final review Flashcards
T/F Compensatory metabolic acidosis by excretion of bicarb maintains normal pH
True
how does vital capacity and TLC change in pregnancy
it doesnt
p50 of hb ____ from __ to ___
increases 27 to 30
dead space ___
decreases
airway resistance ___
decreases
Hyperventilation - alkalosis causes uterine ___ and ___ placental blood flow
vasoconstriction decreased
alkalosis will shift HgbO2 curve to the ___, ___ the release of O2 to the fetus
left, decrease
response to adrenergic drugs is ____, and plasma colloid osmotic pressure ___
blunted, declines
RBF and GFR are ____ by about ___ by 16th week, remains elevated until delivery
increased , 50%
BUN and Cr are ____
mildly reduced
T/F Mom has a decrease in pseudocholinesterase levels, but simultaneous increase in VOD counters any clinically significant prolongation of NMB with succs
TRUE
Fetal oxy-hemoglobi curve is ___ shifted and maternal is ___ shifted
left, right
transfer of CO2 occurs by
simple diffusion
first stage of labor
onset of true labor until complete cervical dilation
2nd stage of labor
time from complete dilation until infant delivered
third stage of labor
time from silvery of infant until placenta delivered
high serum LA levels can result in uterine ____
vasoconstriction
dermatomes for first stage of labor
T10-L1
dermatomes for second stage of labor
S2-S4
T/F Nearly all opioids cross the placenta and depress the fetus
TRUE
neonatal depression is unlikely if demerol is given….
less than 1h prior to delivery
whats the major side effect of IH
decreased uterine tone
paracervical block is used for
first stage of labor
pudendal block is used for
second stage of labor
A1 acid glycoprotein = ___ affinity, ___ capacity
high, low
albumin = ___ affinity, ____ capacity
low , high
___ amounts of LA are required in mom, and ____ onset
smaller, faster
what drugs for labor epidural
bupiv, ropiv, lido
what drugs for operative epidural
lido, 2choloro
what drugs for spinal
tetra, bupiv
which drug isnt great for continuous infusion bc it has a lot of motor block
lidocaine
which drug has a rapid onset, very short duration, lot of motor block, low risk of toxicity, very rapidly metabolized
2-cholor
which drug has a long duration but less of a motor block
bupiv
rank the drugs in terms of CV toxicity
ropiv < levobupiv < bupiv
what spinal levels do you wanna cover
T10-S4
in adults the spinal cord ends at
L1
turns out most providers are actually ___ than they think
higher
T/F Drugs delivered via spinal route are __x more potent and ____ needles are used
10x, smaller
____ paCO2 and ____ lowers seizure threshold
increased acidosis
acidosis decreases protein binding so you have _____
more free LA
what type of drug is sodium citrate? why is it given? how long does it last?
antacid. raises gastric pH. lasts 15min.
what type of drug is ranitidine? when is the max effect?
H2 blocker, usually used in addition to antacids as it does nothing for acid already there. 50mg IV dose. max effect seen 2h after admin.
reglan effects may be inhibited by ___
opioids
which drug is useful in the face of maternal hemorrhage, decreases risk of bronchospasm, but has side effects of htn and dysphoria
ketamine
____ causes more neonatal depression than other agents
midazolam
avoid block for ___ if therapeutic anti coagulated, avoid block for ___ if prophylactic anti-coagulated
24, 12
for neruaxial block an LWMH - remove catheter at least __h after last dose, and dont administer LWMH until ___h after block is placed or catheter is removed
2-4
epidural abscess - if an infection is present it takes ___days for sx (usually pain; loss of function) to occur. treatment (abx and lammy) have a ___hr window before permanent damage
4-10. 6-12
where is the conus
T12-L3
stop injecting for epidural blood patch when
patient says HA is gone or they have a pressure sensation in the ears
causes of total spinal
migrated epidural cath, unrecognized dural puncture, SAB after failed epidural
deficiency of protein C&S make a person ____coaguable
hyper
T/F Hypotension d/t dec. afterload will reverse a left to R shunt, with resulting R to L shunting and cyanosis - beware SAB in these patients
true
