ISST-12 EXAM 1

How many trimesters are in pregnancy?

3

How many months is a trimester?

9 months

What phase does a primary oocyte progress through meiosis 1 and 2 to become a halpoid ovum?

Follicular phase

What activates cilia?

Estrogen

What can impede movement in uterus?

Smooth muscle contraction near isthmus for up to 3 days after ovulation

What can cause smooth muscle relaxation in the uterus?

Progesterone

What can delayed fertilized ovum(zygote) form?

Blastocyst

Where does blastocyst get its nutrition?

Uterine milk

What are essential for implantation and survival of blastocyts?

Trophoblastic cells

What secrete proteolytic enzymes and break down endometrium(decidual cells) and secrete human chorioinic gonadotropin?

Trophoblasts

What are the germ layers of embryo?

Ecto

Endo

Mesoderm

What does embyronic develpment rely on?

Trophoblastic nutrition

What is unique about the fetus?

All major organs present

Rely on placental diffusion for nutrition

Is there intermingling of maternal and fetal blood?

No

What is developed into a placenta?

Trophoblasts

Decidua

What can masses of trophoblastic cells develop into?

Chorionic villi

• 2 cell layers thick

What happens during the vascular remodeling in decidua?

Sinuses develop around the villi

What is found in the outer layer of the chorionic villi?

Synctiotrophoblast

What are the functions of synctoptrophoblasts?

Secrete proteolytic enzymes

Transport

hCG, progesterone, estriol, letpin, lactogen production

What happens during development of fetus?

Increase permeability

Lower ratio of cytophoblast/syncytiotrophoblast

How do trophoblastic cells transport glucose?

Express GLUT-1 transporters

What may happen due to fetal low pH?

Ion trapping

• Ionization less likely to diffuse back to mom

What drugs have teratogenic effects?

NSAIDs

Tetracyclines

Warfarin

Antiseizure

Retinoids

Lithium

Sex hormones

Chemo

What hormone goes down during pregnancy?

Human chorionic gonadotropin

What are characteristics of hCG?

Secreted by syncytiotrophoblastic cells

Prevents early involution of corpus luteum(LHR Ligand)

Stimulates growth of endometrium(prevents periods)

Prevents ovulation

• suppress LH and FSH

Aids in fetal testosterone surge

What do placental trophoblasts convert androgens to?

Estriol

What hormone helps with the relaxation of maternal pelvic ligaments, sacroiliac joints, and symphysis pubis for birth?

Estrogen

What do placental trophoblasts convert cholesterol to?

Progesterone

What are the characteristics of placental progesterone?

Develop decidual cells

Decrease uterine contractility

• lowers risk of spontaneous abortion

Promotes breast lobule growth

What can Human Chorionic Somatomammotropin do?

Metabolic hormone
Decreases maternal insulin sensitivity and glucose utilization

• gestational diabetes

Releases free fatty acids

What can increase response to hCG and secreted by the corpus luteum and placenta?

Relaxin

What is increased in the latter half of pregnancy leading in week 27?

Increased water/sodium retention arising form aldosterone and estrogen expression

Cardiac output increases by 30-50% above normal

What role does progesterone play in maternal ventilation?

Increases CO2 sensitivity to commensurate increased O2 consumption

What goes down in maternal respiration?

CO2

• mild respiratory alkalosis

What happens to kidney function in pregnancy?

Increased urine formation

Renal blood flow and GFR increase by 50%

What increases secretion by posterior pituitary and triggers increased intracellular calcium and increases local prostagalndin synthesis→ contractions?

Oxytocin

Where are oxytocin receptors found?

Myometrium

What are periodic episodes of slow rythmical uterine contractions that occur in 2nd or 3rd trimesters?

Braxton-hicks

What may cause uterine contractions?

Irritation of cervix

Stretch of uterine walls

What happens in the 3rd stage of labor?

Seperation and delivery of the placenta

Why is there pain in stage 1 of pregnancy?

Hypoxia in uterine muscles from compression of uterine blood vessels

Why is there pain in stage 2 of labor?

Cervical and perineal stretching and stretching/tearing of the vaginal canal

What develops in the breast during pregenancy?

Alveoli

What happens in the regulation of lactaction?

High levels of estrogen andprogesterone develop ductal and alveoli amturation but both inhibit milk production

High prolactin and low estrogen/progesterone→ milk production

How does oxytocin trigger milk production?

Stimulation of myoepithelial cells to contract outside of alveoli

What is colostrum?

SecBreast secretables a few days before and after birth

Hold immune cells and proteins

What is secretory pathway during lactation?

Secretory

Transcellular

Lipid

Paracellular

What SE may lead from high progesterone and hCG?

NVP

Hyperemesis gravidarum

What is it called when a post preg woman has significant weight loss, ketonuria, hypovolemia, electrolyte abnormalitites, and elevated liver enzymes?

Hyperemesis Gravidum

What may be aggravated if post preg woman takes iron and prenatal vitamins?

Constipation

What is it called when a patent has pregnancy induced gestational HTN and proteinuria?

Preeclampsia

What is pathophys if pre-eclampsia?

Abnormal placental development

Poor perfusion

Oxidative stress

Hypoxia

Inflammation

What is it called post preg in patient has convulsions, coma or end organ failure?

Clampsia

• occurs shortly before birth

What can be used to tx clampsia?

Rapid vasodilators

Diuretics

Cesearean

What do all pregnancies lead to diabetes related?

Pancreatic beta-cell hyperplasia

• human choroinic somatomammotropin effect

Less beta cell response to overcome insulin resistance

What may hapen in a activation of the partuirtion pathway between 20 and 37 weeks of gestation regardless of birth weight?

Preterm

Why is there increased free plasma drug concentration?

Lower albumin

What are the teratogenic drugs Kaur(boxed period and effect?

Warfarin

Amphetamine

Aminopterin

ACEi

What is the period of Warfarin in preg?

2nd part of the first trimester 6-9 weeks

What is the period of amphetamines in preg?

All trimester

What is the period of aminopterin in preg?

Organogenesis(18-60) days

What is period of ACEi in preg?

2nd or 3rd trimester(13th week)

What drug leads to nasal hypoplasia, limb hypoplasia, optic atrophy, bone abnormalities, and neurological impairment in pregnancy?

Warfarin

What drug leads to cleft palate, heart defects, inestinal atresias, and structural brain abnormalities in preg?

Amphetamines

What leads to CNS, limb, and skeletal defects in preg?

Aminopterin

What leads to craniofacial abnormalities, neonatal renal failure, and pulmonary hypoplasia in preg?

ACEi

What are notable teratogens kaur?

ACEi

Warfarin

Retinoids

DHFR inhibitors

Tetracyclines

What teratogen may cause developmental programming disruption?

Retinoids

What teratogen causes spina bifida and more severe effects for proper developent?

DHFRi

What is transplacental drug diffusion affected by?

Thickness of placental membranes

Protein binding

Molecule size

Ionization state

Lipid solubility

What are examples of highly lipophilic drugs?

Diazepam

Haloperidol

Thiopental

Sufentanil

What is it called when weak bases move across placenta and remain in fetal circulation?

Ion trapping

• lidocaine and caines effect this

What is the best molecule size for diffusion?

<500 Da

• corticosteroids, acetaminophen

What size has limited trasnplacental movement?

500-1000 Da

• antibiotics

What have poor/no transplacental movement?

>1000 Da

• insulin

  • antifungals

Why is heparin good in pregnancy?

High molecular weight 3-30 kDA

• cannot reach placenta

Does maternal albumin decrease during pregnancy?

Yes

What goes up during pregnancy?

Free fatty acids

• drug bases

What can actively transport drugs from the placenta back into maternal circulation?

P-glycoproteins

Efflux pumps:xenobiotic exclusion

MDR1

BCRP

What are influx pumps into placenta?

Dopamine

NE

Nucelosides

OCT3

hENT1, 2

What are the enzymes in placenta?

Gluthathione S-transferase

Amino,acetyl,sulfo

UDP-glucoronosyl transferase

What CYPS are increased in preg?

3A4

2D6

What CYPS are reduced in preg?

1A2

Xanthine oxidase

N-acetyltransferase

What causes changes in CYP during preg?

Changing in estrogen and progesterone levels affecting liver enzymes

What happens in phase 1?

Hydroxylation

What happens in phase 2?

Conjugation reaction(excretion)

During first pass metabolism where does most of the blood get diverted to?

Ductus venosus

What goes up in pregnancy?

GFR

Renal blood flow

Renal clearance

What are drugs that will be cleared fast in pregnancy?

Beta-lactam antibiotics

Enoxaparin

Digoxin

What CANNOT be used in constipation in preg?

Castor oil(stimulant)

Mineral oil(lubricant)

What can be used in constipation in preg?

Osmotic laxatives

What can be used for N/V in preg?

Ondansetron

Metoclorpamide

Chlorpromazine

What can be used in gestational diabetes?

Glyburide

Metformin

What nondrug can be used in gestational HTN?

Supplemental Ca

What fetal drug can be used to stimulate lung development?

Corticosteroids

What fetal drug can be used to stimulate UGT and enables clearance of billirubin preventing jaundice?

Phenobarbital

What fetal drug can be used to decrease HIV spread from mother?

Zidovudine/nevirapine

What drugs can decrease fetal arrythmias?

Digoxin

Verapamil

What is a local drug for labor and delivery?

Bupivacaine/ropivacaine + fentanyl

What are systemic drugs for Labor and delivery?

Inhaled N2O

Opioids