ITE OB 1 Flashcards by Franz Biehl

______ is a tocolytic that can cause hyperglycemia, tachycardia and hypokalemia

terbutaline
B2 > B1 receptors
- B agonism in liver: glycogenolysis
- B agonism in pancreas: glucagon secretion and suppress insulin release

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______ is a contraindicated tocolytic agent in pts w/ myasthenia gravis

Magnesium (competitive antagonist of calcium)

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Pudendal block aka “saddle blocks” targets ___ nerve, which originates at ___ level

Pudendal nerve

S2 - S4

Not useful for first stage of labor

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Active stage of labor starts when ______. And ends with _____.

Contractions are regular intervals of 2-3 min

Full cervical dilation (10cm)

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Stage two of labor starts with _______.

Full cervical dilation

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First stage of labor includes innervation from _____ nerve roots. Pain travels via sympathetic fibers going through the _____ nerve plexus

T10 - L1

inferior hypogastric plexus

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The second stage of labor includes innervation from the ____ nerve roots.

T12 - L1, and S2-S4

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__________ is the formation of scar tissue in the uterine cavity

asherman syndrome

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Two autoantibodies associated with antiphospholipid syndrome are:

Lupus anticoagulant

2. anticardiolipin antibody

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Is it safe to administer neuraxial anesthesia to pts with antiphospholipid syndrome?

Yes, Lupus anticoagulant has no true ac activity

- does not suggest bleeding tendency

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Which is elevated in antiphospholipid syndrome, Pt or aPTT?

elevated aPTT

- does not suggest bleeding tendency

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________ is a uterotonic agent that is contraindicated in pts with coronary artery spasm and systemic vasoconstriction that increases systemic hypertension

methylergonovine (methergine)

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High dose of the uterotonic, _______, stimulates antidiuresis and natriuresis, which can lead to hyponatremia

oxytocin

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The cervix is covered by dermatomes _____, and the vaginal/perineal are covered by _____

T10-L1

S2-S4

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Why are paracervical blocks not typically tolerated in pregnant pts?

associated with high freq of fetal bradycardia -> decreased fetal oxygenation and fetal acidosis

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The 45% increase in maternal blood volume is mediated by ___________

sodium retention via the renin angiotensin system

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Treatment choice of polyhydramnios is ______

indomethacin

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Sensory block of ____ dermatomes is the goal of neuraxial anesthesia for cesarean delivery.

T4-S4

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In an awake pt with no hemorrhage, _____ is the best first line choice for uterine relaxation

nitroglycerin

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In an awake pt with hemorrhage, _____ is the best first line choice for uterine relaxation

- Epidural, spinal, vasodil drugs would create vasodilation and promote bleeding

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_______ is the pressure transduced in the RA of the heart, and does NOT change with pregnancy

Central venous pressure

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The tocolytic, terbutaline MOA ______, and can result in fetal hyperinsulinemia.

B-agonist
- raises moms BG -> cross placenta to fetus (insulin does not), and in response to hyperglycemia -> fetal pancreas secretes more insulin

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_________ can be initially treated with B-adrenergic agonists (terbutaline, ritodrine), CCB, COX-inhibitors (NSAIDS), Mg sulfate

Preterm labor

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_______ is the drug of choice for pruritus induced by neuraxial opioids

Nalbuphine in 3mg small doses

*intrathecal opioids does not cause histamine release

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DIC is associated with elevated (PT/PTT) and if it is seen, it is very likely that a pt has a significant in consumption of clotting factors.

Heparin and LMWH are effective only when adequate lvls of ______ are present

antithrombin III

Glycocopyrrolate is poorly transferred across the placenta b/c it is a ______, which is highly ______ and does not easily cross lipid membranes

quaternary amine highly hydrophilic

Glycocopyrrolate is poorly transferred across the placenta b/c it is a ______, which is highly ______ and does not easily cross lipid membranes

quaternary amine highly hydrophilic *Atropine and scopolamine easily cross

______ is an antidopaminergic medication that enhances motility, accelerated gastric emptying, and increased resting lower esophageal sphincter tone in both nonpregnant and pregnant women

Metoclopramide (reglan)

In pregnant women, gastric secretions are more (acidic/basic)

acidic

In pregnant women, (lower/upper) esophageal sphincter tone is decreased

lower

In pregnant women, overall gastrointestinal time is prolonged (true/false)

true

Ondansetron is a ________, blocking serotonin, both peripherally on the vagal nerve terminals and centrally in the chemoreceptor trigger zone

5-HT3 receptor antagonist

Ranitidine is a ________ of the gastric parietal cells, resulting in decreased gastric acid secretion, decrased gastric volume, and decreased H ion [ ]

competitive inhibitor of histamine at H2-receptors

______ is the only commonly used inhalational anesthetic that does NOT cause uterine relaxation

nitrous oxide (blue)

``` Colors of tanks Helium Air Oxygen Nitric oxide Nitrogen Carbon Dioxide ```

``` Helium - brown Air - yellow Oxygen - green Nitric oxide - blue Nitrogen - black Carbon Dioxide - gray ```

Cornual pregnancy (rare implantation of fetus in horn/fundus of uterus), predisposes a pt to _____

having a baby in breech position

Factors associated with breech presentation include:

Anything weird with uterus (causing distention) or baby or fluids 1. Uterine anomalies 2. Cornual-fundal placental 3. multiparity 4. multiple gestations 5. hydramnios and oligohydramnios 6. macrosomia 7. pelvic tumors 8. anencephaly 9. hydrocephalus 10. preterm gestation

Risk of DVT increases during pregnancy mainly bc of increase circulating lvls of ______

fibrinogen (factor I) - Almost doubles! *remember fibrinogen is activated by thrombin to fibrin

Coagulation factors __ and ___ decrease during pregnancy

XI and XIII

Protein S and C degrades/inactivates factors __ and ___, promoting (anticoagulation/thrombosis)

Va and VIIa anticoagulation

If oxytocin is ineffective in IOL d/t prolonged use, what medication is indicated?

IM Carboprost (hemabate) - a PG Then Misoprostol (PG) or IM methylergometrine (eergot alkaloid)

#1 side effect of carboprost (hemabate)?

brOnchOspasm

#1 side effect of IM methylergometrine?

HYpERtension - esp if given IV metHYlERgometrine

at high doses, magnesium sulfate can cause _____

complete heart block

std treatment for preeclampsia includes

1. bedrest 2. antihypertensives (labetalol, hydral) 3. mg sulfate gtt

Magnesium sulfate is used in preeclampsia why?

1. antiseizure medication to prevent eclampsia | 2. antihypertensive - vasodilating

First sx of magnesium toxicity

loss of DTR and generalized weakness

Serum Cr [ ] > __ mg/dL or a BUN > __ mg/dL suggests renal insufficiency in pregnant women

Cr > 0.8 mg/dL BUN > 13 * production of creatinine is same during preg, but GFR is increased, so Cr should be reduced. * normal in nonpregnant pts

Placenta accreta, where placenta adheres to implantation site. Treatment is ____

cesarean hysterectomy

Fetal heart rate variability is mediated by (sympathetic/parasympathetic) tone.

Parasympathetic

The primary cause of fetal bradycardia is increased parasympathetic activity via the ____ nerve, in the setting of fetal ____

vagus nerve hypoxia

GA during pregnancy has the advantages of relaxing uterine smooth muscle -> _________

decreased intrauterine pressure

(True/False) elective C/S are associated with significantly more complications than vaginal delivery

True *uterine rupture risk goes down though with elective c/s

Spinal block after failed epidural is a risk factor for _____

a high spinal * you usually bolus the epidural, but volume in the epidural space can displace your spinal meds higher - Brennan

Bupivacaine is highly protein bound and high pKa of 8.1, which results in (high/low) placental transfer

low high pKa = more [ionized] drug, which does not easily cross the placenta

Two important determinants of local anesthetic placental transfer

1. degree of ionization at physiological pH - more ionized, less placental transfer 2. amt of protein binding - more protein bound, less placental transfer

These drug characteristics _______ maternal to placental transfer - Ionized - High protein binding - Low free drug fraction - Charged

decrease

These drug characteristics _______ maternal to placental transfer - Unionized - Low protein binding - High free drug fraction - Uncharged

Increase

"______" refers to fetal drug accumulation d/t pH differences btwn maternal and fetal blood, particular in cases of fetal acidosis

Ion trapping

Since fetal blood pH is less than maternal blood pH, most of the drug will exist in (ionized/nonionized) forms in fetal circulation, and does not readily transfer back across the placenta to the maternal circulation

ionized

Amniotic fluid embolism leads to intense pulmonary vasospasm, and typically involves ______ shock and ______ coagulopathy. WHich can lead to fetal bradycardia and distress.

cardiogenic (RHF), consumptive

Terbutaline (beta 2) and nitroglycerin are used as ___ to help with preterm labor

tocolytics through uterine muscle relaxation

_____ is the most sensitive presenting sx of uterine rupture. Anesthetic management is ____

Fetal distress (bradycardia) - Emergent ETGA

_____ has been shown to reduce neonatal morbidity and mortality when given to mothers in preterm labor (20-37 weeks)

corticosteroids | - betamethasone or dexamethasone

Hypercalcemia inhibits ___ resulting in sodium and water depletion. Initial treatment is _____

ADH Normal saline

______ is the hormonally active metabolite of vitamin D

Calcitriol | - can worsen hypercalcemia

Hyperparathyroidism most often manifested by _____, which can lead to preop skeletal muscle weakness and unpredictable response to NMBs

hypercalcemia