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Anesthesia 101 > ITE OB 1 > Flashcards

ITE OB 1 Flashcards

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1
Q

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

A

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

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2
Q

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

A

Magnesium (competitive antagonist of calcium)

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3
Q

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

A

Pudendal nerve

S2 - S4

  • Not useful for first stage of labor
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4
Q

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

A

Contractions are regular intervals of 2-3 min

Full cervical dilation (10cm)

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5
Q

Stage two of labor starts with _______.

A

Full cervical dilation

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6
Q

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

A

T10 - L1

inferior hypogastric plexus

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7
Q

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

A

T12 - L1, and S2-S4

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8
Q

__________ is the formation of scar tissue in the uterine cavity

A

asherman syndrome

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9
Q

Two autoantibodies associated with antiphospholipid syndrome are:

A
  1. Lupus anticoagulant

2. anticardiolipin antibody

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10
Q

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

A

Yes, Lupus anticoagulant has no true ac activity

- does not suggest bleeding tendency

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11
Q

Which is elevated in antiphospholipid syndrome, Pt or aPTT?

A

elevated aPTT

- does not suggest bleeding tendency

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12
Q

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

A

methylergonovine (methergine)

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13
Q

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

A

oxytocin

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14
Q

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

A

T10-L1

S2-S4

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15
Q

Why are paracervical blocks not typically tolerated in pregnant pts?

A

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

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16
Q

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

A

sodium retention via the renin angiotensin system

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17
Q

Treatment choice of polyhydramnios is ______

A

indomethacin

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18
Q

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

A

T4-S4

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19
Q

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

A

nitroglycerin

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20
Q

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

A

GA

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

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21
Q

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

A

Central venous pressure

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22
Q

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

A

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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23
Q

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

A

Preterm labor

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24
Q

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

A

Nalbuphine in 3mg small doses

*intrathecal opioids does not cause histamine release

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25
Q

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.

A

PT

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26
Q

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

A

antithrombin III

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27
Q

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

A

quaternary amine

highly hydrophilic

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28
Q

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

A

quaternary amine

highly hydrophilic

*Atropine and scopolamine easily cross

29
Q

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

A

Metoclopramide (reglan)

30
Q

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

A

acidic

31
Q

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

A

lower

32
Q

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

A

true

33
Q

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

A

5-HT3 receptor antagonist

34
Q

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

A

competitive inhibitor of histamine at H2-receptors

35
Q

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

A

nitrous oxide (blue)

36
Q 
Colors of tanks
Helium 
Air 
Oxygen 
Nitric oxide  
Nitrogen 
Carbon Dioxide
A 
Helium - brown
Air - yellow
Oxygen - green
Nitric oxide  - blue
Nitrogen - black
Carbon Dioxide - gray
37
Q

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

A

having a baby in breech position

38
Q

Factors associated with breech presentation include:

A

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
39
Q

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

A

fibrinogen (factor I)
- Almost doubles!

*remember fibrinogen is activated by thrombin to fibrin

40
Q

Coagulation factors __ and ___ decrease during pregnancy

A

XI and XIII

41
Q

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

A

Va and VIIa

anticoagulation

42
Q

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

A

IM Carboprost (hemabate) - a PG

Then Misoprostol (PG) or IM methylergometrine (eergot alkaloid)

43
Q

1 side effect of carboprost (hemabate)?

A

brOnchOspasm

44
Q

1 side effect of IM methylergometrine?

A

HYpERtension
- esp if given IV

metHYlERgometrine

45
Q

at high doses, magnesium sulfate can cause _____

A

complete heart block

46
Q

std treatment for preeclampsia includes

A
  1. bedrest
  2. antihypertensives (labetalol, hydral)
  3. mg sulfate gtt
47
Q

Magnesium sulfate is used in preeclampsia why?

A
  1. antiseizure medication to prevent eclampsia

2. antihypertensive - vasodilating

48
Q

First sx of magnesium toxicity

A

loss of DTR and generalized weakness

49
Q

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

A

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
50
Q

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

A

cesarean hysterectomy

51
Q

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

A

Parasympathetic

52
Q

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

A

vagus nerve

hypoxia

53
Q

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

A

decreased intrauterine pressure

54
Q

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

A

True

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

55
Q

Spinal block after failed epidural is a risk factor for _____

A

a high spinal

  • you usually bolus the epidural, but volume in the epidural space can displace your spinal meds higher
  • Brennan
56
Q

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

A

low

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

57
Q

Two important determinants of local anesthetic placental transfer

A
  1. degree of ionization at physiological pH
    - more ionized, less placental transfer
  2. amt of protein binding
    - more protein bound, less placental transfer
58
Q

These drug characteristics _______ maternal to placental transfer

  • Ionized
  • High protein binding
  • Low free drug fraction
  • Charged
A

decrease

59
Q

These drug characteristics _______ maternal to placental transfer

  • Unionized
  • Low protein binding
  • High free drug fraction
  • Uncharged
A

Increase

60
Q

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

A

Ion trapping

61
Q

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

A

ionized

62
Q

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

A

cardiogenic (RHF), consumptive

63
Q

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

A

tocolytics through uterine muscle relaxation

64
Q

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

A

Fetal distress (bradycardia)

  • Emergent ETGA
65
Q

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

A

corticosteroids

- betamethasone or dexamethasone

66
Q

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

A

ADH

Normal saline

67
Q

______ is the hormonally active metabolite of vitamin D

A

Calcitriol

- can worsen hypercalcemia

68
Q

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

A

hypercalcemia

Anesthesia 101 (38 decks)

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