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
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
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%
Slide 4
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
Slide 5
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
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
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
slide 6
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
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
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
Slide 6
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%
Slide 8
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
13
Q
True or False
The uteroplacental circulation is a low resistance system
A
True
slide 8
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
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
Slide 9
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
Slide 9
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
slide 9
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
Slide 10
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
Slide 10
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
Slide 10
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
Slide 11
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
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
24
Q
Neuraxial anesthesia can cause hypotension by inducing a ______ blockade.
A) Sympathetic
B) Parasympathetic
C) Neuromuscular
D) Sensory
A
A) Sympathetic
Slide 12
25
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
C) Ephedrine
E) Phenylephrine
## Footnote
Slide 12
26
# True or False
You should only give a fluid bolus before neuraxial anesthesia to help prevent hypotension
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.
## Footnote
Slide 12
27
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) Propofol
C) Magnesium sulfate
E) Opioids
G) Volatile anesthetics
## Footnote
Slide 12
28
# True or False
A decrease in maternal blood pressure leads to a decrease in uterine arterial pressure.
True
NO autoregulation
## Footnote
Slide 13
29
# 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) Supine positioning
B) Uterine tachysystole
D) Pushing efforts during labor
## Footnote
Slide 14
30
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
B) Increased frequency of uterine contractions
## Footnote
Slide 14
31
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) Oxytocin
B) Cocaine
D) Methamphetamine
## Footnote
Slide 14
32
Hyperemia occurs during uterine ______, allowing increased blood return to the uterus.
A) Contraction
B) Relaxation
C) Tachysystole
D) Compression
B) Relaxation
## Footnote
Slide 14
33
# True or False
Seizures can increase uterine venous pressure due to increased intra-abdominal pressure and muscle contractions.
True
## Footnote
Slide 14
34
# 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) Catecholamines
Dopamine, Epinephrine, Norepinephrine
## Footnote
Slide 15
35
# True or false
**Exogenous catecholamines** like phenylephrine and ephedrine always improve uterine blood flow.
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."
## Footnote
Slide 15
36
Which vasopressor crosses the placenta and **increases fetal metabolic requirements?**
A) Phenylephrine
B) Norepinephrine
C) Ephedrine
D) Dopamine
C) Ephedrine
## Footnote
Slide 16
37
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
B) pH
C) Base Excess
D) Umbilical oxygen content
## Footnote
Slide 16
38
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
C) When repeated vasopressor doses are required
## Footnote
Slide 16
39
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
B – They decrease uterine blood flow by **increasing uterine vascular resistance** - *via vasoconstriction*
## Footnote
Slide 17
40
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
C) It has no significant effect on UBF in healthy parturients
## Footnote
Slide 18
41
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
C – It has no significant effect on uterine blood flow
## Footnote
Slide 18
42
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) 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"
## Footnote
Slide 18
43
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
C) They have no significant effect on UBF
## Footnote
Slide 19
44
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
B) Decrease uterine blood flow due to **increased uterine vascular resistance**
## Footnote
Slide 19
45
Neuraxial anesthesia can **increase uterine blood** flow when ______ is avoided.
A) Bradycardia
B) Catecholamine release
C) Hypotension
D) Hyperthermia
C) Hypotension
Sympathectomy → peripheral vasodilation → **hypotension** decrease of UAP → Decreased UBF
## Footnote
Slide 20
46
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) Decreased circulating catecholamines
B) Effective pain control
E) Prevention of hypotension
## Footnote
Slide 20
47
Magnesium sulfate increases uterine blood flow by relaxing ____ muscle and causing **vasodilation**.
A) Skeletal
B) Smooth
C) Cardiac
D) Endothelial
B) Smooth
**Decreases Uterine Vascular Resistance**
Freeman - "Remember though, if it causes hypotension, it will drop the urine arterial pressure and therefore decrease UBF"
## Footnote
slide 21
48
Hydralazine increases uterine blood flow through direct relaxation of ______.
A) Venules
B) Veins
C) Capillaries
D) Arterioles
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"
## Footnote
Slide 21
49
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) They have minimal effect on UBF
## Footnote
Slide 22
50
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
B) It causes a reduction in cardiac output and blood pressure
Increased MAC → Decreased CO & BP → Decrease in Uterine arterial pressure → Decreased UBF
## Footnote
Slide 22
51
Where is the chorionic plate located
A. maternal side
B. fetal side
C. paternal side
D.near the anchoring vilus
B. fetal side
the yellow part of the picture
## Footnote
slide 24
52
Where is the basal plate
A.maternal side
B.fetal side
C. near the fetal circulation
D .near the aminochorionic membrane
A. maternal side
purple part of picture
## Footnote
slide 24
53
# True or false
The placenta grows in proportion to fetus
True
## Footnote
slide 24
54
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. gas exchange
C. production of proteins, hormones and enzymes
D. nutrient and waste exchange
| also drug and toxin transfer
## Footnote
slide 25
55
What type or organ is the placenta (choose 2)
A. permanent organ
B.transient organ
C.endocrine organ
D. pituitary organ
B.transient organ
C.endocrine organ
## Footnote
slide 25 (what she said in lecture)
56
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. low resistance area
D. large sinus with multiple folds
## Footnote
slide 26
57
How much maternal blood does the intervillous space accommadate?
A. 500mL
B. 200mL
C. 350mL
D. 860mL
C. 350mL
"remember 70 to 90% of blood flow to the uterus is going through and pooling in this interval of space."
## Footnote
slide 26
58
Where does blood enter the intervillous space
A. spiral arteries
B. spinal arteries
C. umbilical arteries
D. descending aorta
A. spiral arteries
## Footnote
slide 26
59
# true or false
Spiral arteries are only present when the placenta is present
False
spiral arteries are present all the time in uterus but when placenta develops they embed themselves into the placenta
## Footnote
slide 26
60
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. permeability
C. concentration gradient
E. restriction of movement
## Footnote
slide 28
61
# true or false
some substances are bound within placental tissues to minimize fetal exposure and accumulation
true
## Footnote
slide 28
62
Oxygen will move down concentration gradient from _______ to _______
A. maternal to fetal
B. low to high concentration
C. fetal to maternal
A. maternal to fetal
## Footnote
slide 29
63
CO2 will move down concentration gradient from _____ to ________
A. maternal to fetal
B. low to high concentration
C. fetal to maternal
C. fatal to maternal
## Footnote
slide 29
64
# 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
1:B
2: C
3: D
4: A
## Footnote
slide 31-34
65
What are examples of Passive diffusion
A. immunoglobulin G
B. glucose
C. sodium, potassium, calcium
D. O2, CO2 and most anesthetic drugs
D. oxygen, CO2, and most anesthetic drugs
## Footnote
slide 31
66
What are examples of facilitated diffusion
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs
B. glucose
## Footnote
slide 32
67
What are examples of active transport
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs
C. sodium, potassium, calcium
| ATP!
## Footnote
slide 33
68
What are examples of pinocytosis
A. immunoglobulin G
B.Glucose
C. sodium, potassium, calcium
D. oxygen CO2 and most anesthetic drugs
A. immunoglobulin G from mother to fetus
## Footnote
slide 34
69
What happens during facilitated diffusion when binding sites are saturated
A. the rate of transfer increases
B. it is maxed out
C. it continues facilitated diffusion and overloads the sites
D. it transfers to active diffusion
B. the rate of transfer is maxed out
## Footnote
slide 32
70
What can lead to an increase in transfer during facilitated diffusion
A. low temperature
B. saturated sites
C. higher molecular weight
D. high temperature
D. high temperature
## Footnote
slide 32
71
Active transport requires (select 2)
A. ATP
B. carrier protein
C. non competitive inhibition
D. desaturation kinetics
A. ATP
B. carrier protein
| also saturation kinetics and **competitve** inhibition
## Footnote
slide 33
72
What does pinocytosis transfer
A. large micromolecules
B. large macromolecules
C. small macromolecules
D. small micromolecules
B. large macromolecules
## Footnote
slide 34
73
Pinocytosis is known for (select 2)
A. no energy required
B. passive transport
C. membrane rearrangment
D. vesicle formation
C. membrane rearrangment
D. vesicle formation
| **Requires energy**
## Footnote
slide 34
74
What are pharmocokinetic factors impacting drug transfer across the placenta (select 5)
A. maternal renal flow
B. Blood flow
C. maternal hepatic flow
D. lipid solubility
E. gestational age
F. protein binding
G. pKa and pH/ charge
H. size of molecule
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
## Footnote
slide 35
75
Most anesthetic drugs are ___ transferred
A. actively
B. passively
B. Passively
| high concentration to low concentration
## Footnote
slide 36
76
# True or false
Rate of blood impacts amount of drug crossing placenta
true
| have to have blood bring it to placenta to have transfer
## Footnote
slide 36
77
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. may encourage drug to become trapped in placental tissue
C. bilayer penetration
## Footnote
slide 37
78
Which drug is an example mentioned in lecture for high lipid solubility?
A. sufentanil
B. bupivacaine
C. ropivacaine
D. succinylchoine
A. sufentanil
## Footnote
slide 37
79
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.
c) The free, unbound fraction of a drug equilibrates across the placenta.
## Footnote
slide 38
80
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
b) Acidic and lipophilic compounds
## Footnote
slide 38
81
Which protein primarily binds to basic compounds?
a) Albumin
b) lipoprotein
c) Alpha1-Acid Glycoprotein
d) Globulin
c. Alpha1-Acid Glycoprotein
## Footnote
slide 38
82
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) Impacts highly protein-bound drugs.
## Footnote
slide 38
83
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.
d. They are highly protein bound
## Footnote
slide 38
84
# true or false
pKA is that pH at which 50% of a drug is ionized and 50% is non-ionized
true
## Footnote
slide 39
85
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
C. molecular weight of <500
D. non ionized
## Footnote
slide 39 and 40
86
The fetus normally has a _______ pH leading to ion trapping
A. higher
B. lower
B. lower
## Footnote
slide 39
87
What ion binds to non ionized form of the drug and trap it in fetal circulation
A. sodium
B. potassium
C. oxygen
D. hydrogen
D. hydrogen
## Footnote
slide 39
88
Which drug is an example from lecture for ion trapping?
A.lidocaine
B. succinylcholine
C. esmolol
D. sugammadex
A. lidocaine
## Footnote
slide 39
89
Which drug from lecture is highly ionized and does not cross the placenta easily?
A.lidocaine
B. succinylcholine
C. esmolol
D. sugammadex
b. succinylcholine
## Footnote
slide 39
90
Which **3** drugs are examples of high molecular weight preventing crossing through placenta
A. esmolol
B. rocuronium
C. heparin
D. tylenol
E. protamine
B. Rocuronium (non depolarizing muscle relaxors)
C. heparin
E. protamine
## Footnote
slide 40
91
# 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 100 it will be harder to cross
better have memorized that 💁
## Footnote
slide 41
92
What drugs readily cross placenta (select 2)
A. Atropine
B. glycopyrolate
C. scopolamine
D.heparin
A. atropine
C. scopolamine
## Footnote
slide 42
93
Which will cross placenta readily (select 3)
A. panuronium
B. nitroglycerine
C. nitroprusside
D. rocuronium
E. labetolol
B. nitroglycerine
C. nitroprusside
E. labetolol (Beta antagonists)
## Footnote
slide 42
94
Which drugs will readily cross placenta (select 2)
A. phenylephrine
B. benzos
C. succinycholine
D. volatile agents
B. Benzos
D. volatile agents
## Footnote
slide 42
95
Which drugs readily cross placenta? (select 3)
A. opioids
B. phenylephrine
C. ephedrine
D. protamine
E. lidocaine
A. opioids
C. ephedrine
E. lidocaine
## Footnote
slide 42
96
Which induction agents will cross the placenta
A.propofol
B. ketamine
C. etomidate
D. dexmedetomidine
E. all the above
E. all the above
## Footnote
slide 43
97
Which will readily cross the placenta
A. edrophonium
B. acetaminophen
C. neostigmine
D. warfarin
E. all the above
E. all the above
## Footnote
slide 43
98
________ is an anticholinergic drug that does NOT readily cross the placenta.
A) Atropine
B) Scopolamine
C) Glycopyrrolate
D) Physostigmine
C) Glycopyrrolate
## Footnote
Slide 44
99
________ is a vasopressor that does not readily cross the placenta.
A) Ephedrine
B) Phenylephrine
C) Dopamine
D) Epinephrine
B) Phenylephrine
## Footnote
Slide 44
100
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
B) Heparin
## Footnote
Slide 44
101
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
D) All of the above
| SUX is highly ionized and NDMBs are too large
## Footnote
Slide 44
102
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
C) Sugammadex
**Sugammadex has not been studied widely in pregnant population & is NOT recommended**
## Footnote
Slide 44
103
Which of the following drugs readily crosses the placenta?
A) Neostigmine
B) Glycopyrrolate
C) Sugammadex
D) Rocuronium
A) Neostigmine
## Footnote
Slide 45
104
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
C) Atropine crosses the placenta and can help prevent fetal bradycardia caused by neostigmine
## Footnote
Slide 45
105
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
B) A substance that increases the incidence of defects that cannot be attributed to chance
## Footnote
Slide 46
106
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
B) 15 to 60 days
*Prudent to minimize or eliminate fetal exposure to anesthesia if at all possible*
## Footnote
Slide 46
107
# True or False
Anesthetic drugs have been conclusively proven to cause birth defects.
FALSE
No anesthetic drug has proven to be a teratogen
| it's very difficult & impossible to study in humans for obvious reasons
## Footnote
Slide 46
108
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) Animal models
B) Retrospective studies
*Drug teratogenicity is difficult (to impossible) to study in humans for obvious reasons*
## Footnote
Slide 47
109
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
B) A classification A-D
## Footnote
Slide 47
110
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) It is a medical gas and not regulated by the FDA.
## Footnote
Slide 48
111
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
B) DNA synthesis
## Footnote
Slide 48
112
# True or False
Despite theoretical concerns, nitrous oxide has been associated with congenital abnormalities in humans.
False
## Footnote
Slide 48
113
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.
B) Benzodiazepines have been shown to cause cleft palate formation by enhancing GABA activity in the CNS.
## Footnote
Slide 49
114
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
B) 6 weeks
## Footnote
Slide 49
115
# True or False
In all of these studies, a one-time low dose of benzodiazepines is associated with an increased risk of cleft formation.
False
## Footnote
Slide 49
116
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
B) Neonatal CNS depression
## Footnote
Slide 50
117
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
B) Seizures in the neonate
## Footnote
Slide 50
118
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
B) Decreased maternal respiration, which can lead to deoxygenation of the fetus
## Footnote
Slide 50
119
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
B) Fewer fetal heart rate accelerations
## Footnote
Slide 50
120
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.
B) It provides maternal sedation without significant neonatal effects.
*Rapid metabolism = minimal fetal exposure*
## Footnote
Slide 51
121
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.
B) It is a mixed agonist-antagonist, both blocking and activating pain receptors.
## Footnote
Slide 51
122
# True or False
Butorphanol (Stadol) can be used for pain relief but has many side effects on the fetus compared to other opioids.
False
Butorphanol (Stadol) can be used for pain relief **without** as many side effects on the fetus compared to other opioids.
## Footnote
Slide 51
123
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.
B) Oxygen moves from the pool of maternal blood into fetal capillaries.
| moves down concentration gradient
## Footnote
Slide 53
124
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.
B) CO2 moves from fetal circulation into maternal blood.
| moves down concentration gradient
## Footnote
Slide 53
125
What is the main mechanism of placental oxygen transfer?
A) Active transport
B) Passive diffusion
C) Facilitated diffusion
D) Ion exchange
B) Passive diffusion
## Footnote
Slide 54
126
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) Partial pressure of oxygen available,
B) Blood flow from the placenta to the uterus,
C) Placental ability to compensate for low oxygen
## Footnote
Slide 54
127
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
B) The partial pressure of oxygen at which hemoglobin is 50% saturated
| Quantifies the affinity of hemoglobin for oxygen
## Footnote
Slide 55
128
# True or False
Fetal hemoglobin (HbF) has a higher P50 value than adult hemoglobin (HbA).
False
Fetal hemoglobin (HbF) has a **lower** P50 value than adult hemoglobin (HbA).
## Footnote
Slide 56
129
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.
B) It allows fetal hemoglobin to efficiently pick up oxygen from maternal hemoglobin.
| Lower P50 = Higher oxygen affinity
## Footnote
Slide 56
130
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
B) Carbon dioxide; pH
## Footnote
Slide 57
131
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
B) Enhances
| increase CO2/decrease pH will results decreased affinity of Hgb fo O2
## Footnote
Slide 58
132
RIGHT SHIFT OF MATERNAL OXYHGB DISSOCIATION CURVE = ____.
A) BINDING
B) RELEASE
C) DECREASED AFFINITY
D) OXYGEN ABSORPTION
B) **Release** of oxygen from maternal hemoglobin
## Footnote
Slide 58
133
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
B) De-oxygenated with high CO2 content
## Footnote
Slide 59
134
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
B) Relatively alkaline
## Footnote
Slide 59
135
LEFT SHIFT OF FETAL OXYHGB DISSOCIATION CURVE = ___.
A) RELEASE
B) LOCK
C) BINDING
D) SHIFT
B) **LOCK** of oxygen from maternal hemoglobin
## Footnote
Slide 59
136
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 right shift of maternal arterial hemoglobin due to increased placental PCO2
C) The release of oxygen from maternal hemoglobin due to increased placental PCO2
## Footnote
Slide 60
137
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
C) Additional oxygen loaded into fetal blood
## Footnote
Slide 60
138
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.
B) The fetus is good at extracting oxygen from maternal blood.
C) The mother is really good at giving oxygen to the fetus.
## Footnote
Slide 61
139
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) Hypocapnia and hypercapnia
## Footnote
Slide 62
140
Hypocapnia/Maternal alkalosis (ex: hyperventilation) causes the maternal oxyhemoglobin dissociation curve to shift ___.
A) Left
B) Right
C) Up
D) Down
A) Left
| LOCK of oxygen from maternal hemoglobin
## Footnote
Slide 62
141
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) Acidosis and myocardial depression
## Footnote
Slide 62
