Seizure Disorder
The importance of preconception counseling in patients with a seizure disorder.
What are know about the anti-seizure medications she is taking and side effects to fetus. What to know the frequency of seizures before pregnancy, she will need more folic acid than normal pregnancies. 4 mg/day.
The definition of Hyperemesis Gravidarum.
What is intractable vomiting during pregnancy, leading to wt loss, volume depletion (dehydration), kentonuria.
Elevated bile acids from intrahepatic cholestasis of pregnancy cause what symptom?
What is generalized itching?
Migraine headaches
What is a unilateral or bilateral headache, pulsatile, moderate to severe, may present with aura? May have photophobia, nausea and vomiting?
What is Valproic Acid?
Hormones that may be a pathologic cause of hyperemesis gravidarum.
What are high hCG and estrogen levels?
The risk to fetus from intrahepatic cholestasis of pregnancy and how to reduce it.
What is increased risk of stillbirth (IUFD), more frequent and early fetal monitoring?
Tension headache
bilateral, non-pulsatile, with pressing/tightening like pain quality.
Can the person breastfeed taking antiseizure medication?
Common meds used to treat N&V in pregnancy?
Antacid to avoid in pregnancy?
What are Pepto-Bismol - has salicylate (aspirin) which crosses the placenta risk of bleeding, jaundice and low birth wt.
What is Alka-seltzer or sodium bicarbonate which can cause maternal or fetal alkalosis.
Red flags that indicate further diagnostic testing may be indicated to diagnose cause of headache.
What are age above 50, change in headache pattern, severe thunderclap headache, systemic signs such as fever, neurologic symptoms, positional headache.
Patients on certain AEDs may need Vitamin D supplementation.
What are enzyme inducing AEDs decrease vitamin D levels. Enzymatic reactions from these meds reduces the concentration of active Vitamin D. This can affect calcium absorption and bone health.
Approximate time N&V resolve during pregnancy?
What is between 20 weeks gestation?
Risk factors for GERD during pregnancy?
What are certain foods, fatty foods, caffeine, onions, garlic, spicy foods, overeating or eating quickly, lying down after eating?
Cluster headache
More common in men, unilateral around the eye or along the face, severe pain constant, nasal congestion
Patients with AEDs may need Vitamin K supplementation.
What is vitamin K supplementation in women taking enzyme inducing antiepileptic drugs (eg, carbamazepine, phenytoin, primidone, and phenobarbital). Vitamin K dependent clotting factors may be reduced in these babies, resulting in an increased risk of haemorrhagic disease in the newborn. Consequently, these women should be advised to take 10 mg prophylactic vitamin K orally from 36 weeks’ gestation, and the babies should be given 1 mg vitamin K parenterally at delivery
Treatment recommendation for GERD during pregnancy.
What is lifestyle changes, then antacids, sucralfate coats the lining, then H2 receptor antagonists next and last is proton pump inhibitors.
Non-pharmacologic management nausea/vomiting in pregnancy.
What are frequent, small meals every 1-2 hours, bland, dry foods, high-protein snacks, avoid odors, ginger 1 gram per day in divided doses, acupressure, acupuncture therapy.
Management for headaches
Migraines: NSAIDs, acetaminophen, triptans
Tension: NSAIDS, acetaminophen, Fioricet (has butalbital barbiturate; muscle relaxant)
Cluster - refer to primary care