 divided doses, with a max of 15 mg/kg/day;
Major toxicity from parenteral use: excessive hypotension
Hyperglycemia can complicate diazoxide use, especially in renal insufficiency
Causes renal salt and water retention

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Description

Test your knowledge on the management and characteristics of preeclampsia in this obstetrics and gynecology quiz. Questions cover the use of medications, side effects, and treatment options related to severe preeclampsia and eclampsia. Perfect for medical students and healthcare professionals.