Flashcards in Exam 2B: Systemic Diseases I Deck (78):
This is the most common respiratory disease in women of childbearing age.
Decreases in maternal arterial oxygen saturation to less than _____ can result in insufficient fetal oxygenation.
These two can lead to decreased cardiac output compromising UBF.
1. Dehydration during exacerbation
2. Airway obstruction leading to increased intrathoracic pressure.
Treatment for Asthma during labor and delivery.
Use short acting, rapid onset B2 agonist (albuterol) and steroids.
This drug can accelerate lung function in baby. It can affect asthmatics.
Treatment for mild intermittent asthma (4)
1. Short acting beta agonists
2. Inhaled steroids
4. Sustained release Theophylline
1. Treatment for moderate persistent asthma (2)
2. Treatment for severe persistent asthma
1. Long acting B2 agonists, intensification of inhaled steriods
2. Addition of systemic steroid
Name 3 long acting B2 agonists
2. Ritodrine (crosses placenta)
Note: 1&2 are tocolytics
This is a severe bronchospasm unresponsive to intensive B2 agonists and systemic steroids.
T/F: Status Asthmaticus
Positive pressure ventilation may make the decrease in cardiac output even more pronounced
This is the best regional anesthesia approach for asthmatic patients.
In patients who require the use of accessory muscles of respiration, regional anesthesia may not be appropriate.
RSI may increase possibility of bronchospasm because ___
patients are not yet deep enough.
1. This drug has been shown to be efficacious in blunting airway responsiveness and may have weak bronchodilating action.
2. Name induction agents which cause histamine release.
3. This drug will attenuate both airway reflexes and hemodynamic response associated with intubation
4. This drug can exacerbate airflow obstruction by increasing secretions and bronchospasm
2. Thiopental, atracurium, Sch
3. IV lidocaine 1 mg/kg
High MAC concentration can lead to bleeding because of uterine relaxation.
1. At what weeks of gestation the patient is considered high risk for aspiration?
2. How many weeks postpartum, is still considered risk for aspiration (full stomach)?
1. 8 - 12 weeks
2. 3 - 6 weeks
Labor induction agent which does not cause bronchospasm.
1. What drugs to avoid in patients with preeclampsia, HTN and asthma?
2. What drugs may be better alternatives?
1. ASA and non B-1 selective agents (labetalol)
2. Hydralazine, CCB, NTG, nitroprusside, Mag
1. During pregnancy, 90% of DM cases represent
2. This is the major cause of perinatal morbidity in #1.
1. gestational diabetes
Diabetics with associated ______ (2) may be prone to pulmonary edema.
nephropathy (low oncotic pressure) and HTn (LV dysfunction)
Val salve maneuver during the 2nd stage of labor may predispose to ____.
Poor metabolic control during the period from ____ weeks of pregnancy appears to be related to a higher incidence of anomalies.
4- 8 weeks
___ can diagnose macrosomia and give OB choice of elective CS to avoid chance of shoulder dystocia with vaginal delivery
Why is there less fetal acidosis with regional anesthesia?
Decreased maternal CO2 retention (mom not breathing too fast)
Insulin requirements of diabetic mom.
Decrease during 1st stage of labor, increase during secind stage, decrease again after delivery.
Fetus may be more susceptible to hypoxia secondary to hypotension than fetus of a non diabetic mother. If hypotension continues during labor ,after administration of vasopressors and fluids, ____ is actually safer for the baby due to less chance of hypotension
If maternal DM is well controlled, if dextrose containing solutions are not used for maternal IV expansion and if maternal hypotension is avoided, ___is safe for DM mothers undergoing CS.
Sign of stiff joint syndrome.
What is the effect of B2 agonist in DM?
It increases glycogenolysis in the liver and skeletal muscle (stimulates hepatic glycogenolysis and pancreatic release of glucagon. Insulin not enough to counter high levels of glucose)
Hypothyroidism is unusual during pregnancy, most likely because hypothyroid patients have decreased fertility. Neonatal thyroid function is normal in most cases of maternal hypothyroidism.
Fetal goiter may develop as a result of placental transfer of antithyroid meds or Thyroid stimulating antibodies. Neonate can be treated with ___
intrauterine injections of thyroxine
1. These can lower the seizure threshold (5)
2. This can increase the seizure threshold.
1. High estrogen level, Ketamine, Demerol, enflurane and sevo
Maternal seizure can be devastating. _____ that occur during a generalized seizure can result in fetal compromise or fetal death.
Hypoxia and acidosis
Maternal Vit K supplements are recommended due to medication depression of ____
PT and CF 5,7
Vitamin K supports which clotting factors?
CF 2, 7, 9, 10
This drug has been used to terminate epileptic seizures.
1. Neurofibromatosis patient may have increase in neurofibroma size associated with pregnancy and potential for ____ into the lesions themselves.
2. This is often in patient by age 20.
2. Renovascular HTN
1. Hx of labile hypertension might be indicative of _____ (2)
2. These diseases have been reported with neurofibromatosis. (2)
1. Pheochromocytoma or renovascular disease.
2. Pulmonary stenosis and coarctation of aorta
This is the most common MSK complaint during pregnancy
Low back pain
Corpus lute synthesizes and releases this hormone. It induces ligamentous softening and peripheral pelvic joint laxity, which cause instability of hr symphysis pubis and SI joints.
This is the most prevalent form of myotonic syndromes. Term used to described prolonged contraction of certain muscles after stimulation, followed by a delay in relaxation.
This triggers myotonia.
Cold (management: warm fluids, blankets, etc)
This drug is avoided in patients with myotonia.
1. This is a neurologic disorder with ascending paralysis. This is an acute, inflammatory demyelinating disease with axonal degeneration of peripheral nerves.
2. Possible etiology if #1
1. Landry-Guillain-Barre- Strohl Syndrome
Dx test for Guillain-Barre
Increased CSF protein with normal cell count
In pregnancy, GBS need to be ruled out from disorders with same symptoms such as ____.
Vit. B complex deficiency due to hyperemesis gravid arum, porphyria, lead poisoning.
Leading causes of death in GBS (2)
1. Respiratory failure
2. Pulmonary infection
A group of disorders passed down through families, in which important part of Hgb (heme) is not made properly.
This management of GBS is reserved for more extreme cases. It may decrease the duration of illness if started early.
This is characterized by multiple, random sites of demyelination in the brain and spinal cord.
This is a chronic autoimmune disease involving NMJ of striated muscles.
Common affected muscles in myasthenia graves (5
Oculomotor, facial, laryngeal, pharyngeal, respiratory muscles
Drug therapy for MG
Drugs which could exacerbate symptoms of myasthenia graves by presynaptic block (3)
Aminoglycosides, Kanamycin, Gentamycin
1. Too little anticholinesterase
2. Too much anti cholinesterase
3. Used to distinguish between the 2 crises
4. Drug avoided because it crosses BBB
5. Preferred drug due to less muscarinic S/E
1. myasthenia crises
2. cholinergic crises
4. Physostigmine (antilirium)
5. Pyridostigmine (mestinon)
In myasthenia graves, drugs metabolized by plasma esterase's will have prolonged effects if patient is on anti cholinesterase therapy. Name 2 examples.
If baby is suspected of having MG, what do you give to help diagnose the baby?
edrophonium 1 - 1.5 mg IM
Why do we still give spinal anesthesia in paralyze patients?
to prevent autonomic hyperreflexia
Women with lesion above ____ have increased risk for preterm labor. They do not have labor pain. OB management includes weekly cervical exams during 3rd trimester. Vaginal delivery preferred.
Autonomic dysreflexia distinguished from intrapartum HTN by occurrence of ____
cyclic hypertension (BP increases during contractions and decreases between contractions)
For control of autonomic hyperreflexia in any patient with T7 level injury or higher, ____ should be considered.
This results from failure of developing spine to enclose the neural elements.
Lesion typically occurs at what level?
L5 - S1
This syndrome is described as terminal portion of the spinal cord typically lies at a vertebral level that is lower than normal in these patients. So higher incidence of direct needle trauma during epic/spinal anesthesia.
Tethered cord syndrome
1. Puncture, even with a 25G needle, may cause CSF leak and descent of the hindbrain into the foramen magnum with resulting traction on the temporal meninges and severe, recurrent headaches.
2. IN extreme cases this could lead to ___
3. What do you need to monitor closely?
1. Arnold Chiari Syndrome
2. Bilateral subdural hematomas
3. Vision problems
1. This is the most common form of dwarfism.
2. These (2) may contribute to difficulty in giving regional anesthesia for #1.
3. Preferred regional anesthesia method.
2. Lumbar lordosis and thoracic kyphosis
3. Continuous epidural
Genetic defect with the genome that encodes for type I collagen, the major collagen that requires structural strength. Mild osteoporosis to multiple bone fractures.
Policies of accelerated discharge
1. Vaginal delivery
1. 1 - 2 days
2. 2- 3 days
If while doing epic/ spinal and you get "into: an AVM (pulsatile flow), what do you do?
Secondary phase of hemostasis consists of (3)
extrinsic, intrinsic, final common pathways
All clotting factors are formed in the liver except for ___
CF 8 (made by endothelial cells and megakarycytes)
Extrinsic and intrinsic factors merge at ____. Begins final common pathway resulting in ____. Except for the first 2 steps in the intrinsic pathway, ___ are required for promotion of all reactions.
CF X (stuart factor)........ fibrin clot...... calcium ions
This drug has greater antithrombotic activity than anticoagulant activity.
VWD has disorder in what CFs?
VW Factor and CF 8
1. Factor 8 is released from VWF by action of ____.
2. VW binds to other proteins, particularly ____.
2. CF 8
What CF are not usually depressed in liver disease?
CF 1 (fibrinogen) and 5
Treatment for deficiency in CF 2 (prothrombin), 7, 9, 10?
1. Vitamin K 50 mg IM
2. FFP: 10 - 20 ml.kg