Ch 5 - Pharmacology Flashcards by Courtney W

Requires candidate for the advanced level exam to have some understanding regarding the types some understanding regarding the types & administration routes, indications, contraindications and complications of various drugs

ARRT

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“Keyholes” for specific drugs
Specialized location on a cell membrane or inside a cell
Specific biological sites located on a cell surface or within a cell

Receptor

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3 drugs that have a specific affinity or attraction for their specific receptors

Agonist
Antagonist
Mixed agonist/antagonist

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Drug or natural substance that combines with receptors and initiates a series of biochemical and physiological changes
Stimulates or enhances the body’s natural response to stimulation
Ex: given epinephrine for someone with asthma like symptoms, this is a bronchodilator, no new function was developed only enhanced to make the person able to breath properly again

Agonist

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Drug’s ability able to produce a response

Intrinsic activity

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Blocks/doesn’t stimulate receptors

Inhibit or counteract effects produced by other drugs or undesired effects

Antagonist

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Used at times to counteract the action of the agonist
Each class of drugs is competing for the receptor sites
Overall result will depend upon which class binds to the most receptor sites

Competitive antagonism

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3 different names of drugs

Chemical name (N- (4-hydroxphenyl))
Generic name (Acetaminophen)
Trade/brand/proprietary name (Tylenol)

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Study of drugs in living
Medications can be very helpful but can also cause serious harm to patients
The technologist should understand thoroughly any medication before giving it to a patient

Pharmacology

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Drugs

Pharmaco

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What happens when two things meet and interact

Dynamics

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Study of how the effects of a drug are manifested

Pharmacodynamics

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Treatment or therapy

Therapeutics

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Use of drugs to prevent and treat diseases

Pharmacotherapeutics

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Mechanisms of bodily absorption, distribution, metabolism and excretion of the drug; movement of drug throughout the body

Pharmacokinetics

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2 administration routes

Local medication

Systemic medication

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Medication usually administered at a specific site and are injected into the tissues only in that particular area

Local medication

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Medications that produce a wide variety of effects to the patients and usually used before the procedure begins, at times during the procedure and often in emergent situations to alleviate a problem

Systemic medication

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Application of drug directly onto the skin or mucous membrane
Drug is diffuse through the skin or membrane and absorbed into the bloodstream

Local-topical route

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6 topical routes

Astringent
Antiseptic or bacteriostatic
Emollient
Cleansing
Anesthetic
Antihistamine

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Topical route that counteracts inflammatory effects, decrease secretions

Astringent

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Topical route that inhibits growth of development of microorganisms

Antiseptic or bacteriostatic

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Topical route that soothes and has a softening effect, overcomes dryness

Emollient

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Topical route that removes dirt and secretion

Cleansing

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Topical route that removes the sensation of pain

Anesthetic

Topical route that calms the manifestations caused by allergic reactions

Antihistamine

Most common method of drug administration | Safest, most economical and most convenient way of giving medication

Systemic-oral route

Administration is performed by placing the drug under the tongue for dissolution and absorption

Sublingual route

Tablet is held in the mouth in the pocket between the gums and cheek for local dissolution and absorption Lorazepam (Ativan) can be used in this form

Buccal route

Safe method of giving drugs when the oral method is unsuitable, as when the patient is a small child or unconscious

Rectal route

To be administered by injection | Anything not by the digestive system

Parenteral route

4 most common methods by which drugs are administered parenterally

Intradermal Subcutaneous Intramuscular Intravenous

Parenteral method where drugs are administered between the layers of the skin Injection made in the upper layers of the skin almost parallel to the skin surface Amount of drug given is small and absorption is slow Mostly used in testing for allergies Usually on the medial surface of the forearm or skin of the back

Intradermal method (ID)

Parenteral method where drugs are administered beneath the skin, yet above the muscle Angle of insertion about 45-60 degrees Done on the fat pads of the abdomen, outer surface of the upper anterior surface of the thigh or occasionally the lower abdominal surface When giving these drugs the technologist should slightly withdraw the plunger of the syringe before injecting the drug to make sure that a blood vessel has not been entered; if blood is seen, then it might be in a vein which could be extremely dangerous Massage the area of injection to help increase rate of absorption

Subcutaneous method (SC)

Parenteral method where drugs are administered in the muscle when a drug is too irritating to be given subcutaneously Larger doses can be given by this injection (up to 5 mL); larger than some other routes

Intramuscular method (IM)

Parenteral method where drugs are administered in the vein, diret injection into a vein Most common; most emergency drugs are pushed IV, quickest route because most patients already have IV in place

Intravenous

Medication inserted into or occurring in the space under the arachnoid membrane of the brain or spinal cord, never done by technologist

Intrathecal

4 drugs that may be given intramuscularly

Aqueous solution Aqueous suspension Oily solution Oily suspension

Form a drug supply in the tissue that results in slow, gradual absorption, not clear and don't dissolve

Suspensions

Absorbed faster from the tissue than suspensions, clear and dissolve

Solutions

2 disadvantages of oils

Patients are usually sensitive to the oil | The oil isn't usually absorbed

4 large vulnerable things that affect intramuscular site criteria

Nerves Blood vessels Bone Scars, bruises and swollen areas from previous injection sites

3 areas for intramuscular injections

Musculature of gluteal region of the lower back (love handle) Deltoid area Anterolateral thigh

5 common IV injection sites of the hand

``` Digital dorsal Dorsal metacarpal Dorsal network Cephalic Basilic ```

2 most common IV injection sites for long term use in the hand

Cephalic | Basilic

Vein on thumb/radial side

Cephalic

Vein on ulnar side

Basilic

Last resort vein on hand for IV injection site because it is so small Probably don't want to use automatic injector or slow down flow rate because vein could blow

Digital dorsal

6 areas of the antecubital space where you will normally inject contrast

``` Cephalic Median cubital Accessory cephalic Basilic (5th digit side) Cephalic (thumb side) Med. antebrachial ```

Anterior recess of elbow where veins are located

Antecubital space

Most common IV injection site

Median cubital

6 rights of drug administration

``` Right patient Right drug Right amount/dosage Right time Right route Right documentation ```

Set of infection control procedures

Standard precautions

7 complications of IV

``` Dislodged catheter Thrombosis Phlebitis Catheter occlusion Extravasation Vasovagal reaction Damage to nerve or tendons ```

Possible infiltration of medication, tell patient to keep arm still

Dislodged catheter

IV flow will stop because of an injury to the vein wall | Can get small blood clot and medication won't go in

Thrombosis

Backflow of blood in line, line clamped too long

Catheter occlusion

Catheter dislodged and swelling into arm from medication, contrast outside of vein

Extravasation

Anxiety, sweating, fainting or dizziness

Vasovagal reaction

Improper techniques can cause this | Extreme pain, feels like an electrical shock

Damage to nerves or tendons

4 systemic allergic reactions/complications

Allergic reaction Infection Air embolism: empty bag or bottle, air in line; can result in respiratory distress - Circulatory overload: flow rate too rapid, can cause increased blood pressure & discomfort

Urticaria, wheezing, cardiac arrest, itching

Anaphylactic symptoms

Hives

Uticaria

Can be caused by poor aseptic technique, catheter left in place too long; usually causes malaise

Infection

Drowsiness

Malaise

Can be caused by empty bag or bottle, air in line; can result in respiratory distress

Air embolism

Fow rate too rapid, can cause increased blood pressure and discomfort

Circulatory overload

Administered to decrease the activity of the central nervous system Treat anxiety, acute stress reactions, panic attacks and sleep disorders Also referred to as depressants, benzodiazepines and tranquilizers

Sedatives

Drugs that act as a central nervous system depressants and can therefore produce a wide spectrum of effects from mild sedation to total anesthesia Used to treat insomnia, anxiety and seizure disorders Ex: thiopental, methohexital and phenobarbital

Barbiturates

Barbiturate mostly used in surgical suite to induce full anesthesia, rectally Can also be used rectally for pediatric conscious sedation before MRI studies

Thiopental

Barbiturate used in brief procedures, rectally Not good choice for procedures requiring more than 5 min of sedation but good for CT exams Extremely rapid in onset and very short duration

Methohexital

Barbiturate orally given to an adult patient the night before and morning of scheduled exam to keep patient calm

Phenobarbital

Type of medication known as tranquilizers Cause muscle relaxation, anti anxiety, anticonvulsants and sedative-hypnotic activities Ex: Valium, Xanax and Midazolam Patients may experience “hangover” type of effect

Benzodiazepines

Most widely used benzodiazepine Shown to decrease anxiety and improve the outcome of MRI studies by decreasing motion artifact Given to pediatric patients rectally or intranasally about 15 min prior to exam Quick onset and short duration of action

Midazolam

Stimulate the CNS receptors to decrease pain perception | Adverse reactions: nausea, vomiting, dizziness, headaches, lightheadedness, constipation

Opiate analgesics

5 cardiac medications

``` Antiarrhythmic Antihypertensive Heart failure medication Diuretics Lipid lowering medications ```

Affect the electrical conduction (movement of electrically charged particles) of the myocardium Goal is to suppress excess electrical conduction within the cardiac system and thus decrease arrhythmia production (irregular heartbeat) Ex: Lidocaine and Digoxin

Antiarrhythmic

Lower blood pressure and decreases amount of work for heart Ex: Clonidine and Hydralazine Patients with severe hypertension (high bp) will require more than one of these

Antihypertensive

Muscle of the heart

Myocardium

Usually increase the contractile force of the heart Basically it’s not pumping very strong, too low of BP Ex to increase BP: Digoxin, Domamine and Epinephrine (used in radiology)

Heart failure medication

Decrease intravascular pressure Frequently called “water pills" Designed to eliminate excess fluid and sodium from the bloodstream, thus decreasing overall pressure within vessels Can cause dehydration, imp to watch for this with patients receiving contrast because since they’re dehydrated potentially the contrast won’t be eliminated as fast Ex: Metalozone and Hydrochlorothizide

Diuretics

Lower serum cholesterol Patients usually have high cholesterol with probably a lot of of plaque; if plaque dislodges from vessel it can cause en embolism or blood clot Ex: Niacin and Lovastatin

Lipid lowering medication

3 blood altering medication

Anticoagulants Antiplatelet Thrombolytic

“Blood thinners”, used to stop clot formation Used in patients who have either a history of blood clot formation or potential to develop blood clots Patient wtih blood clot = area usually warm to touch, swollen and red Ex: Heparin, Warfarin and Coumadin

Anticoagulants

Stop platelet formation Used to treat heart disease For patients who have experience an acute ischemic event (decrease in blood supply) to either their heart or brain in the past (ex: Transient Ischemic Attack (TIA) - mini stroke) Ex: Aspirin

Antiplatelet

Clot busters used to actively break up newly formed clot, such as found in patients wtih an acute stroke These patients are at high risk for bleeding internally/externally, so starting an IV shouldn’t be done without physician supervision, because it thins out blood Ex: Urokinase

Thrombolytic

Relieve pain and treat headaches, arthritis, muscle aches, etc; ex: Tylenol

Analgesics

4 analgesics

Narcotics Non-steroidal Anti-Inflammatory Drugs (NSAIDS) Muscle relaxants Acetaminophen

Meds that stimulate CNS receptors Generally highly controlled by the local and federal enforcement agencies to prevent misuse in the community, unfortunately a lot of people sell these drugs they were prescribed Respiratory arrest (stop breathing) can occur at too high dose Ex: Fentanyl & Hydrocodone

Narcotics

Used to treat pain associated with inflammation such as arthritis, muscle tears, broken bones, etc Long-term use of NSAIDs can lead to stomach ulcers and gastrointestinal bleeding Ex: Ibuprofen and Naproxen

Non-steroidal Anti-Inflammatory Drugs (NSAIDS)

Treat muscle spasms Usually people with whiplash or spinal cord injuries Can make you sleepy Ex: Diazepam, Lorazepam and Demerol

Muscle relaxants

Most common analgesic in use today Contained in almost all pain medication combonations Low potency pain reliever Long term use of high doses can cause renal and cardiac damage

Acetaminophen

Prohibit histamine release in an allergic reaction to relieve adverse effects such as sneezing, itching, inflammation and respiratory distress Also used for common allergies Ex: Benadryl, Claritin, Zyrtec

Antihistamines

2 endocrine medications

Antidiabetic | Thyroid

Aid in maintaining the balance between blood sugar and tissue sugar Some patients are termed insulin dependent because they have little or no circulating endogenous (within the body) insulin When injecting contrast you should have the patient suspend these medications for 48 hours after injection or it can hurt kidney function Ex: Glipizide, Metformin and Glucophage

Antidiabetic

``` Used to treat hypothyroidism that’s either primary because of lack of endogenous thyroid production or secondary to removal of the thyroid gland Ex: Thyroxine For hyperthyroidism (overactive thyroid) you would take an anti-thyroid medication like methimazole ```

Thyroid

Underactive thyroid, doesn’t produce enough thyroid hormone

Hypothyroidism

4 central nervous medications

Anti-seizure Antipsychotic Antidepressants Antianxiety

Medications used to prevent and treat seizure disorders Convulsions result from decrease in O2 and blood flow to brain Goal is to stop the seizure activity and prolong the interval between each seizure event Ex: Diazepam, Lorazepam and Clonazepam

Anti-seizure

Used to treat psychotic episodes and disorders such as schizophrenia, hallucinations, antisocial behavior, etc Ex: Clozapine and Loxapine

Antipsychotic

Used to treat clinical depression that results from neurotransmitter deficiencies Take very seriously if patients talk to you about suicide Ex: Nortiptyline and Amitriptyline

Antidepressants

Used for treating acute and chronic anxiety states In radiology field, you will see this with patients that require a sedative for ex: claustrophobia (especially in MRI) Ex: Diazepam and Clonazepam

Antianxiety

3 anti-infective agents

Antibiotics Antifungals Antivirals

Therapeutic agents used to kill or suppress pathologic microorganisms responsible for causing infectious disease Will kill or inhibit the growth of bacteria Ex: Penicillin

Antibiotics

Used to kill fungal organisms For treating athletes foot, yeast infection, etc Ex: Nystatin

Antifungals

Used for treating viral infections | Ex: influenza

Antivirals

Drug that’s effective against vomiting and nausea; used to treat motion sickness and the side effects of opioid analgesics, general anesthetics and chemo directed against cancer

Antiemtetics

Medication or other intervention that inhibits anxiety

Anxiolytics

Drug used to reduce the effect of laryngospasm Sometimes given as a preoperative agent to reduce salivation and excessive secretions in the respiratory tract Can prevent cardiac arrhythmias, hypotension and bradycardia

Atropine

Inflammation of the vein, swollen vein

Phlebitis