Obesity & Drug Abuse Flashcards
(128 cards)
1
Q
What percentage of pregnant women are obese?
A
20%
2
Q
What procedure rate is increased with obese pregnancy?
A
C-section
3
Q
Morbidity and mortality is increased by what factor with pregnancy?
A
Obesity
4
Q
Oxygen consumption and CO2 production in obese pregnancy? Increase or decrease?
A
Increase due to energy expenditure from increase in body mass
5
Q
Minute ventilation is obese pregnancy? Increase or decrease?
A
Increase due to the elevated respiratory demand
6
Q
What size respirations occur with obese pregnancy?
A
Frequent shallow breaths
7
Q
What increases the WOB in obese pregnancy?
A
Increased weight on the chest wall and the weight gain during pregnancy
8
Q
What restricts diaphragm movement in the obese pregnancy patient?
A
Greater abdominal weight
9
Q
Why do obese pregnancy women deteriorate even quicker with supine or Tburg positioning?
A
FRC is decreased even further
VQ mismatching
10
Q
What happens with compliance in obese pregnancy?
A
Both chest wall and lung compliance decrease
11
Q
What happens with airway resistance with obese pregnancy?
A
Increases as a result of reduction in lung volumes
12
Q
What promotes dependent portion airway closure in obese pregnancy?
A
Decreased chest wall compliance and greater abdominal weight
13
Q
What happens to blood volume and cardiac output during obese pregnancy?
A
Increase
-CO increases due to both SV and HR increases
14
Q
Both preload and LV afterload are increased in obese pregnancy causing what type of hypertrophy?
A
Both eccentric and concentric LV hypertrophy
15
Q
Heart size changes in obese pregnancy
A
LA size
LV thickness
Interventricular septal thickness
LV mass
16
Q
What is the consequence of increased HR in the obese pregnant woman?
A
Limits diastolic fill time
-diastolic relaxation in impaired
17
Q
What occurs in the pulmonary system as a result of the increased CO and total blood volume in the obese pregnant woman?
A
Pulmonary HTN
18
Q
What is 3x higher incidence in pregnancy with a BMI of 30+?
A
HTN
19
Q
Supine causes even more what in the obsess pregnant woman?
A
Aortocaval compression
20
Q
Fatty infiltration of the heart and conduction system with obese pregnancy causes ~30 fold increase in?
A
PVCs
21
Q
Gastric volume and decreased pH in obese pregnancy?
A
Unclear if affected
22
Q
What GI conditions are more common in obese that nonobese patients?
A
GERD
Hiatal hernia
Gallbladder disease
23
Q
The higher risk for difficult airway management in obese pregnancy increases the risk for what?
A
Aspiration
24
Q
Obesity is associated with a higher risk of what coagulation problem?
A
Thromboembolic complications
25
What is the leading cause of direct maternal mortality?
Venous thromboembolism
26
What CV comorbidities risks are increased with obese pregnancy?
HTN
CAD
Cerebrovascular disease
Thromboembolic disease
27
What endocrine comorbidities risks are increased with obese pregnancy?
DM
Gestational DM
Gall bladder disease
28
What liver problem is associated with a higher risk with obese pregnancy?
Nonalcoholic fatty liver
29
What happens with infection risk and obese pregnancy?
Increases
30
How does BMI affect progress of labor?
Labor progresses more slowly
| Uterine contractions are less forceful
31
Decreased uterine contractility with obese pregnancy is implicated in a higher rate of?
Uterine atony
| Postpartum hemorrhage
32
Medical induction of labor in obese pregnancy has a higher rate of?
Failure
33
Risk of c-section in obese pregnancy is?
Increased
34
Fetal macrosomia risk is higher with obese pregnancy and increases the risk for what?
Shoulder dystosia and its associated birth trauma
| -forceps delivery
35
What is the most important risk that is increased with obese pregnancy?
Risk for death
36
What is the anesthetic of choice for obese pregnancy?
Neuraxial technique
37
What is increased with neuraxial technique and obese pregnancy?
Higher incidence of failed epidural
| Unintentional dural puncture
38
What BMI and over should be ramped?
30 and over
39
A BP cuff that exceeds the circumference of the arm by what percentage is needed? If it’s not will it over or under estimate SBP and DBP?
20%
| Overestimate
40
Forearm BP compared to upper arm BP?
Forearm BPs exceed upper arm BPs by 10+/- 10mmHg
41
Standard operating tables are generally rated for persons weighing?
500 lbs
| 227 kg
42
Why is sitting position preferred for epidural placement in obese pregnancy?
Lateral can obscure midline
| Distance from skin to epidural space is minimized in sitting-flexed position
43
What factors increase the likelihood of difficult laryngoscopy on obese pregnancy?
large breasts
Greater AP chest diameter
Airway edema
Reduced chin-to-chest distance
44
How quickly can sodium citrate effectively increase gastric pH?
5 minutes
45
Cephalad retraction of panus has what affect?
Difficulty with ventilation
| Hypotension
46
How long should preoxygenation occur?
3 minutes
| - or 8 deep tidal breaths
47
Succs dosing for obese pregnancy?
1-1.5mg/kg of IBW
48
Vt for obese pregnancy?
6-8ml/kg IBW
49
What can be done during periods of apnea and tracheal intubation to help increase the time to desaturation?
N/C insufflating oxygen at 5L/min
50
Is MAC altered in the obese pregnant patient?
No more than what it normally is with pregnancy
51
How should obese preg be extubated?
Awake
| Semi-upright
52
2 choices for neuraxial anesthesia in pregnant obese c-section?
Spinal
CSE
Epidural okay if already in place and functional
53
Typically a GA will be preformed due to what? But can be considered for what else?
Emergent section
Active vomiting, extreme reflux
54
Most of the anesthesia related deaths occur from?
Airway issues
55
There is no contraindication to which heparin prophylaxis treatment?
SQ standard unfractionated heparin
56
LMWH:
| Needle placement
10-12 hours after last dose
57
1st post op dose of LMWH
6-8 hours post op
58
Remove epidural catheter after LWMH?
At least 10-12 hours after last dose
59
No LMWH till how long after epidural catheter removal?
At least 2 hours
60
High doses of LMWH:
| Needle placement
Not till 24 hours after last dose
61
1st post op dose of high dose LMWH?
Not till 24 hours after surgery
62
When can high dose LMWH be restarted after indwelling catheter removal?
At least 2 hours before initiation of therapy
63
Is it okay to do an epidural with ASA use?
No significant risk
64
What percentage of pregnant women abuse drugs?
5%
65
What is the highest leading cause of preventable birth defects?
Alcohol
66
Awareness can occur with alcohol use because?
Of high requirements
67
What is the most common substance abused?
Smoking
68
What problems can smoking cause (with pregnancy)?
Bronchospasm (marijuana too)
| Low birth weight
69
Alcohol use during pregnancy can lead to what life long defects?
Heart
Behavioral
Physical
Intellectual
70
Caffeine use during pregnancy can cause what complications?
Withdrawal can be mistaken for PDPH
Increased anxiety
Restlessness
Decreases fertility
71
Quitting smoking when has the greatest benefit for mom and baby?
Before 15 weeks gestation
72
What is one of the most important modifiable causes of poor pregnancy outcomes?
Smoking
73
What risk is increased with a smoker and GA? (Besides bronchospasm)
Pneumonia
74
Smoking causes what respiratory changes?
Volume and composition of mucus thicker
Impaired mucociliary clearance
More bronchitis and COPD
75
Fetal mortality is what percentage higher in smokers?
40%
76
Compared to non smokers, smokers are:
More likely to die (17%)
Have serious heart and lung problems (53%)
Greater risk of heart attack after sx, delayed healing (77%)
77
Marijuana elimination?
25-30 days
78
Is marijuana associated with congenital abnormalities?
No
| -some show association with increased risk of still-birth, preterm birth and neurobehavioral abnormalities
79
Long-term associated effects of marijuana in children?
Inattention and impulsivity
Deficits in problem solving
Academic underachievement
Predisposition to smoking MJ and tobacco
80
Affect of MJ on NMB?
Potentials NMB
81
How does chronic use of MJ affect induction?
Requires higher doses of anesthetics
82
Peak introp HR can increase by how much with MJ use?
24%
83
Acute use of MJ can cause what with he heart?
Tachycardia and arrhythmias
84
Chronic use of MJ can cause what with the heart?
Bradycardia and hypotension
85
What part of MJ has an anti-hemostasis effect? How?
Cannaboid
| Diminished ability for platelet aggregation
86
What part of MJ may be prothrombic and favor CV events and stroke?
THC
87
What is the most important thing for anesthesia to remember with cocaine abuse?
It depletes catecholamines
| -decreased response to stress
88
Cocaine use increases risk of:
```
Increased risk of:
STDs
Preterm labor
No prenatal care
Abruption
```
89
Chronic use of cocaine leads to _________ of receptors
Upregulation
| -requires higher dose
90
Cocaines effect on the peripheral nervous system
HTN and/or lability BP
Tachycardia
Widespread vessel occlusion through vasospasm, thrombosis and endothelial injury
91
Cocaine’s effect on CV
Increases peripheral vascular resistance
Increases contractility
Increases myocardial oxygen demand
Coronary vasoconstriction
92
What is a common complaint among cocaine users who present to the ED?
Chest pain (cocaine induced)
93
Why is labetalol preferred when cocaine induced hypertension requires treatment?
Beta blockade may result in unopposed alpha mediated vasoconstriction, labetalol is an alpha and beta antagonist
94
What other class of medications can be given to help relieve some of the CV effects of cocaine use?
Benzodiazepines
| Magnesium
95
What vassopressor may cocaine users not respond to? So which should you use?
May not respond to ephedrine
| Use phenylephrine
96
GI effects of cocaine
Ischemia
Ulceration
Perforation
97
Why does cocaine cause delayed gastric emptying?
Cocaine’s anticholinergic effect
98
Neurologic effects of cocaine
Cocaine induced seizures
99
Respiratory effects from smoking cocaine
Bronchospasm
Chronic cough
Diffusion capacity abnormalites
100
Hematologic effect of cocaine? Tx?
Cocaine induced thrombocytopenia
| -responds to corticosteroids
101
How does cocaine cause hyperthermia?
Impairs cutaneous vasodilation and sweating
102
Does cocaine cross the placenta?
Readily
103
OB complications associated with maternal cocaine use?
Higher incidence of placental abruption and preterm labor
104
What condition can cocaine toxicity mimic?
Preeclampsia or eclampsia
| -HTN, HA, blurred vision, sz
105
What anesthetic technique can reduce circulating levels of catecholamines in cocaine patients?
Neuraxial anesthesia
106
How is hypotension in cocaine patients treated?
Volume
| Direct acting vasopressor: phenylephrine
107
Changes in mu and kappa receptors and altered baseline endorphin levels may result in what in cocaine patients?
Increased perception of pain
108
What anesthetic may potential the vasoconstrictive effects of cocaine?
Ketamine
109
What anesthetic can result in disinhibition of CNS control of extrapyramidal activity, just like cocaine?
Etomidate
110
What drug may delay the onset of seizures in cocaine patients?
Dexmedetomidine
111
What medication may impair metabolism of cocaine?
succinylcholine (she says, but cocaine is metabolized by the liver???)
-may compete for plasma cholinesterase
112
What is the half-life of cocaine?
30-90 minutes, up to 6 hours
113
Drinking alcohol with cocaine use has what affect?
Synergistic
- greater physiologic effect
- prolongs half life
- increases risk of sudden death by 25%
114
Most common illicit substance that requires medical treatment in pregnancy?
Meth
115
Meth use may result in what affect on labor?
Preterm labor
Small for gestational age
Low birth weight
116
Long term affects on fetus of meth
Fall behind in school and sports
Increased risk of retinal defects, cleft palate and rib malformations
Decreased overall rate of growth and motor development
117
CV effects of meth
Vasoconstriction
Tachycardia
Labile BP
(Similar to cocaine)
118
Sensory hallucinations with meth use are due to what?
Dehydration
119
How is heroin metabolized and what drugs can inhibit clearance?
cytochrome P450
| -omeprazole, amitriptyline
120
What class of drugs may increase heroin clearance?
Anticonvulsants
121
What type of activity do opioids have on the CNS?
Reduce SNS
| Increase PNS
122
What do opioids promote the release of?
Histamine from mast cells
123
How does opioid induced respiratory depression occur?
Through direct effect on the brainstem that reduces ventilators response to hypercapnia
124
Abuse of IV opioids or others are at increased risk for:
```
Infective endocarditis (tricuspid most commonly affected)
HIV
Viral hepatitis
Septic emboli
Pulmonary abscess formation
```
125
What is considered the first-line medication for pregnant opioid-dependent women new to treatment?
buprenorphine
126
Why is buprenorphine considered first line treatment?
Hospitalizations and complications less frequent
| Amount of morphine needed to tx infant is less
127
Signs of neonatal opioid withdrawal syndrome (NOWS)
```
Irritability
Poor feeding
Abnormal sleep patterns
Diarrhea
Fever
Seizures
```
128
Heroin use during pregnancy is associated with first trimester:
spontaneous abortion
Preterm delivery
Fetal growth restriction
