drug dosing

Question 1

route of radio-iodine vs pertechnetate dosing

Answer 1

radio-iodine is oral pertechnetate is IV

Question 2

meckel scan cimetidine dosing

Answer 2

20 mg/kg per day x 2 days Premedication can improve the sensitivity of a Meckel Scan. This usually comes in 3 flavors: H2 Blockers (cimetidine, famotidine, or ranitidine… something that ends in the word “dine”) to block the release of the tracer from ectopic mucosa. Pentagastrin to enhance the uptake of the tracer Glucagon to decrease small bowel motility The classic dosing for cimetidine is 20 mg/kg per day x 2 days.

Question 3

HIDA scan for biliary atresia. Drug and dosing

Answer 3

phenobarbital 2.5 mg/kg twice a day for 5 days Many centers will attempt to improve the study by first “priming the liver” with 5-7 days of phenobarbital therapy, 2.5 mg/kg orally twice a day. “5 for 5” — 2.5 x 2 = 5 for 5 days This is supposed to ramp up hepatocyte function and stimulate better excretion of the tracer – improving visualization of the biliary tree. Would be awful to go the OR when the kid has hepatitis because you fucked the study up.

Question 4

morphine dose for HIDA

Answer 4

0.04 mg/kg IV

Question 5

phenobarbital dose

Answer 5

5 mg/kg/day orally for 5-7 days before examination used to prime hepatic enzymes to increase IDA excretion in distinguishing between biliary atresia and neonatal hepatitis

Question 6

sincalide dosing

Answer 6

sincalide (CCK) dosing: 0.02 mcg/kg in 10 mL of saline SINCALIDE is MICROgrams MORPHINE is MILIgrams 0.04 mg/kg IV

Question 7

During a chemical stress test using Dipyridamole, the patient develops chest discomfort, headache, dizziness, flushing, and nausea – next step ?

Answer 7

given them IV aminophylline 100-200mg

Question 8

aminophylline dosing for reversal of dipyridamole

Answer 8

IV aminophylline 100-200mg.

Question 9

particle size TcDTPA (VQ scan)

Answer 9

0.1 to 0.5 um

MICROmeters

Question 10

particle size of TcMAA (perfusion)

Answer 10

10-90 um

MICROmeters

Question 11

pt with Hives after IV contrast, treatment?

Answer 11

25 to 50mg diphenhydramine PO, IM or IV

or

fexofenadine 180 mg PO

Question 12

Pt with diffuse erythema and hypotension, treatment?

Answer 12

considered anaphylaxis with the combo of both

IM dose: 0.3 mg (inject 0.3 mL of 1 mg/mL)

IV dose: 0.1 mg (inject 1 mL of 1mg/10mL)

Question 13

IM dose epinephrine

Answer 13

IM dose: 0.3 mg (inject 0.3 mL of 1 mg/mL)

Question 14

IV dose epinephrine

Answer 14

IV dose: 0.1 mg (inject 1 mL of 1mg/10mL)

1:10,000

Question 15

atropine dosing in hypotension with bradycardia

Answer 15

0.6 to 1.0 mg IV into a running infusion of IV fluids

may repeat atropine up to a total dose of 3 mg

Question 16

patient is pulseless, how much epi?

Answer 16

1 mg IV

follow ACLS protocol on this one. pt is dead.

Question 17

Pediatric dosing for isotonic fluid in a contrast rxn

Answer 17

10-20 mL/kg of 0.9% normal saline or Lactated Ringers up to a maximum volume of 500-1,000 mL

Question 18

Pediatric dosing for benadryl, contrast rxn

Answer 18

1 mg/kg up to a maximum of 50 mg

Question 19

albuterol pediatric dosing

Answer 19

2 puffs (90 mcg/puff) for a total of 180 mcg = adult dose; can repeat up to three times

Question 20

PEDIATRIC epinephrine dosing, IM

Answer 20

(up to 30 kg): 0.15 mg

(over 30 kg): 0.01 mL/kg of 1:1000 dilution (maximum single dose of 0.3 mL [0.3 mg]); repeated every 5-15 minutes needed up to a maximum dose of 1 mg (1 mL)

Question 21

PEDIATRIC epinephrine dosing, IV

Answer 21

0.1 mL/kg (0.01 mg/kg) of 1:10,000 dilution (maximum single dose of 1 mL [0.1 mg]), repeated every 5 – 15 minutes, as needed up a maximum dose of 1 mg (1 mL)

Question 22

patient with wheezing after IV contrast. treatment and dosing

Answer 22

wheezing = bronchospasm

Two puffs of beta-2 agonist inhaler (albuterol); repeat x 3

Question 23

protocol for minimizing risk of PC-AKI

Answer 23

IV volume expansion with isotonic fluids, such as 0.9% saline or Lactated Ringer’s solution.

suggested protocol: give IV 100 mL/h for 6 to 12 hours before and continued for 4 to 12 hours after.

Question 24

rapid premedication protocol (for the ED)

Answer 24

IV 200 mg of hydrocortisone every 4 hours until the study is performed, preferably deferring imaging until at least two doses of hydrocortisone have been administered.

50 mg of diphenhydramine is also administered 1 hour before contrast media injection

Question 25

typical premedication protocol, PEDIATRICS

Answer 25

1. oral prednisone 0.5- 0.7 mg/kg; 13, 7, and 1 hours prior
2. oral diphenhydramine (Benadryl ®) 1.25 mg/kg; 1 hour prior

(BOTH up to a maximum dose of 50 mg.)

Question 26

typical premedication protocol, ADULT

Answer 26

1. Oral prednisone 50mg; 13, 7, and 1 hour(s) prior
2. Oral Benadryl 50 mg; 1 hour prior

or

Oral methylprednisolone 32 mg; 12 and 2 hrs prior

Question 27

Radionuclide purity Mo-99/Tc-99m generator in Ci

Answer 27

0. 15 uCi Mo-99/ 1 mCi Tc-99m
   (0. 15 kBq Mo99/ MBq Tc-99m)

Question 28

Radionuclide purity Mo-99/Tc-99m generator in Bq

Answer 28

0. 15 kBq Mo99/ MBq Tc-99m
   (0. 15 uCi Mo-99/ 1 mCi Tc-99m)

Question 29

chemical purity threshold Mo-99m/Tc-99m generator

Answer 29

<10 ug/mL of aluminum

Question 30

Papillary thryoid cancer <1.5cm and no invasion of the thyroid capsule

Answer 30

<30 uCi I-131

Question 31

When do you treat with I-131 <30 mCi

Answer 31

Low risk patient: tumor <1.5cm and no invasion of the thyroid capsule

Question 32

typical treatment and dose for treatment of multinodular goiter

Answer 32

25mCi

Question 33

typical # of MAA particles (normal patient)

Answer 33

200-600k

Question 34

Patient with known right to left shunt

V/Q scan MAA particle dose

Answer 34

100k particles

(normal range is 200k-600k)

Question 35

Patient with known mild pulmonary HTN

V/Q scan MAA particle dose

Answer 35

100k particles

(normal range is 200k-600k)

Question 36

pediatric V/Q scan MAA particle dose

Answer 36

100k particles

(normal range is 200k-600k)

Question 37

preggo patient V/Q scan MAA particle dose

Answer 37

100k particles

(normal range is 200k-600k)