EXAM 2- Diagrams/Extras Flashcards
What is this graph describing?
X-axis: induction agent
Y-axis: airway resistance (cmH2O/liter/sec)
- This graph describes the bronchodilatory benefit of propofol vs. thiopental or etomidate. We see that airway resistance on average is lower following propofol administration for induction vs. using thiopental or etomidate.
What is represented by this graph?
X-axis: time (minutes)
Y-axis: Percentage of Systemic Vascular Resistance (% of normal baseline SVR)
- We see that SVR at 5 minutes post propofol infusion is approximately 55% of baseline SVR, whereas Thiopental is only dropped to 80% of normal SVR. The graph includes changes in SVR up to 45 minutes post administration of both agents, demonstrating that overall Thiopental has a much less impact on SVR than Propofol
What is this graph depicting?
X-axis: atropine dose (mcg/kg)
Y-axis: change in heart rate (+ change) in bpm
Red line: no propofol
Blue line: 5 mg/kg/hour of Propofol
Yellow line: 10 mg/kg/hour of Propofol
-Thus we see the resistance to increase in heart rate after atropine administration in the presence of propofol. The higher the infusion rate of propofol, the more resistant to increases in heart rate even with higher atropine dosing.
What is demonstrated by this graph?
X-axis: heart rate
Y-axis: blood pressure
- It’s hard to tell, but this represents thiopental and its transient effects on decreasing BP, while increasing heart rate to compensate for decrease BP.
What is this graph teaching us?
- Propofol metabolism by both microsomal hepatic enzymes (CYP450’s) as well as Phase 2 conjugation metabolism (UGT1A9)
- CYP450 converts propofol into 4-hydroxypropofol, UGT1A9 converts propofol or 4-hydroxypropofol into glucuronide metabolites, then these metabolites are excreted in the urine.
What is the elimination half-time of etomidate?
Vd of etomidate?
Clearance of etomidate?
Effects of etomidate on BP? HR?
What is the elimination half-time of ketamine?
Vd of ketamine?
Clearance of ketamine?
Effects of ketamine on BP? HR?
What is the time to peak effect for fentanyl?
What effects does each drug have on plasma cortisol concentrations?
Thus we see that etomidate will suppress plasma cortisol concentrations for 4-8 hours post-administration. Thiopental does not.
Ketamine and its effects on the heart –> what are the three biggest effects?
Increased heart rate
Increased MAP
Increased PAP
What is this graph describing?
The benefit of analgesic maintenance using PCA over bolus dosing
What is “baracity” when talking about spinal/epidural medications?
Baracity of a drug refers to it’s density.
Hypobaric –> less dense, therefore it “floats”
Hyperbaric –> more dense, therefore it “sinks”
What area of the spinal cord is associated with the “cardiac accelerators”? What would this mean if our local anesthetic agents migrate to this area?
T1-T4. Hypotension, bradycardia.
What PCA basal rate is recommended for Morphine? Hydromorphone? Fentanyl?
What PCA bolus dose is recommended for Morphine? Hydromorphone? Fentanyl?
What is the onset for opioid withdrawal associated with fentanyl use? Peak intensity? Duration?
2-6 hours
6-12 hours
4-5 days
What is the onset for opioid withdrawal associated with Morphine? Peak intensity? Duration?
6-18 hours
36-72 hours
7-10 days
What is the onset for opioid withdrawal associated with heroin? Peak intensity? Duration?
6-18 hours
36-72 hours
7-10 days
What is the time to peak effect for etomidate?
What is the time to peak effect for propofol?
What is the time to peak effect for midazolam?
