Unit 3 Module 2 UP&F Phys (Exam 2) Flashcards

1
Q

What is one of the most important determinants of maternal/fetal gas exchange?
A) Placental weight
B) Uterine perfusion
C) Fetal heart rate
D) Amniotic fluid volume

A

B) Uterine perfusion

Slide 4

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2
Q

By term, uterine blood flow is approximately:
A) 300 ml/min
B) 500 ml/min
C) 700 ml/min
D) 1000 ml/min

A

C) 700 ml/min

Slide 4

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3
Q

Uterine blood flow at term accounts for approximately what percentage of total maternal cardiac output?
A) 5%
B) 8%
C) 10%
D) 12%

A

D) 12%

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4
Q

The uterine perfusion system is characterized as a ________ circuit due to systemic vasodilation.
A) Low resistance
B) High resistance
C) Moderate resistance
D) No resistance

A

A) Low resistance

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5
Q

Which of the following contribute to high uterine blood flow? (Select 2)

A) Increased blood volume
B) Decreased cardiac output
C) Increased vascular resistance
D) Increased cardiac output

A

A) Increased blood volume
D) Increased cardiac output

Slide 5

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6
Q

The uterine arterial bed is maximally dilated at ________.
A) The first trimester
B) The second trimester
C) Term
D) Postpartum

A

C) Term

Slide 5

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7
Q

What is the primary source of uterine blood flow?
A) Ovarian arteries
B) Uterine arteries
C) External iliac arteries
D) Femoral arteries

A

B) Uterine arteries

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8
Q

The uterine arteries branch from which major vessel?
A) Aorta
B) External iliac arteries
C) Internal iliac arteries
D) Renal arteries

A

C – Internal iliac

Aka - hypogastric arteries

Slide 6

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9
Q

The secondary source of uterine blood flow comes from which arteries?
A) Ovarian arteries
B) Femoral arteries
C) Pudendal arteries
D) Inferior epigastric arteries

A

A) Ovarian arteries

Slide 6

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10
Q

The ovarian arteries branch directly from the:
A) Inferior vena cava L5
B) Aorta at L4 level
C) Inferior mesenteric artery at L3
D) Renal arteries L1-L2

A

B) Aorta at L4 level

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11
Q

What percentage of uterine blood flow passes through the intervillous space?
A) 10-30%
B) 40-60%
C) 70-90%
D) 95-100%

A

C) 70-90%

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12
Q

The primary function of the intervillous space is to allow the exchange of ______ and ______ between maternal and fetal blood.
A) Gas; nutrients
B) Carbon dioxide; amniotic fluid
C) Red blood cells; nutrients
D) Gas; hemoglobin

A

A) Gas; nutrients

Slide 8

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13
Q

True or False

The uteroplacental circulation is a low resistance system

A

True

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14
Q

Uterine blood flow (UBF) is determined by the ratio of uterine perfusion pressure (UPP) to ______.
A) Maternal heart rate
B) Uterine vascular resistance
C) Fetal hemoglobin concentration
D) Uteroplacental oxygen consumption

A

B) Uterine vascular resistance

UBF = UPP/UVR

Slide 9

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15
Q

Uterine perfusion pressure (UPP) is calculated as uterine arterial pressure (UAP) minus ______.
A) Umbilical venous pressure (UVP)
B) Intervillous space pressure (ISP)
C) Uterine venous pressure (UVP)
D) Placental resistance (PR)

A

C) Uterine venous pressure

UPP = UAP - UVP

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16
Q

Why is uterine blood flow highly dependent on maternal blood pressure?
A) It lacks autoregulation
B) It has a high resistance system
C) Fetal circulation directly controls uterine flow
D) Uterine venous pressure is greater than arterial pressure

A

A) It lacks autoregulation

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17
Q

In a normal, healthy pregnancy, uterine blood flow exceeds the minimal demand for ______.
A) Fetal glucose metabolism
B) Placental circulation
C) Intervillous space expansion
D) Fetal oxygenation

A

D) Fetal oxygenation

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18
Q

Which of the following is a cause of decreased uterine blood flow?
A) Increased uterine arterial pressure
B) Decreased uterine vascular resistance
C) Increased uterine venous pressure
D) Increased cardiac output

A

C) Increased uterine venous pressure
UPP = UAP - UVP

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19
Q

What happens when uterine arterial pressure decreases?
A) Uterine blood flow increases
B) Uterine blood flow decreases
C) Uterine vascular resistance increases
D) Uterine venous pressure decreases

A

B) Uterine blood flow decreases

UPP = UAP - UVP

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20
Q

Uterine blood flow is reduced when uterine vascular resistance is ______.
A) Increased
B) Decreased
C) Unchanged
D) Not related to vascular resistance

A

A) Increased

UBF = UPP/UVR

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21
Q

Decreased Uterine Arterial Pressure

To avoid decreased uterine arterial pressure d/t aortocaval compression, pregnant patients should NOT be placed in a ______ position.
A) Trendelenburg
B) Prone
C) Left lateral
D) Supine

A

D) Supine

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22
Q

At what gestational age can aortocaval compression potentially begin to affect uterine blood flow?
A) 4-6 weeks
B) 8-10 weeks
C) 13-16 weeks
D) 20-24 weeks

A

C) 13-16 weeks

Slide 11

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23
Q

Which of the following factors can contribute to decreased uterine arterial pressure?
(Select 3)
A) Hypovolemia
B) Sitting positioning
C) Dehydration
D) Maternal hypertension
E) Hemorrhage

A

A) Hypovolemia
C) Dehydration
E) Hemorrhage

Important to get ahead of these with fluid bolus/ vasoconstrictors

Slide 11

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24
Q

Neuraxial anesthesia can cause hypotension by inducing a ______ blockade.
A) Sympathetic
B) Parasympathetic
C) Neuromuscular
D) Sensory

A

A) Sympathetic

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25
Q

Which of the following should be administered to treat hypotension caused by neuraxial anesthesia? Choose 2
A) Atropine
B) Epinephrine
C) Ephedrine
D) Nitroglycerin
E) Phenylephrine

A

C) Ephedrine
E) Phenylephrine

Slide 12

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26
Q

True or False

You should only give a fluid bolus before neuraxial anesthesia to help prevent hypotension

A

False

Freeman - “Research has shown that it is OK to co-load the patient with fluid while you’re placing the block, so you’re not delaying putting the block in because you’re waiting for the fluid to go in.

Slide 12

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27
Q

Which of the following dose dependent drugs can contribute to decreased uterine arterial pressure? (Select 4)

A) Propofol
B) Lidocaine
C) Magnesium sulfate
D) Ketorolac
E) Opioids
F) Neostigmine
G) Volatile anesthetics

A

A) Propofol
C) Magnesium sulfate
E) Opioids
G) Volatile anesthetics

Slide 12

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28
Q

True or False

A decrease in maternal blood pressure leads to a decrease in uterine arterial pressure.

A

True

NO autoregulation

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29
Q

Increased Uterine Venous Pressure

Which of the following conditions can increase uterine venous pressure? (Select 3)

A) Supine positioning
B) Uterine tachysystole
C) Increased maternal hydration
D) Pushing efforts during labor
E) Maternal hyperglycemia

A

A) Supine positioning
B) Uterine tachysystole
D) Pushing efforts during labor

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30
Q

Tachysystole is a condition characterized by:
A) Reduced uterine contraction strength
B) Increased frequency of uterine contractions
C) Decreased uterine vascular resistance
D) Increased fetal movement

A

B) Increased frequency of uterine contractions

Slide 14

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31
Q

Which of the following drugs or substances can contribute to increased uterine venous pressure? (Select 3)
A) Oxytocin
B) Cocaine
C) Epinephrine
D) Methamphetamine
E) Beta-blockers

A

A) Oxytocin
B) Cocaine
D) Methamphetamine

Slide 14

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32
Q

Hyperemia occurs during uterine ______, allowing increased blood return to the uterus.
A) Contraction
B) Relaxation
C) Tachysystole
D) Compression

A

B) Relaxation

Slide 14

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33
Q

True or False

Seizures can increase uterine venous pressure due to increased intra-abdominal pressure and muscle contractions.

A

True

Slide 14

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34
Q

Increased Uterine Vascular Resistance

Endogenous vasoconstrictors such as ______ are released in response to stress or hypotension and can increase uterine vascular resistance.
A) Catecholamines
B) Prostaglandins
C) Estrogen
D) Oxytocin

A

A) Catecholamines

Dopamine, Epinephrine, Norepinephrine

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35
Q

True or false

Exogenous catecholamines like phenylephrine and ephedrine always improve uterine blood flow.

A

False
Freeman - “If we’ve given too much of them or swung the other way, then that can cause increased uterine vascular resistance and a drop in uterine blood flow.”

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36
Q

Which vasopressor crosses the placenta and increases fetal metabolic requirements?
A) Phenylephrine
B) Norepinephrine
C) Ephedrine
D) Dopamine

A

C) Ephedrine

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37
Q

Ephedrine crosses the placenta and has been shown to decrease fetal ______. Select 3
A) Heart rate
B) pH
C) Base Excess
D) Umbilical oxygen content
E) Catecholamine release

A

B) pH
C) Base Excess
D) Umbilical oxygen content

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38
Q

When is phenylephrine preferred over ephedrine for maternal hypotension?
A) When the fetus shows signs of metabolic alkalosis
B) When the maternal heart rate is significantly elevated
C) When repeated vasopressor doses are required
D) When treating hypertension rather than hypotension

A

C) When repeated vasopressor doses are required

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39
Q

How do phenylephrine and ephedrine affect uterine blood flow (UBF)?

A) They increase uterine blood flow by causing decreasing uterine vascular resistance
B) They decrease uterine blood flow by increasing uterine vascular resistance
C) They have no effect on uterine vascular resistance
D) They directly increase fetal oxygenation

A

B – They decrease uterine blood flow by increasing uterine vascular resistance - via vasoconstriction

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40
Q

What effect does an “Epi Wash” have on uterine blood flow (UBF)?
A) It significantly decreases UBF due to vasoconstriction
B) It significantly increases UBF by stimulating Beta-2 receptors
C) It has no significant effect on UBF in healthy parturients
D) It causes fetal bradycardia

A

C) It has no significant effect on UBF in healthy parturients

Slide 18

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41
Q

What is the effect of an epidural test dose (10-15 mcg of epinephrine) on uterine blood flow?
A) It significantly reduces uterine blood flow
B) It increases uterine blood flow by inducing vasodilation
C) It has no significant effect on uterine blood flow
D) It directly increases fetal oxygenation

A

C – It has no significant effect on uterine blood flow

Slide 18

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42
Q

Epinephrine given intravenously in high doses can ____ uterine blood flow by increasing uterine vascular resistance.
A) Decrease
B) Increase
C) Have no effect on
D) Stabilize

A

A) Decrease

Remember everything is dose dependent “If you’re giving EPI for the reason of hypotension and you swing the other way now it’s causing a lot of vasoconstriction (Increased UVR). Then you will see decreased uterine blood flow”

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43
Q

What effect do epidurally administered clonidine and dexmedetomidine have on uterine blood flow (UBF)?
A) They significantly decrease UBF due to vasoconstriction
B) They significantly increase UBF by stimulating Beta-2 receptors
C) They have no significant effect on UBF
D) They cause fetal bradycardia and increased UBF

A

C) They have no significant effect on UBF

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44
Q

When administered intravenously, clonidine and dexmedetomidine can:
A) Increase uterine blood flow
B) Decrease uterine blood flow due to increased uterine vascular resistance
C) Cause no change in uterine blood flow
D) Increase fetal metabolic demand

A

B) Decrease uterine blood flow due to increased uterine vascular resistance

Slide 19

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45
Q

Neuraxial anesthesia can increase uterine blood flow when ______ is avoided.
A) Bradycardia
B) Catecholamine release
C) Hypotension
D) Hyperthermia

A

C) Hypotension

Sympathectomy → peripheral vasodilation → hypotension decrease of UAP → Decreased UBF

Slide 20

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46
Q

Which of the following factors contribute to increased uterine blood flow when neuraxial anesthesia is administered?
(Select 3)
A) Decreased circulating catecholamines
B) Effective pain control
C) Uncontrolled maternal hypotension
D) Peripheral vasoconstriction
E) Prevention of hypotension

A

A) Decreased circulating catecholamines
B) Effective pain control
E) Prevention of hypotension

Slide 20

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47
Q

Magnesium sulfate increases uterine blood flow by relaxing ____ muscle and causing vasodilation.
A) Skeletal
B) Smooth
C) Cardiac
D) Endothelial

A

B) Smooth

Decreases Uterine Vascular Resistance

Freeman - “Remember though, if it causes hypotension, it will drop the urine arterial pressure and therefore decrease UBF”

slide 21

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48
Q

Hydralazine increases uterine blood flow through direct relaxation of ______.
A) Venules
B) Veins
C) Capillaries
D) Arterioles

A

D) Arterioles

Decreases Uterine Vascular Resistance

Freeman - “..if the patient’s super hypertensive to begin with and you give them hydralazine, it’s going to relax their arterioles, bring their blood pressure back to normal and that is actually helpful and it’s increasing the uterine blood flow”

Slide 21

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49
Q

What is the effect of volatile anesthetics on uterine blood flow (UBF) when administered at 0.5–1.5 MAC?
A) They have minimal effect on UBF
B) They significantly reduce UBF
C) They completely stop uteroplacental perfusion
D) They cause fetal distress in all cases

A

A) They have minimal effect on UBF

Slide 22

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50
Q

Why does an increase in MAC lead to decreased uterine blood flow?

A) It causes a decrease in catecholamines
B) It causes a reduction in cardiac output and blood pressure
C) It has no effect on uterine circulation
D) It improves placental perfusion

A

B) It causes a reduction in cardiac output and blood pressure

Increased MAC → Decreased CO & BP → Decrease in Uterine arterial pressure → Decreased UBF

Slide 22

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51
Q

Where is the chorionic plate located
A. maternal side
B. fetal side
C. paternal side
D.near the anchoring vilus

A

B. fetal side
the yellow part of the picture

slide 24

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52
Q

Where is the basal plate
A.maternal side
B.fetal side
C. near the fetal circulation
D .near the aminochorionic membrane

A

A. maternal side
purple part of picture

slide 24

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53
Q

True or false

The placenta grows in proportion to fetus

A

True

slide 24

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54
Q

What are the functions of the placenta (select 3)
A. gas exchange
B. oxygenation to mother
C. production of proteins, hormones, and enzymes
D. Nutrient and waste exchange
E. permanent organ

A

A. gas exchange
C. production of proteins, hormones and enzymes
D. nutrient and waste exchange

also drug and toxin transfer

slide 25

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55
Q

What type or organ is the placenta (choose 2)
A. permanent organ
B.transient organ
C.endocrine organ
D. pituitary organ

A

B.transient organ
C.endocrine organ

slide 25 (what she said in lecture)

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56
Q

Characteristics of the intervillous space include (select 2)
A. Low resistance
B. small sinus with multiple folds
C. high resistance
D. large sinus with multiple folds

A

A. low resistance area
D. large sinus with multiple folds

slide 26

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57
Q

How much maternal blood does the intervillous space accommadate?
A. 500mL
B. 200mL
C. 350mL
D. 860mL

A

C. 350mL

“remember 70 to 90% of blood flow to the uterus is going through and pooling in this interval of space.”

slide 26

58
Q

Where does blood enter the intervillous space
A. spiral arteries
B. spinal arteries
C. umbilical arteries
D. descending aorta

A

A. spiral arteries

slide 26

59
Q

true or false

Spiral arteries are only present when the placenta is present

A

False
spiral arteries are present all the time in uterus but when placenta develops they embed themselves into the placenta

slide 26

60
Q

The two-way transfer is variable by rate and amount of substances because of what 3 factors
A. permeability
B. osmosis
C. concentration of gradient
D. fetal oxygenation
E. restriction of movement

A

A. permeability
C. concentration gradient
E. restriction of movement

slide 28

61
Q

true or false

some substances are bound within placental tissues to minimize fetal exposure and accumulation

A

true

slide 28

62
Q

Oxygen will move down concentration gradient from _______ to _______
A. maternal to fetal
B. low to high concentration
C. fetal to maternal

A

A. maternal to fetal

slide 29

63
Q

CO2 will move down concentration gradient from _____ to ________
A. maternal to fetal
B. low to high concentration
C. fetal to maternal

A

C. fetal to maternal

slide 29

64
Q

Matching

  1. passive diffusion
  2. facilitated diffusion
  3. Active transport
  4. pinocytosis

A. cellular engulfment
B. movement along a concentration gradient
C. movement with the help of carrier proteins still follwoing concentration gradient
D. movement against concentration gradient

A

1:B
2: C
3: D
4: A

slide 31-34

65
Q

What are examples of Passive diffusion
A. immunoglobulin G
B. glucose
C. sodium, potassium, calcium
D. O2, CO2 and most anesthetic drugs

A

D. oxygen, CO2, and most anesthetic drugs

slide 31

66
Q

What are examples of facilitated diffusion
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs

A

B. glucose

slide 32

67
Q

What are examples of active transport
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs

A

C. sodium, potassium, calcium

ATP!

slide 33

68
Q

What are examples of pinocytosis
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs

A

A. immunoglobulin G from mother to fetus

slide 34

69
Q

What happens during facilitated diffusion when binding sites are saturated
A. the rate of transfer increases
B. The rate of transfer is maxed out
C. The rate of transfer decreases
D. It continues facilitated diffusion and overloads the sites
E. It changes to active diffusion

A

B. the rate of transfer is maxed out

slide 32

70
Q

What can lead to an increase in transfer during facilitated diffusion
A. low temperature
B. saturated sites
C. higher molecular weight
D. high temperature

A

D. high temperature

slide 32

71
Q

Active transport requires (select 2)
A. ATP
B. carrier protein
C. non competitive inhibition
D. desaturation kinetics

A

A. ATP
B. carrier protein

also saturation kinetics and competitve inhibition

slide 33

72
Q

What does pinocytosis transfer
A. large micromolecules
B. large macromolecules
C. small macromolecules
D. small micromolecules

A

B. large macromolecules

slide 34

73
Q

Pinocytosis is known for (select 2)
A. no energy required
B. passive transport
C. membrane rearrangment
D. vesicle formation

A

C. membrane rearrangment
D. vesicle formation

Requires energy

slide 34

74
Q

What are pharmocokinetic factors impacting drug transfer across the placenta (select 5)
A. Fetus renal flow
B. Blood flow
C. Fetus hepatic flow
D. lipid solubility
E. Blood pressure
F. protein binding
G. pKa and pH/ charge
H. size of molecule

A

B. blood flow
D. lipid solubility
F. protein binding
G. pKa and pH/ charge
H. size of molecule

other factors include gestational age, maternal factors (hepatic and renal function), drug metabolism in placenta

slide 35

75
Q

Most anesthetic drugs are ___ transferred
A. actively
B. passively

A

B. Passively

high concentration to low concentration

slide 36

76
Q

True or false

Rate of blood impacts amount of drug crossing placenta

A

true

have to have blood bring it to placenta to have transfer

slide 36

77
Q

High lipid solubility leads to (select 2)
A. trapped drug in placental
B. monopolar transport
C. bilayer penetration
D. free drug in placental tissue

A

A. may encourage drug to become trapped in placental tissue
C. bilayer penetration

slide 37

78
Q

Which drug is an example mentioned in lecture for high lipid solubility?
A. sufentanil
B. bupivacaine
C. ropivacaine
D. succinylchoine

A

A. sufentanil

slide 37

79
Q

Which of the following statements is TRUE regarding protein binding and drug transfer across the placenta?

a) Only protein-bound drugs can cross the placenta.
b) The concentration of maternal plasma proteins has no impact on drug transfer.
c) The free, unbound fraction of a drug equilibrates across the placenta.
d) Alpha1-Acid Glycoprotein binds to acidic compounds.

A

c) The free, unbound fraction of a drug equilibrates across the placenta.

slide 38

80
Q

What type of compounds does Albumin primarily bind to?

a) Basic compounds
b) Acidic and lipophilic compounds
c) Only hydrophilic compounds
d) Neither acidic nor basic compounds

A

b) Acidic and lipophilic compounds

slide 38

81
Q

Which protein primarily binds to basic compounds?

a) Albumin
b) lipoprotein
c) Alpha1-Acid Glycoprotein
d) Globulin

A

c. Alpha1-Acid Glycoprotein

slide 38

82
Q

The concentration of maternal and fetal plasma proteins:

a) Impacts highly protein-bound drugs.
b) Only affects hydrophilic drugs.
c) has no impact on drug transfer
d) Only affects drugs bound to Albumin.

A

A) Impacts highly protein-bound drugs.

slide 38

83
Q

Why are Bupivacaine and Ropivacaine less likely to cross the placenta?

a) They are hydrophilic.
b) They are metabolized quickly.
c) They are acidic compounds.
d) They are highly protein-bound.

A

d. They are highly protein bound

slide 38

84
Q

true or false

pKA is that pH at which 50% of a drug is ionized and 50% is non-ionized

A

true

slide 39

85
Q

Which type of drugs tend to cross the placenta easier
select 2

A. molecular weight >1000
B. ionized
C. molecular weight of <500
D. non ionized

A

C. molecular weight of <500
D. non ionized

slide 39 and 40

86
Q

The fetus normally has a _______ pH leading to ion trapping
A. higher
B. lower

A

B. lower

slide 39

87
Q

What ion binds to non ionized form of the drug and trap it in fetal circulation
A. sodium
B. potassium
C. oxygen
D. hydrogen

A

D. hydrogen

slide 39

88
Q

Which drug is an example from lecture for ion trapping?
A.lidocaine
B. succinylcholine
C. esmolol
D. sugammadex

A

A. lidocaine

slide 39

89
Q

Which drug from lecture is highly ionized and does not cross the placenta easily?
A.lidocaine
B. succinylcholine
C. esmolol
D. sugammadex

A

b. succinylcholine

slide 39

90
Q

Which 3 drugs are examples of high molecular weight preventing crossing through placenta
A. esmolol
B. rocuronium
C. heparin
D. tylenol
E. protamine

A

B. Rocuronium (non depolarizing muscle relaxors)
C. heparin
E. protamine

slide 40

91
Q

This is a chart provided to go over what we just did

note that <500 daltons will cross easily, <1000 will cross but the bigger the molecule weight is up to 1000 it will be harder to cross

A

better have memorized that 💁

slide 41

92
Q

What drugs readily cross placenta (select 2)
A. Atropine
B. glycopyrolate
C. scopolamine
D.heparin

A

A. atropine
C. scopolamine

slide 42

93
Q

Which will cross placenta readily (select 3)
A. panuronium
B. nitroglycerine
C. nitroprusside
D. rocuronium
E. labetolol

A

B. nitroglycerine
C. nitroprusside
E. labetolol (Beta antagonists)

slide 42

94
Q

Which drugs will readily cross placenta (select 2)
A. phenylephrine
B. benzos
C. succinycholine
D. volatile agents

A

B. Benzos
D. volatile agents

slide 42

95
Q

Which drugs readily cross placenta? (select 3)
A. opioids
B. phenylephrine
C. ephedrine
D. protamine
E. lidocaine

A

A. opioids
C. ephedrine
E. lidocaine

slide 42

96
Q

Which induction agents will cross the placenta
A.propofol
B. ketamine
C. etomidate
D. dexmedetomidine
E. All the above
F. None of the above
G. A&C
H. A&D

A

E. all the above

slide 43

97
Q

Which will readily cross the placenta
A. edrophonium
B. acetaminophen
C. neostigmine
D. warfarin
E. All the above
F. None of the above
G. A&B
H. B&D
I. A&C

A

E. all the above

slide 43

98
Q

________ is an anticholinergic drug that does NOT readily cross the placenta.

A) Atropine
B) Scopolamine
C) Glycopyrrolate
D) Physostigmine

A

C) Glycopyrrolate

Slide 44

99
Q

________ is a vasopressor that does not readily cross the placenta.

A) Ephedrine
B) Phenylephrine
C) Dopamine
D) Epinephrine

A

B) Phenylephrine

Slide 44

100
Q

The anticoagulant ________ does NOT readily cross the placenta due to its high polarity and has a large molecular weight

A) Warfarin
B) Heparin
C) Aspirin
D) Clopidogrel

A

B) Heparin

Slide 44

101
Q

Which muscle relaxant is included in the list of drugs that do not readily cross the placenta?

A) Rocuronium
B) Vecuronium
C) Succinylcholine
D) All of the above
E) None of the above
F) A&C

A

D) All of the above

SUX is highly ionized and NDMBs are too large

Slide 44

102
Q

Which of the following drugs is used to reverse neuromuscular blockade and does NOT readily cross the placenta?

A) Neostigmine
B) Edrophonium
C) Sugammadex
D) Atropine

A

C) Sugammadex

Sugammadex has not been studied widely in pregnant population & is NOT recommended

Slide 44

103
Q

Which of the following drugs readily crosses the placenta?

A) Neostigmine
B) Glycopyrrolate
C) Sugammadex
D) Rocuronium

A

A) Neostigmine

Slide 45

104
Q

Why is atropine used instead of glycopyrrolate when reversing paralytics in pregnant patients?

A) Atropine has fewer side effects
B) Glycopyrrolate causes fetal tachycardia
C) Atropine crosses the placenta and can help prevent fetal bradycardia caused by neostigmine
D) Glycopyrrolate has a longer duration of action

A

C) Atropine crosses the placenta and can help prevent fetal bradycardia caused by neostigmine

Slide 45

105
Q

A teratogen is best defined as which of the following?

A) A substance that produces a congenital defect by genetic mutation
B) A substance that increases the incidence of defects that cannot be attributed to chance
C) A drug that crosses the placenta and causes immediate fetal death
D) Any anesthetic drug given during pregnancy

A

B) A substance that increases the incidence of defects that cannot be attributed to chance

Slide 46

106
Q

At what gestational age range is a fetus most susceptible to teratogens?

A) 1 to 14 days
B) 15 to 60 days
C) 61 to 100 days
D) After 100 days

A

B) 15 to 60 days

Prudent to minimize or eliminate fetal exposure to anesthesia if at all possible

Slide 46

107
Q

True or False

Anesthetic drugs have been conclusively proven to cause birth defects.

A

FALSE

No anesthetic drug has proven to be a teratogen

it’s very difficult & impossible to study in humans for obvious reasons

Slide 46

108
Q

Which of the following methods are used to study drug teratogenicity? (Select 2)
A) Animal models
B) Retrospective studies
C) Controlled human trials
D) Laboratory simulations

A

A) Animal models
B) Retrospective studies

Drug teratogenicity is difficult (to impossible) to study in humans for obvious reasons

Slide 47

109
Q

Drugs regulated by the FDA are given _______;
A) A rating scale from 1 to 10
B) A classification A-D
C) A numerical ranking based on effectiveness
D) A letter grade from A to F

A

B) A classification A-D

Slide 47

110
Q

Why is N2O not classified by the FDA?
A) It is a medical gas and not regulated by the FDA.
B) It is a controlled substance.
C) It is classified as a Class D drug.
D) It is only used in emergency situations.

A

A) It is a medical gas and not regulated by the FDA.

Slide 48

111
Q

N2O has been studied in animal models and is thought to be harmful to _______ in high doses.
A) Protein synthesis
B) DNA synthesis
C) Cell division
D) Bone marrow function

A

B) DNA synthesis

Slide 48

112
Q

True or False

Despite theoretical concerns, nitrous oxide has been associated with congenital abnormalities in humans.

A

False

Slide 48

113
Q

What is the relationship between benzodiazepines and cleft palate formation?
A) Benzodiazepines increase the risk of cleft palate only when used in high doses.
B) Benzodiazepines have been shown to cause cleft palate formation by enhancing GABA activity in the CNS.
C) Benzodiazepines do not cause cleft palate formation in humans.
D) Benzodiazepines are only associated with cleft palate in animal studies.

A

B) Benzodiazepines have been shown to cause cleft palate formation by enhancing GABA activity in the CNS.

Slide 49

114
Q

Human retrospective studies have shown an association between diazepam use in the first ____ of pregnancy and cleft formation.
A) 4 weeks
B) 6 weeks
C) 8 weeks
D) 12 weeks

A

B) 6 weeks

Slide 49

115
Q

True or False

In all of these studies, a one-time low dose of benzodiazepines is associated with an increased risk of cleft formation.

A

False

Slide 49

116
Q

Which of the following is a potential effect of Meperidine (Demerol) on the neonate?
A) Decreased fetal heart rate
B) Neonatal CNS depression
C) Increased fetal heart rate accelerations
D) Respiratory depression in the mother only

A

B) Neonatal CNS depression

Slide 50

117
Q

What is the potential danger associated with the accumulation of the metabolite normeperidine when Meperidine (Demerol) is administered?
A) Decreased maternal blood pressure
B) Seizures in the neonate
C) Respiratory distress in the mother
D) Premature labor

A

B) Seizures in the neonate

Slide 50

118
Q

What effect does Morphine have on maternal respiration and fetal oxygenation?
A) Increased maternal respiration and better oxygenation for the fetus
B) Decreased maternal respiration, which can lead to deoxygenation of the fetus
C) No effect on maternal respiration or fetal oxygenation
D) Increased fetal oxygenation despite decreased maternal respiration

A

B) Decreased maternal respiration, which can lead to deoxygenation of the fetus

Slide 50

119
Q

Which of the following is associated with the use of Morphine during pregnancy?
A) Increased fetal heart rate accelerations
B) Fewer fetal heart rate accelerations
C) Improved fetal oxygen levels
D) Increased fetal movement

A

B) Fewer fetal heart rate accelerations

Slide 50

120
Q

What is a primary effect of Remifentanil on the neonate?
A) It causes significant neonatal depression.
B) It provides maternal sedation without significant neonatal effects.
C) It leads to rapid fetal sedation and respiratory depression.
D) It can cause neonatal seizures.

A

B) It provides maternal sedation without significant neonatal effects.

Rapid metabolism = minimal fetal exposure

Slide 51

121
Q

How does Butorphanol (Stadol) work to provide pain relief?
A) It is a pure agonist that activates pain receptors.
B) It is a mixed agonist-antagonist, both blocking and activating pain receptors.
C) It works by blocking only pain receptors without activating them.
D) It works by inhibiting CNS depressants in the mother.

A

B) It is a mixed agonist-antagonist, both blocking and activating pain receptors.

Slide 51

122
Q

True or False

Butorphanol (Stadol) can be used for pain relief but has many side effects on the fetus compared to other opioids.

A

False

Butorphanol (Stadol) can be used for pain relief without as many side effects on the fetus compared to other opioids.

Slide 51

123
Q

What is the direction of oxygen movement in the intervillous space?
A) Oxygen moves from fetal capillaries into maternal blood.
B) Oxygen moves from the pool of maternal blood into fetal capillaries.
C) Oxygen does not move between maternal and fetal circulations.
D) Oxygen moves from the pool of fetal blood into maternal capillaries.

A

B) Oxygen moves from the pool of maternal blood into fetal capillaries.

moves down concentration gradient

Slide 53

124
Q

How does carbon dioxide (CO2) move in the intervillous space?
A) CO2 moves from maternal blood into fetal circulation.
B) CO2 moves from fetal circulation into maternal blood.
C) CO2 moves into the fetal capillaries for exhalation.
D) CO2 is not exchanged between maternal and fetal blood.

A

B) CO2 moves from fetal circulation into maternal blood.

moves down concentration gradient

Slide 53

125
Q

What is the main mechanism of placental oxygen transfer?
A) Active transport
B) Passive diffusion
C) Facilitated diffusion
D) Ion exchange

A

B) Passive diffusion

Slide 54

126
Q

Which of the following factors influence placental oxygen transfer? (Select 3)
A) Partial pressure of oxygen available
B) Blood flow from the placenta to the uterus
C) Placental ability to compensate for low oxygen
D) Fetal blood pressure

A

A) Partial pressure of oxygen available,
B) Blood flow from the placenta to the uterus,
C) Placental ability to compensate for low oxygen

Slide 54

127
Q

What does the P50 value represent?
A) The amount of oxygen that is carried by hemoglobin
B) The partial pressure of oxygen at which hemoglobin is 50% saturated
C) The difference in oxygen levels between maternal and fetal blood
D) The rate of oxygen exchange between maternal and fetal circulations

A

B) The partial pressure of oxygen at which hemoglobin is 50% saturated

Quantifies the affinity of hemoglobin for oxygen

Slide 55

128
Q

True or False

Fetal hemoglobin (HbF) has a higher P50 value than adult hemoglobin (HbA).

A

False

Fetal hemoglobin (HbF) has a lower P50 value than adult hemoglobin (HbA).

Slide 56

129
Q

Why is fetal hemoglobin’s lower P50 significant in the placenta?
A) It allows fetal hemoglobin to release more oxygen to the mother.
B) It allows fetal hemoglobin to efficiently pick up oxygen from maternal hemoglobin.
C) It reduces the amount of oxygen the fetus receives.
D) It prevents oxygen from passing from maternal to fetal blood.

A

B) It allows fetal hemoglobin to efficiently pick up oxygen from maternal hemoglobin.

Lower P50 = Higher oxygen affinity

Slide 56

130
Q

The Bohr effect describes how hemoglobin’s affinity for oxygen is influenced by the concentration of ____ and the ____ of the surrounding environment.
A) Oxygen; temperature
B) Carbon dioxide; pH
C) Nitrogen; blood pressure
D) Glucose; acidity

A

B) Carbon dioxide; pH

Slide 57

131
Q

The presence of CO2 and lower pH in fetal blood ___ the release of oxygen from maternal hemoglobin.
A) Decreases
B) Enhances
C) Has no effect on
D) Prevents

A

B) Enhances

increase CO2/decrease pH will results decreased affinity of Hgb fo O2

Slide 58

132
Q

RIGHT SHIFT OF MATERNAL OXYHGB DISSOCIATION CURVE = ____.
A) BINDING
B) RELEASE
C) DECREASED AFFINITY
D) OXYGEN ABSORPTION

A

B) Release of oxygen from maternal hemoglobin

Slide 58

133
Q

What is the primary characteristic of fetal blood returning to the placenta?
A) Oxygenated with low CO2 content
B) De-oxygenated with high CO2 content
C) Oxygenated with high CO2 content
D) De-oxygenated with low CO2 content

A

B) De-oxygenated with high CO2 content

Slide 59

134
Q

As CO2 content in fetal blood decreases, fetal blood becomes ___ and shifts the fetal oxygen-hemoglobin dissociation curve to the left.
A) Relatively acidic
B) Relatively alkaline
C) Neutral
D) Hyperoxic

A

B) Relatively alkaline

Slide 59

135
Q

LEFT SHIFT OF FETAL OXYHGB DISSOCIATION CURVE = ___.
A) RELEASE
B) LOCK
C) BINDING
D) SHIFT

A

B) LOCK of oxygen from maternal hemoglobin

Slide 59

136
Q

What does the first Bohr effect describe? (Select 2)
A) A right shift of maternal arterial hemoglobin due to increased placental PCO2
B) A left shift of maternal arterial hemoglobin due to increased fetal oxygen levels
C) The release of oxygen from maternal hemoglobin due to increased placental PCO2
D) The absorption of oxygen into fetal hemoglobin due to high fetal blood pH

A

A) A right shift of maternal arterial hemoglobin due to increased placental PCO2

C) The release of oxygen from maternal hemoglobin due to increased placental PCO2

Slide 60

137
Q

What is shown by the left shift of fetal hemoglobin in the second Bohr effect?
A) A decrease in oxygen loading into fetal blood
B) An increase in oxygen release from maternal blood
C) Additional oxygen loaded into fetal blood
D) Oxygen is unloaded from fetal blood to maternal blood

A

C) Additional oxygen loaded into fetal blood

Slide 60

138
Q

Which of the following statements are true? (Select 2)
A) The fetus is good at giving oxygen to the maternal blood.
B) The fetus is good at extracting oxygen from maternal blood.
C) The mother is really good at giving oxygen to the fetus.
D) The mother is bad at giving oxygen to the fetus.

A

B) The fetus is good at extracting oxygen from maternal blood.

C) The mother is really good at giving oxygen to the fetus.

Slide 61

139
Q

Maternal ___ and ___ can both be detrimental to the fetus.
A) Hypocapnia and hypercapnia
B) Hyperventilation and hypoxia
C) Hypoxemia and acidosis
D) Hypotension and hypertension

A

A) Hypocapnia and hypercapnia

Slide 62

140
Q

Hypocapnia/Maternal alkalosis (ex: hyperventilation) causes the maternal oxyhemoglobin dissociation curve to shift ___.
A) Left
B) Right
C) Up
D) Down

A

A) Left

LOCK of oxygen from maternal hemoglobin

Slide 62

141
Q

Maternal hypercapnia occurs when carbon dioxide readily crosses the placenta, and if severe, it can result in fetal __ and __.
A) Acidosis and myocardial depression
B) Hypoxia and cardiac arrest
C) Hypotension and hyperglycemia
D) Alkalosis and tachycardia

A

A) Acidosis and myocardial depression

Slide 62