9.1 Pharmacology for the Radiographer Flashcards
CT Scan, General Radiography, Fluoroscopy, Catherization laboratory uses what type of contrast media
Iodinated Contrast Media
General Radiography and sometime CT scan uses what type of contrast media
Barium Contrast Media
applying contrast media through the rectum
Retrograde
MRI uses what type of contrast media
Gadolinium Contrast Agent
Ultrasound uses what type of contrast media
Microbubbles
Nuclear Medicine uses what type of contrast media
Radioisotopes or Radioactive material
Most of the Contrast Agent are
Water-based
Some procedures require
Oil-based contrast agents
Seldom used route
intra-arterial route
cold sweats
Diaphoresis
Most commonly used needle gauge
22 gauge
For pediatric or geriatric gauge number
23 or 25 gauge
CT scan uses the __ mL syringe
60 mL (cc)
“Venipuncture falls within the profession’s scope of practice and practice standards and
that it shall be included in the didactic and clinical curriculum with demonstrated
competencies of all appropriate disciplines regardless of the state or institution where
such curriculum is taught.”
American Society of Radiologic Technologists
30% of all imaging examinations involve the use of a form of
_____ to aid in the visualization of a body part or body
system
contrast media
Categorized as drugs because they can be absorbed into the
systemic circulation and may produce a physiologic response on
the body
Contrast Agents
are required to visualize areas of the body
when the organ or system of interest is too similar to the
surrounding area
Contrast Agents
Radiopaque
Positive Contrast Agent
Radiolucent
Negative Contrast Agent
Most common type of contrast; GI system
Barium
Metal, does not dissolve; suspended in solution
Barium
The metallic component of _____ makes it an ideal substance for use as
a contrast agent
Barium
another type of contrast used for GI imaging
Gastrografin
All positive contrast agents used in diagnostic imaging contain iodine,
except ____
barium
able to absorb the x-ray photons, allowing an
area of interest to be seen on the image as white
area
Iodine (53)
able to accomplish the same absorption of x-ray
photons and the same radiopaque image
Barium (56)
IODINATED CONTRAST AGENTS ARE USED IN THE EXAMINATION OF:
- GI Tract
- Kidneys
- Gallbladder
- Pancreas
- Heart
- Brain
- Uterus
- Spinal Column
- Arteries
- Veins
- Joints
Variables the physician consider when selecting a contrast agents:
- Ability to mix with the body fluids
- The viscosity
- The ionic strength
- Its persistence in the body
- The osmolality
- The iodine content
- The potential for toxicity
IODINATED CONTRAST AGENTS ARE ADMINISTERED BY:
➢ Oral, vaginal, intravenous, and intra-arterial routes
➢ Directly instilled into the organ through a retrograde procedure
➢ Directly into the joints or cavities
are distributed easily to areas where visualization is
required for diagnosis and then excreted from the body in a relatively safe
manner
Contrast agents
WHY IS IODINE USED AS CONTRAST AGENT?
-k-shell binding energy = 33.2 keV
-similar to the average energy of
x-rays used in diagnostic
radiography
-When the incident x-ray energy is
closer to the k-edge of the atom it
encounters, photoelectric
absorption is more likely to occur
have ideal K-shell
binding energies for absorption of X-rays
Iodine-53 & Barium-56
k-shell binding energy of Iodine
33.2 keV
k-shell binding energy of Barium
37.4 keV
close to the mean energy of most
diagnostic X-ray beams
Iodine-53 & Barium-56
k-shell binding energy of Calcium (20)
4.0
k-shell binding energy of Molybdenum (42)
20
k-shell binding energy of Tungsten (74)
70
k-shell binding energy of Lead (82)
88
k-shell binding energy of Oxygen (8)
0.5
can be used in hysterosalpingography (HSG)
Oil based contrast
HSG
hysterosalpingography
Oil based contrast higher iodine concentration=
480 mgI/ml
Water-based iodine concentration
240-300 mgI/ml
Instilled in organs – not vessels
Oil based contrast
Made from fatty acids
Oil based contrast
Not ingested
Oil based contrast
tests uterine shape and makes sure the fallopian tube are clear
Hysterosalpingography (HSG)
conducted with an oil-based contrast, they have improved pregnancy rates unlike water-based contrast
Hysterosalpingography (HSG)
PATIENTS OF CHOICE FOR LOCM INCLUDE THE FOLLOWING:
- Patients with a history of previous adverse reaction to contrast agents
- Patients with asthmatic conditions
- Patients with known cardiac conditions
- Patients who are severely debilitated
- Patients at high risk for contrast extravasation
- Patients for whom the physician feels there is an indication for its use
THE RADIOGRAPHER MAY ASSIST IN REDUCING ANXIETY IN THE
FOLLOWING WAYS:
- Assessment of the patient’s understanding of the procedure.
- Informing the patient in detail concerning how the examination will
proceed. - Explanation of the expected side effects and assurance that these are not
unusual. - Allowing the patient to express feelings of anxiety and obtaining patient
feedback to ascertain his complete understanding of the procedure.
PATIENT ASSESSMENT PRIOR TO ADMINISTRATION OF CONTRAST MEDIUM (1)
- Patient’s age
- History of impaired hepatic function
- History of impaired renal function
- History of allergic or anaphylactic reactions
- History of thyroid disease
- Last menstrual period and possible
pregnancy - Nursing mother
- Sensitivity to aspirin
- History of diabetes mellitus
PATIENT ASSESSMENT PRIOR TO ADMINISTRATION OF CONTRAST MEDIUM (2)
- History of sickle cell disease
- History of hypertension
- History of pheochromocytoma
- History of seizures
- Medication history
- History of previous reactions to
medications or contrast agents - Allergy to seafood
POTENTIAL SIDE EFFECTS OF CONTRAST ARE AS FOLLOWS:
- Expected Side Effects
- Vasovagal reaction
- Mild reaction
- Moderate reaction
- Severe reaction
CLINICAL MANIFESTATIONS OF EXPECTED SIDE EFFECTS
- A feeling of flushing or warmth
- Nausea
- Headache
- Pain at the injection site
- Altered taste, may be metallic
EXPECTED SIDE EFFECTS
RADIOGRAPHER’S RESPONSE 1. Slow the rate of the contrast infusion 2. Observe the patient closely and offer reassurance
CLINICAL MANIFESTATIONS OF A VASOVAGAL REACTION
- Pallor
- Cold sweats
- Rapid pulse
- Syncope or complaint of
feeling faint - Bradycardia
- Hypotension
VASOVAGAL REACTION
- Stop the infusion of contrast medium.
- Place the patient in flat or
Trendelenburg position - Notify the radiologist
- Remain with the patient and offer
reassurance
CLINICAL MANIFESTATIONS OF A MILD REACTION
- Nausea, vomiting
- Cough
- Feeling of warmth
- Headache
- Dizziness
- Shaking
- Itching
- Pallor
MILD REACTION
1. Stop the infusion and notify the radiologist or radiology nurse. 2. Remain with the patient and offer reassurance. 3. Prepare to assist in the administration of an antihistamine or subcutaneous epinephrine
CLINICAL MANIFESTATIONS OF A MODERATE REACTION
- Tachycardia or bradycardia
- Hypertension or hypotension
- Dyspnea
- Broncospasm or wheezing
- Patient complains of feeling of
throat closing (laryngeal edema)
MODERATE REACTION
- Stop the infusion
- Notify the radiologist and the radiology nurse
- Call for the emergency team if symptoms
progress rapidly. - Remain with the patient and offer reassurance
- Prepare to administer oxygen and intravenous
medication - If the patient is in respiratory distress, place
him in semi-fowler’s position - Position patient who is vomiting in a position to
prevent aspiration.
CLINICAL MANIFESTATIONS OF A SEVERE REACTION
- Dyspnea related to laryngeal edema
- Hypotension
- Seizures
- Cardiac arrhythmia
- Lack of patient response
- Cardiac arrest
SEVERE REACTION
1. Call for emergency response team (Code blue) 2. Notify the radiologist and the radiology nurse 3. Prepare to use AED (automated external defibrillator) 4. Prepare to administer oxygen and intravenous medications.
All drugs (medications) are potentially _____
harmful
All _____ who
administer drugs must understand the
intended action, contraindications, side
effects and potential adverse effects of any drug they administer
health care workers
THE RADIOGRAPHER MUST ADHERE TO THE FIVE
RIGHTS OF DRUG ADMINISTRATION AT ALL TIMES:
- The Right Time
- The Right Route
- The Right Amount/Dose
- The Right Medication/Drug
- The Right Patient
OTHER PRECAUTIONS THAT MUST BE TAKEN BEFORE ADMINISTRATION OF ANY
DRUGS ARE AS FOLLOWS (1):
- Read all drug labels carefully before drawing up or pouring a drug. Check the name, strength, and
dosage of the drug. - If a drug contains a sediment or appears to be cloudy, do not use until the pharmacist approves
the drug. - Check the expiration date of the drug on the label. If that date has passed, do not use.
- Do not use drugs from unmarked, or poorly marked containers. Discard them.
- Measure exact amounts of every drug used. If medication is left over, do not replace it in the
container; discard it according to institutional policy. - Drugs must be stored in accordance with the manufacturer’s specifications. No drug should be
stored in an area where temperature and humidity vary greatly or are extreme. Low room
temperature is advised. - If a medication is a liquid to be poured, pour away from the label
OTHER PRECAUTIONS THAT MUST BE TAKEN BEFORE ADMINISTRATION OF
ANY DRUGS ARE AS FOLLOWS (2):
- Do not combine two drugs in a syringe without verifying their compatibility with the pharmacist. If in
doubt, do not combine! - Before selecting a medication, check the label of the container three times: before taking it from
storage, before pouring it or drawing it up, and after it has been prepared for administration. - Take only one drug to one patient at one time and remain with the patient until it has been taken. Do
not leave the patient to take the drug later. - When approaching a patient who is to receive a drug, ask the patient to state his or her name. Do not
accept the fact that a patient answers to what is thought to be the correct name. An anxious patient
may respond incorrectly. Read the name label on the patient’s wrist. - After identifying the patient, explain to him how the due is to be taken
by mouth
PO
intramuscular
IM
intravenous
IV
at once
STAT
verbal order
VO
subcutaneous
SC/SQ
intradermal
ID
twice a day
bid
drop
gtt
cubic centimeter
cc
before meals
ac
after meals
pc
at beadtime
hs
as necessary
PRN
every
q
everyday
qd
three times a day
tid
every 2 hours
q2hrs
mililiter
mL
No health care worker may prescribe or administer drugs that are not
ordered by a person _____ to do so
licensed
WRITTEN REQUEST FOR AN EXAMINATION USING IV CONTRAST MEDIUM
1 . Medical Necessity for the Examination
- Type of Contrast to be used
- Manner in which the procedure will be performed
Medical Necessity for the Examination
▪ Signs and symptoms
▪ Relevant history
▪ Current diagnoses
▪ Specific reason for the procedure requested (physician)
It is legal and ethical obligations of
the radiographer to be
knowledgeable about any drug that he administers to prevent _____
Medication Error
If a drug is incorrectly administered
or an order is misinterpreted, the radiographer is legally ____
liable
ITEMS TO INCLUDE IN THE REPORT ARE AS FOLLOWS:
- The dosage of the drug administered
- The name of the incorrect drug
- Why it was administered
- The patient’s reaction
- How the error was remedied
METHODS OF DRUG ADMINISTRATION
- Enteral
- Parenteral
- Topical
Enteral ex.
Oral, Sublingual, Buccal and
Rectal
used if the drug will not be destroyed by gastric secretions and when slower absorption and longer duration of drug activity are desired
Enteral
skin for local treatment of lesions or skin
conditions
Topical
Topical ex.
eyes, nose, and throat
respiratory mucosa by inhalation
Topical
vagina and in the rectum
Topical
skin for intended systemic effect (transdermal
application)
Topical
Parenteral ex.
Subcutaneous, intramuscular,
intradermal & intravenous,
Intralesional, intra-arterial,
intracardiac, and intra-articular
used only by the physician or specialty nurses
Parenteral
degree angle for Intramuscular
90°
degree angle for Subcutaneous
45°
degree angle for Intravenous
25°
degree angle for Intradermal
10°-15°
atomic number of bromine
35
