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AP III > OB (3/10) > Flashcards

OB (3/10) Flashcards

1
Q

pregnant women experience what musculoskeletal changes

A

lumbar lordosis –> back pain, stretch of lateral femoral cutaneous nerve, and affects the center of gravity

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2
Q

MAC of inhaled anesthetics ___________ by 40% in the pregnant pt

A

decreases

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3
Q

what hormones increase the pregnant woman’s threshold to pain

A

progesterone and endorphins

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4
Q

if you have to run gas on a pregnant pt what MAC level should you run

A

0.5

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5
Q

in the pregnant woman, you need ___________ LA to acquire the same level of blockade

A

less

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6
Q

T/F: with a neuraxial anesthetic in the pregnant pt, sympathectomy will decrease BP much more than in non-pregnant woman

A

true

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7
Q

the pregnant woman is dependent on _______________ of the lower extremities to counteract effects of IVC compression and return blood to the heart

A

venous capacitance

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8
Q

uterine blood flow in early pregnancy is _________ mL/min

A

50-100 mL/min

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9
Q

at term, uterine blood flow is ___________ mL/min

A

700-900

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10
Q

_________% of CO goes to the uterus

A

20

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11
Q

the CO that goes to the uterus, _______% of that perfuses the intervillous space and ________% perfuses the myometrium

A

90; 10

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12
Q

the increase in CO during pregnancy increases the flow to what organs?

A
  1. uterus
  2. kidneys
  3. extremity skin and muscle
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13
Q

T/F: blood flow to brain and liver does not change during pregnancy

A

true

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14
Q

uterine blood supply is mainly from ____________ arteries which arise from the ________________ artery

A

uterine; hypogastric artery (aka the anterior division of the internal iliac artery)

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15
Q

______________ is the number one determinant of O2 and nutrient delivery to the fetus

A

uteroplacental blood flow

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16
Q

uterine blood flow = _________________ (formula)

A

uterine perfusion pressure/uterine vascular pressure

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17
Q

intrauterine growth retardation is a tip that __________________ is an inadequate and can lead to _______________ in adulthood

A

uteroplacental blood flow; CV disease

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18
Q

chronic disease in uteroplacental blood flow leads to

A
  1. intrauterine growth retardation
  2. pre-eclampsia
  3. CV disease in adulthood
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19
Q

T/F: trophoblastic invasion of spiral arteries is normal in pregnancy

A

true

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20
Q

what is the physiologic change that causes the low vascular system in pregnancy?

A

trophoblastic invasion of the spiral arteries –> loss of smooth muscle and the inability of these vessels to constrict

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21
Q

abnormal or inadequate _______________ in pregnancy is integral to the pathophysiology of pre-eclampsia

A

trophoblastic invasion

22
Q

what are the causes of decreased uterine blood flow due to decreased uterine arterial pressure

A
  1. supine position
  2. hemorrhage/hypovolemia
  3. drug induced hypotension
  4. hypotension during sympathetic block
23
Q

what re the causes of decreased uterine blood flow due to increased uterine venous pressure

A
  1. vena caval compression
  2. uterine contraction
  3. drug induced uterine hypertonus (oxytocin, local anesthetics)
  4. skeletal muscle hypertonus (seizures, valsalva)
24
Q

what causes decreased uterine blood flow due to increased uterine vascular resistance

A
  1. endogenous vasoconstrictors: catecholamines and vasopressors
  2. exogenous vasoconstrictors: epinephrine, phenylepherine, LA in high concentrations
25
Q

_________________ + ______________ = decreased uterine vascular resistance

A

increased uterine artery diameter; dilated placenta circulation

26
Q

____________ is when blood flow in the pelvis is preferentially redistributed toward the uterus

A

“steal”

27
Q

uterine circulation is MORE responsive to the vasoconstricting effects of _________________ than systemic circulation

A

alpha adrenergic agonists

28
Q

effect of propofol and barbiturates on uteroplacental blood flow

A

small decrease

29
Q

ketamine effects on uteroplacental blood flow in doses < 1.5 mg/kg

A

no change

30
Q

inhalational agents effects on uteroplacental blood flow

A
  1. potentially decreases uteroplacental blood flow (d/t decrease in maternal BP)
  2. small effects when less than 1 hr
31
Q

local anesthetics effects on uteroplacental blood flow

A

high doses can cause uterine arterial vasoconstriction (so could decrease flow)

32
Q

neuraxial anesthesia effects on uteroplacental blood flow

A
  1. decreases uteroplacntal flow if maternal hypotension occurs
  2. increased uteroplacental blood flow via decreasing pain and stress
33
Q

T/F: placental circulation is completely different than moms

A

true

34
Q

the ________________ is an imperfect barrier than allows most all substances to cross to fetus

A

placenta

35
Q

mechanisms of transfer across the placenta

A
  1. passive transport
  2. facilitated transport
  3. active transport
  4. pinocytosis
36
Q

the fetus depends on the placenta for what 3 things?

A
  1. respiratory gas exchange
  2. nutrition
  3. waste elimination
37
Q

the placenta produces a variety of __________, _________, & ______________ that drives a lot changes seen in mom during pregnancy

A

enzymes, binding proteins, polypeptide hormones.

38
Q

the placenta is a ______ vessel cord; consisting of ________ artery and _______ vein

A

3; 2; 1

39
Q

what characteristics would allow for increased transfer of drug from mom to fetus?

A
  1. < 1000 Da (molec. wt)
  2. uncharged
  3. lipophillic
  4. greater proportion of unionized drug in maternal plasma
  5. absent placental efflux transporter
  6. binds with albumin (lower binding affinity)
  7. high concentration of free (unbound) drug fraction
40
Q

what drug characteristics will decrease drug transfer from mom to fetus

A
  1. large molecular wt (> 1000 Da)
  2. charged
  3. hydrophillic
  4. higher proportion of ionized drug in maternal circ
  5. placental efflux transporter proteins present
  6. alpha-1-acid glycoprotein binding type (higher binding affinity)
  7. low concentration of free unbound drug
41
Q

factors that affect drug transfer from mom to fetus

A
  1. lipid solubility
  2. protein binding
  3. tissue binding
  4. pKa
  5. pH
  6. blood flow
42
Q

_____________ properties of INH anesthetics enhance the transfer the drug across the placenta

A

lipophilic

43
Q

inhalational agents have little fetal effect at less than ______ MAC and _________

A

1; imminent delivery

44
Q

which anesthetic drugs have little effect on the fetus, and thus are used at usual doses

A
  1. propofol
  2. ketamine
  3. benzodiazepines
45
Q

opioid effects in the fetus

A
  1. effects vary
  2. concern for respiratory depression
  3. if close to delivery, avoid
46
Q

_____________ anesthetics cross the placenta into fetal circulation quickly

A

local anesthetics

47
Q

what drugs (used in anesthesia) DO NOT cross the placenta

A
  1. glycopyrrolate
  2. heparin
  3. succinycholine
  4. NDMR
48
Q

fetal concentration of drugs that cross the placenta are dependent on?

A
  1. maternal drug metabolism
  2. placental drug metabolism
  3. fetal drug metabolism
  4. changes is uterine blood flow
49
Q

what is the main different in fetal and postnatal circulation?

A

systemic and pulmonary circulations are NOT completely separated in teh fetus

50
Q

T/F: fetus has no effective oxygen reservoir

A

true - thus mom = gasline for O2 to fetus

AP III (20 decks)

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