Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB Test 3 > Obesity & Drug Abuse > Flashcards

Obesity & Drug Abuse Flashcards

1
Q

What percentage of pregnant women are obese?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What procedure rate is increased with obese pregnancy?

A

C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Morbidity and mortality is increased by what factor with pregnancy?

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Oxygen consumption and CO2 production in obese pregnancy? Increase or decrease?

A

Increase due to energy expenditure from increase in body mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Minute ventilation is obese pregnancy? Increase or decrease?

A

Increase due to the elevated respiratory demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What size respirations occur with obese pregnancy?

A

Frequent shallow breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What increases the WOB in obese pregnancy?

A

Increased weight on the chest wall and the weight gain during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What restricts diaphragm movement in the obese pregnancy patient?

A

Greater abdominal weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why do obese pregnancy women deteriorate even quicker with supine or Tburg positioning?

A

FRC is decreased even further

VQ mismatching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens with compliance in obese pregnancy?

A

Both chest wall and lung compliance decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens with airway resistance with obese pregnancy?

A

Increases as a result of reduction in lung volumes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What promotes dependent portion airway closure in obese pregnancy?

A

Decreased chest wall compliance and greater abdominal weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to blood volume and cardiac output during obese pregnancy?

A

Increase

-CO increases due to both SV and HR increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Both preload and LV afterload are increased in obese pregnancy causing what type of hypertrophy?

A

Both eccentric and concentric LV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Heart size changes in obese pregnancy

A

LA size
LV thickness
Interventricular septal thickness
LV mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the consequence of increased HR in the obese pregnant woman?

A

Limits diastolic fill time

-diastolic relaxation in impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is 3x higher incidence in pregnancy with a BMI of 30+?

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Supine causes even more what in the obsess pregnant woman?

A

Aortocaval compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fatty infiltration of the heart and conduction system with obese pregnancy causes ~30 fold increase in?

A

PVCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Gastric volume and decreased pH in obese pregnancy?

A

Unclear if affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What GI conditions are more common in obese that nonobese patients?

A

GERD
Hiatal hernia
Gallbladder disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

The higher risk for difficult airway management in obese pregnancy increases the risk for what?

A

Aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Obesity is associated with a higher risk of what coagulation problem?

A

Thromboembolic complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the leading cause of direct maternal mortality?

A

Venous thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What CV comorbidities risks are increased with obese pregnancy?

A

HTN
CAD
Cerebrovascular disease
Thromboembolic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What endocrine comorbidities risks are increased with obese pregnancy?

A

DM
Gestational DM
Gall bladder disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What liver problem is associated with a higher risk with obese pregnancy?

A

Nonalcoholic fatty liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What happens with infection risk and obese pregnancy?

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does BMI affect progress of labor?

A

Labor progresses more slowly

Uterine contractions are less forceful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Decreased uterine contractility with obese pregnancy is implicated in a higher rate of?

A

Uterine atony

Postpartum hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Medical induction of labor in obese pregnancy has a higher rate of?

A

Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Risk of c-section in obese pregnancy is?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Fetal macrosomia risk is higher with obese pregnancy and increases the risk for what?

A

Shoulder dystosia and its associated birth trauma

-forceps delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the most important risk that is increased with obese pregnancy?

A

Risk for death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the anesthetic of choice for obese pregnancy?

A

Neuraxial technique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is increased with neuraxial technique and obese pregnancy?

A

Higher incidence of failed epidural

Unintentional dural puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What BMI and over should be ramped?

A

30 and over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

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?

A

20%

Overestimate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Forearm BP compared to upper arm BP?

A

Forearm BPs exceed upper arm BPs by 10+/- 10mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Standard operating tables are generally rated for persons weighing?

A

500 lbs

227 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why is sitting position preferred for epidural placement in obese pregnancy?

A

Lateral can obscure midline

Distance from skin to epidural space is minimized in sitting-flexed position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What factors increase the likelihood of difficult laryngoscopy on obese pregnancy?

A

large breasts
Greater AP chest diameter
Airway edema
Reduced chin-to-chest distance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How quickly can sodium citrate effectively increase gastric pH?

A

5 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Cephalad retraction of panus has what affect?

A

Difficulty with ventilation

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How long should preoxygenation occur?

A

3 minutes

- or 8 deep tidal breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Succs dosing for obese pregnancy?

A

1-1.5mg/kg of IBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Vt for obese pregnancy?

A

6-8ml/kg IBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What can be done during periods of apnea and tracheal intubation to help increase the time to desaturation?

A

N/C insufflating oxygen at 5L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Is MAC altered in the obese pregnant patient?

A

No more than what it normally is with pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How should obese preg be extubated?

A

Awake

Semi-upright

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

2 choices for neuraxial anesthesia in pregnant obese c-section?

A

Spinal
CSE
Epidural okay if already in place and functional

53
Q

Typically a GA will be preformed due to what? But can be considered for what else?

A

Emergent section

Active vomiting, extreme reflux

54
Q

Most of the anesthesia related deaths occur from?

A

Airway issues

55
Q

There is no contraindication to which heparin prophylaxis treatment?

A

SQ standard unfractionated heparin

56
Q

LMWH:

Needle placement

A

10-12 hours after last dose

57
Q

1st post op dose of LMWH

A

6-8 hours post op

58
Q

Remove epidural catheter after LWMH?

A

At least 10-12 hours after last dose

59
Q

No LMWH till how long after epidural catheter removal?

A

At least 2 hours

60
Q

High doses of LMWH:

Needle placement

A

Not till 24 hours after last dose

61
Q

1st post op dose of high dose LMWH?

A

Not till 24 hours after surgery

62
Q

When can high dose LMWH be restarted after indwelling catheter removal?

A

At least 2 hours before initiation of therapy

63
Q

Is it okay to do an epidural with ASA use?

A

No significant risk

64
Q

What percentage of pregnant women abuse drugs?

A

5%

65
Q

What is the highest leading cause of preventable birth defects?

A

Alcohol

66
Q

Awareness can occur with alcohol use because?

A

Of high requirements

67
Q

What is the most common substance abused?

A

Smoking

68
Q

What problems can smoking cause (with pregnancy)?

A

Bronchospasm (marijuana too)

Low birth weight

69
Q

Alcohol use during pregnancy can lead to what life long defects?

A

Heart
Behavioral
Physical
Intellectual

70
Q

Caffeine use during pregnancy can cause what complications?

A

Withdrawal can be mistaken for PDPH
Increased anxiety
Restlessness
Decreases fertility

71
Q

Quitting smoking when has the greatest benefit for mom and baby?

A

Before 15 weeks gestation

72
Q

What is one of the most important modifiable causes of poor pregnancy outcomes?

A

Smoking

73
Q

What risk is increased with a smoker and GA? (Besides bronchospasm)

A

Pneumonia

74
Q

Smoking causes what respiratory changes?

A

Volume and composition of mucus thicker
Impaired mucociliary clearance
More bronchitis and COPD

75
Q

Fetal mortality is what percentage higher in smokers?

A

40%

76
Q

Compared to non smokers, smokers are:

A

More likely to die (17%)
Have serious heart and lung problems (53%)
Greater risk of heart attack after sx, delayed healing (77%)

77
Q

Marijuana elimination?

A

25-30 days

78
Q

Is marijuana associated with congenital abnormalities?

A

No

-some show association with increased risk of still-birth, preterm birth and neurobehavioral abnormalities

79
Q

Long-term associated effects of marijuana in children?

A

Inattention and impulsivity
Deficits in problem solving
Academic underachievement
Predisposition to smoking MJ and tobacco

80
Q

Affect of MJ on NMB?

A

Potentials NMB

81
Q

How does chronic use of MJ affect induction?

A

Requires higher doses of anesthetics

82
Q

Peak introp HR can increase by how much with MJ use?

A

24%

83
Q

Acute use of MJ can cause what with he heart?

A

Tachycardia and arrhythmias

84
Q

Chronic use of MJ can cause what with the heart?

A

Bradycardia and hypotension

85
Q

What part of MJ has an anti-hemostasis effect? How?

A

Cannaboid

Diminished ability for platelet aggregation

86
Q

What part of MJ may be prothrombic and favor CV events and stroke?

A

THC

87
Q

What is the most important thing for anesthesia to remember with cocaine abuse?

A

It depletes catecholamines

-decreased response to stress

88
Q

Cocaine use increases risk of:

A 
Increased risk of:
STDs
Preterm labor
No prenatal care
Abruption
89
Q

Chronic use of cocaine leads to _________ of receptors

A

Upregulation

-requires higher dose

90
Q

Cocaines effect on the peripheral nervous system

A

HTN and/or lability BP
Tachycardia
Widespread vessel occlusion through vasospasm, thrombosis and endothelial injury

91
Q

Cocaine’s effect on CV

A

Increases peripheral vascular resistance
Increases contractility
Increases myocardial oxygen demand
Coronary vasoconstriction

92
Q

What is a common complaint among cocaine users who present to the ED?

A

Chest pain (cocaine induced)

93
Q

Why is labetalol preferred when cocaine induced hypertension requires treatment?

A

Beta blockade may result in unopposed alpha mediated vasoconstriction, labetalol is an alpha and beta antagonist

94
Q

What other class of medications can be given to help relieve some of the CV effects of cocaine use?

A

Benzodiazepines

Magnesium

95
Q

What vassopressor may cocaine users not respond to? So which should you use?

A

May not respond to ephedrine

Use phenylephrine

96
Q

GI effects of cocaine

A

Ischemia
Ulceration
Perforation

97
Q

Why does cocaine cause delayed gastric emptying?

A

Cocaine’s anticholinergic effect

98
Q

Neurologic effects of cocaine

A

Cocaine induced seizures

99
Q

Respiratory effects from smoking cocaine

A

Bronchospasm
Chronic cough
Diffusion capacity abnormalites

100
Q

Hematologic effect of cocaine? Tx?

A

Cocaine induced thrombocytopenia

-responds to corticosteroids

101
Q

How does cocaine cause hyperthermia?

A

Impairs cutaneous vasodilation and sweating

102
Q

Does cocaine cross the placenta?

A

Readily

103
Q

OB complications associated with maternal cocaine use?

A

Higher incidence of placental abruption and preterm labor

104
Q

What condition can cocaine toxicity mimic?

A

Preeclampsia or eclampsia

-HTN, HA, blurred vision, sz

105
Q

What anesthetic technique can reduce circulating levels of catecholamines in cocaine patients?

A

Neuraxial anesthesia

106
Q

How is hypotension in cocaine patients treated?

A

Volume

Direct acting vasopressor: phenylephrine

107
Q

Changes in mu and kappa receptors and altered baseline endorphin levels may result in what in cocaine patients?

A

Increased perception of pain

108
Q

What anesthetic may potential the vasoconstrictive effects of cocaine?

A

Ketamine

109
Q

What anesthetic can result in disinhibition of CNS control of extrapyramidal activity, just like cocaine?

A

Etomidate

110
Q

What drug may delay the onset of seizures in cocaine patients?

A

Dexmedetomidine

111
Q

What medication may impair metabolism of cocaine?

A

succinylcholine (she says, but cocaine is metabolized by the liver???)
-may compete for plasma cholinesterase

112
Q

What is the half-life of cocaine?

A

30-90 minutes, up to 6 hours

113
Q

Drinking alcohol with cocaine use has what affect?

A

Synergistic

  • greater physiologic effect
  • prolongs half life
  • increases risk of sudden death by 25%
114
Q

Most common illicit substance that requires medical treatment in pregnancy?

A

Meth

115
Q

Meth use may result in what affect on labor?

A

Preterm labor
Small for gestational age
Low birth weight

116
Q

Long term affects on fetus of meth

A

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
Q

CV effects of meth

A

Vasoconstriction
Tachycardia
Labile BP
(Similar to cocaine)

118
Q

Sensory hallucinations with meth use are due to what?

A

Dehydration

119
Q

How is heroin metabolized and what drugs can inhibit clearance?

A

cytochrome P450

-omeprazole, amitriptyline

120
Q

What class of drugs may increase heroin clearance?

A

Anticonvulsants

121
Q

What type of activity do opioids have on the CNS?

A

Reduce SNS

Increase PNS

122
Q

What do opioids promote the release of?

A

Histamine from mast cells

123
Q

How does opioid induced respiratory depression occur?

A

Through direct effect on the brainstem that reduces ventilators response to hypercapnia

124
Q

Abuse of IV opioids or others are at increased risk for:

A 
Infective endocarditis (tricuspid most commonly affected)
HIV
Viral hepatitis
Septic emboli
Pulmonary abscess formation
125
Q

What is considered the first-line medication for pregnant opioid-dependent women new to treatment?

A

buprenorphine

126
Q

Why is buprenorphine considered first line treatment?

A

Hospitalizations and complications less frequent

Amount of morphine needed to tx infant is less

127
Q

Signs of neonatal opioid withdrawal syndrome (NOWS)

A 
Irritability
Poor feeding
Abnormal sleep patterns
Diarrhea
Fever
Seizures
128
Q

Heroin use during pregnancy is associated with first trimester:

A

spontaneous abortion
Preterm delivery
Fetal growth restriction

OB Test 3 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions