EXAM #3 (10-6 → ) Flashcards
How many prescriptions in the 70’s vs. now
800 vs. >10,000
_____ of drugs is becoming a bigger responsibility for the technologist.
As your role increases your knowledge base needs to be broadened to include:
• Drug classification
• Drug action
• Drug interactions
• Drug reactions
• Principles and methods of administration
Preparation of drugs is becoming a bigger responsibility for the technologist.
As your role increases your knowledge base needs to be broadened to include:
• Drug classification
• Drug action
• Drug interactions
• Drug reactions
• Principles and methods of administration
What are drugs?
Substance used in medicine to aid in the diagnosis, treatment, or prevention of disease.
The science concerned with the origin,nature, effects and use of drugs is _____.
Drugs are = any chemical substance that produces a biologic response in a living system.
Substance used in medicine to aid in the diagnosis, treatment, or prevention of disease.
The science concerned with the origin,nature, effects and use of drugs is PHARMACOLOGY.
[Drug Nomenclature]
What is it?
Drugs are classified in many different ways:
• By name
• By action
• By method of legal purchase
It is classified system of names.
Drugs are classified in many different ways:
• By name
• By action
• By method of legal purchase
Chemical name:
• Identifies the actual _____ _____ _____
• Seldom of practical use to the technologist
Chemical name:
• Identifies the actual chemical structure complex
• Seldom of practical use to the technologist
Generic name:
• Name given when drug becomes commercially available
- Simpler name derived from more complex chemical name
- Easier to pronounce
- Never _____
Generic name:
• Name given when drug becomes commercially available
- Simpler name derived from more complex chemical name
- Easier to pronounce
- Never capitalized
Brand name:
• Name given to a drug manufactured by a specific company
- Usually short
- Easy to remember
- Always _____
Brand name:
• Name given to a drug manufactured by a specific company
- Usually short
- Easy to remember
- Always capitalized
What drug is cheaper? Generic or name brand?
Generic is cheaper
[Classification by Action]
Drugs that have similar chemical actions are grouped into categories called drug _____
According to _____ or _____
This is convenient but may not be totally reliable
One drug may have several different effects and is listed under more than one category
EXAMPLE:
_____ - drugs that relieve pain
_____ - drugs that fight inflammation
_____ - drugs used to treat high blood pressure
[Classification by Action]
Drugs that have similar chemical actions are grouped into categories called drug families
According to action or function
This is convenient but may not be totally reliable
One drug may have several different effects and is listed under more than one category
EXAMPLE:
Analgesics - drugs that relieve pain
Anti-inflammatories - drugs that fight inflammation
Antihypertensives - drugs used to treat high blood pressure
[Legal Classification ]
According to federal law drugs are classified as prescription or nonprescription
Prescription drugs need to be ordered by a legally authorized health practitioner.
The prescription is the document that specifies:
- _____
- _____
- _____
[Legal Classification ]
According to federal law drugs are classified as prescription or nonprescription
Prescription drugs need to be ordered by a legally authorized health practitioner.
The prescription is the document that specifies:
- Name of patient
- Name of drug
- Dosage regimen
Nonprescription drugs are better known as _____ _____ _____ drugs (OTC).
Can be obtained legally _____ a prescription.
Nonprescription drugs are better known as over- the - counter drugs (OTC).
Can be obtained legally without a prescription.
{*} No matter the legal classification, all medications administered to a patient must have an _____!
For example – even though Tylenol is an over the counter (OTC) medication, an _____ would be required!
No matter the legal classification, all medications administered to a patient must have an order!
For example – even though Tylenol is an over the counter (OTC) medication, an order would be required!
[Dose Form]
The type of preparation or the manner in which the chemical agent is transported into the human body
A drug may come in may different forms
The form may determine:
Speed of _____ of the therapeutic effect
Speed of the following from slowest to fastest? – patch – IV – injection – oral
[Dose Form]
The type of preparation or the manner in which the chemical agent is transported into the human body
A drug may come in may different forms
The form may determine:
Speed of onset of the therapeutic effect
SLOWEST TO FASTEST:
oral, patch, injection, IV
[Dose Forms]
Tablet -
Capsule -
Suppository -
Solution -
Suspension -
Transdermal patch -
[Dose Forms]
Tablet - compressed into a hard disc
Capsule - contained in a gelatin shell
Suppository - shaped for insertion into a body orifice - rectum, vagina, urethra
Solution - one or more drugs dissolved in a liquid carrier - administered orally or parenterally (any injection of the drug with a needle and syringe beneath the surface of the skin)
Suspension - one or more drugs in small particles are suspended in a liquid carrier - must be shaken thoroughly before administration
Transdermal patch - drug can be applied to the skin and is absorbed into the bloodstream
[Pharmacokinetics ]
What is it?
What are some factors that affect it?
When can contrast be added to a patient?
The study of how a drug is absorbed into the body, circulates within the body, is changed by the body, and leaves the body.
Many factors can affect these happenings:
Age, disease factors, sex, genetics, weight and route and time of administration.
Contrast can be added to a patient when their kidneys are in good working condition
[Drug effects on the body]
Undesirable effects: Side effects Toxic effects Allergic reactions Idiosyncratic reactions
Idiosyncratic = ?
[Drug effects on the body]
Undesirable effects: \_\_\_\_\_ effects \_\_\_\_\_ effects \_\_\_\_\_ reactions \_\_\_\_\_ reactions
Idiosyncratic = something we don’t want to happen that does anyway
[Drug effects on the body]
Side effects:
?
Toxic effects:
?
Allergic Reactions:
?
[Drug effects on the body]
Side effects:
Drug acting on tissues other than those intended - causes a response unrelated to the intended action
Toxic effects:
Adverse effects related to the dose of drug administered
Allergic Reactions:
Bodies immunological system is hypersensitive to the drug
[Drug effects on the body]
What are anaphylactic reactions
Delayed reactions usually _____ severe. May not become evident till _____ or _____ later.
[Drug effects on the body]
Immediate allergic reactions range from mild to severe (anaphylaxis) – carry epipens on person – can happen with contrast media (immediately)
Delayed reactions usually less severe. May not become evident till hours or days later.
[Conscious Sedation]
Used frequently in _____ to sedate for a lengthy, painful or difficult procedure
Most commonly used drugs are _____ (_____) and _____ (______)
_____ must be used with caution as can significantly _____ the respiratory system
Where does it happen most?
[Conscious Sedation]
Used frequently in radiology to sedate for a lengthy, painful or difficult procedure
Most commonly used drugs are Fentanyl (anesthetic) and Versed (antianxiety)
Fentanyl must be used with caution as can significantly depress the respiratory system
Happens most in IVR or SONO
[Levels of Sedation]
_____ - patient will respond normally to verbal commands
_____ (_____ _____) - depression of consciousness but patient will respond to verbal commands (_____ do this the most)
_____ - depression of consciousness in which the patient can not be easily aroused
_____ _____ - loss of consciousness
[Levels of Sedation]
Minimal - patient will respond normally to verbal commands
Moderate (conscious sedation) - depression of consciousness but patient will respond to verbal commands (Nurses do this the most)
Deep - depression of consciousness in which the patient can not be easily aroused
General anesthesia - loss of consciousness
{***} FIVE RIGHTS OF DRUG ADMINISTRATION
P D D T R
Right PATIENT
Right DRUG
Right DOSE
Right TIME
Right ROUTE
Most common routes of administration
- Oral (bust a nut in yo mouf)
- Sublingual (under tongue, immediately absorbed)
- Topical (cream + patches)
- Parenteral (IM, SC, IV)
Common Abbreviations
IM - IV - mg - ml - mm - po - prn - SC - Stat -
Only use abbreviations deemed acceptable by your facility
This list is usually available on the facilities Intranet
Common Abbreviations
IM - intramuscular IV - intravenous mg - Milligram ml - Milliliter mm - millimeter po - by mouth prn - as needed SC - Subcutaneous Stat - Immediately
Only use abbreviations deemed acceptable by your facility
This list is usually available on the facilities Intranet
[Medication Errors]
Errors associated with drug administration are among the most _____ legal problems in which radiologic technologists are involved.
If an error is made report to your _____ or _____
Follow the protocol of the facility for reporting drug _____ or drug _____ errors.
Example #1: X-ray a pt when they weren’t supposed to
Example #2: Oral/IV contrast media in error, needs to be reported to NY state
[Medication Errors]
Errors associated with drug administration are among the most common legal problems in which radiologic technologists are involved.
If an error is made report to your supervisor or physician
Follow the protocol of the facility for reporting drug charting or drug administration errors.
Example #1: X-ray a pt when they weren’t supposed to
Example #2: Oral/IV contrast media in error, needs to be reported to NY state
Can students inject contrast or do anything with contrast media for that matter?
NAH SON WE DON’T DO THAT
Normal level of BUN (blood urea nitrogen)
8-25 mg/dl
What is BUN (blood urea nitrogen)?
Indicator of _____ _____
Measure of _____ in _____ that comes the waste product _____
Values increase with _____ – infants have _____ values
What is BUN (blood urea nitrogen)?
Indicator of kidney function
Measure of nitrogen in blood that comes the waste product urea
Values increase with age – infants have lower values
Causes of high levels of BUN
Urinary tract obstruction
Kidney disease
Gastrointestinal bleed
Dehydration
Burns
Medication
High protein diets
Shock
Causes of low level BUN
Liver disorder
Over hydration
Malnutrition (not eating enough protein)
Normal value of Creatinine
0.6-1.5 mg/dl
What is Creatinine
Chemical waste product produced by muscle
Entirely filtered and eliminated from the blood by the kidneys
As men have higher muscle mass, levels are usually higher in men than women
Causes of high levels of Creatinine
Dehydration
Low blood volume
Medications
High protein diet
Kidney failure, infection
Causes of low levels in Creatinine
Conditions involving muscle
myasthenia gravis
Muscular dystrophy
Glomerular Filtration Rate (GFR)
Stage 1 = Kidney damage with normal or ↑GFR = GFR ?
Stage 2 = Kidney damage with mild ↓GFR = GFR ?
Stage 3 = Moderate ↓GFR = GFR ?
Stage 4 = Severe ↓GFR = GFR ?
Stage 5 = Kidney failure = GFR ?
Stage 1 = GFR >= 90
Stage 2 = GFR 60-89
Stage 3 = GFR 30-59
Stage 4 = GFR 15-29
Stage 5 = GFR < 15
Normal blood cell count for men
4.6-6.2 million/mm3
Normal blood cell count for women
4.2-5.9 million/mm3
Function of red blood cells?
carry oxygen
Function of white blood cells?
Also called leucocytes, cells of the immune system that are involved in protecting against infectious disease and foreign invaders
High causes of white blood cell count
infections
Low causes of white blood cell count
chemo, radiation, leukemia
Normal white blood cell count
4,300-10,800/mm3
Normal platelet count
150,000-350,000/mm3
[Platelets]
Cells produced by _____ _____ and released into blood stream
Function is to release _____ necessary to coagulate blood preventing excessive blood loss from an internal or external injury
_____ causes – cancer, infection, anemia, inflammatory diseases
_____ causes – bone marrow disease, radiation, chemo therapy
[Platelets]
Cells produced by _____ _____ and released into blood stream
Function is to release hormones necessary to coagulate blood preventing excessive blood loss from an internal or external injury
High causes – cancer, infection, anemia, inflammatory diseases
Low causes – bone marrow disease, radiation, chemo therapy
Normal Prothrombin - Protime time
Used to determine…?
10-12 seconds
Used to determine blood clotting tendency of blood in the measure of warfarin (Coumadin) dosing, liver damage and Vitamin K status
Normal thromboplastin time - PTT time
Used to determine…?
30-45 seconds
Determines the time it takes for blood to clot
Usually measured when blood thinner Heparin is used
Normal oxygen saturation O2 saturation
> 95%
What is O2 saturation used to measure?
Measure of concentration of oxygen in the blood
Causes of low O2 saturation?
IF YOU NOT BREATHING RIGHT
anemia
respiratory disease
respiratory depression (from narcotics and anesthetics)
congenital heart disease
sleep apnea
Normal levels of hemoglobin in men
12-18 g/100ml
Normal levels of hemoglobin in women
12-16 g/100ml
Function of hemoglobin?
carry oxygen
Causes of low hemoglobin count?
body produces too few, body destroys faster than produces and blood loss
Normal levels of Hematocrit in men?
45-52%
Normal levels of Hematocrit in women?
37-48%
What is Hematocrit?
Percentage of red blood cells in blood
The higher the GFR (Glomerular Filtration Rate ) the BETTER/WORSE the kidneys are performing
The higher the GFR (Glomerular Filtration Rate) the BETTER the kidneys are performing
What are the three factors needed to see images?
- Magnification of an image until it is visible
- Resolution of the detail of an image to visualize the separate structures that make up the image
- Contrast of an image to distinguish different shades of density
The body absorbs x-ray photons according to the various tissue’s _____ number and amount of _____ per volume of tissue
Tissue’s with higher atomic numbers absorb more x-ray photons than those with lower numbers
There is little contrast within the body except bones; they show up because calcium within has a high atomic number
Soft tissue _____ x-ray easily, resulting in decreased x-ray absorption
The body absorbs x-ray photons according to the various tissue’s atomic number and amount of matter per volume of tissue
Tissue’s with higher atomic numbers absorb more x-ray photons than those with lower numbers
There is little contrast within the body except bones; they show up because calcium within has a high atomic number
Soft tissue scatter x-ray easily, resulting in decreased x-ray absorption
The following are POSITIVE/NEGATIVE contrast media?
- Low-anatomic number elements
- Administered as gas (air) or gas producing tablets, crystals or soda water
- Usually used in combination with radiopaque media to outline lumens or spaces within body structures
The following are NEGATIVE contrast media
- Low-anatomic number elements
- Administered as gas (air) or gas producing tablets, crystals or soda water
- Usually used in combination with radiopaque media to outline lumens or spaces within body structures
The following are POSITIVE contrast media?
- Barium Sulfate – has an atomic number of 56; thus is radiopaque -used for examination of the gastrointestinal system
- Water-soluble Iodine Contrast Media – iodine has an atomic number of 53 making it relatively opaque
The following are POSITIVE/NEGATIVE contrast media?
- Barium Sulfate – has an atomic number of 56; thus is radiopaque -used for examination of the gastrointestinal system
- Water-soluble Iodine Contrast Media – iodine has an atomic number of 53 making it relatively opaque
Purpose of Gadolinium-Based Contrast ?
Gadolinium will accumulate in the _____ tissue
Abnormal areas will be very _____ on MRI
Cleared through the _____
Provides contrast between normal and abnormal tissue in the brain and body
Gadolinium will accumulate in the abnormal tissue
Abnormal areas will be very bright on MRI
Cleared through the kidneys
What is Osmolality ?
Ionic contrast media - HIGH/LOW Osmolality
Nonionic contrast media - HIGH/LOW Osmolality
Isosmolality contrast media - _____
Osmolality as blood (285-295)
Osmolality of a solution determines _____ _____
Osmolality is a measure of the total # of particles in solution per kilogram of water
Ionic contrast media - HIGH Osmolality
Nonionic contrast media - LOW Osmolality
Isosmolality contrast media - SAME
Osmolality as blood (285-295)
Osmolality of a solution determines OSMOTIC PRESSURE
Osmotic pressure controls the movement of _____ in the body
High osmolar contrast media caused increase in adverse effects due to the high movement of fluid into the vascular system
Osmotic pressure controls the movement of water in the body
High osmolar contrast media caused increase in adverse effects due to the high movement of fluid into the vascular system
What is LOCM?
INCREASED/DECREASED the movement of water
INCREASED/DECREASED the incidence of side effects
_ - _% incidence of side effects with LOCM
Low osmolality contrast media was developed - nonionic contrast
DECREASED the movement of water
DECREASED the incidence of side effects
1-3% incidence of side effects with LOCM
[Osmolality Comparisons ]
IONIC: • Conray 30 - 600 • Conray 43 – 1000 • Hexabrix – 600 • Conray – 1400
NON-IONIC:
• Omnipaque -___
• Visipaque – ___
(blood ___-___)
[Osmolality Comparisons]
IONIC: • Conray 30 - 600 • Conray 43 – 1000 • Hexabrix – 600 • Conray – 1400
NON-IONIC:
• Omnipaque -322
• Visipaque – 290
(blood 285-295)
What are adverse events?
“_____” response may be _____, ______, or _____, very rarely _____
Severe _____ _____ reactions are very rare
Although _____ we must always be aware of symptoms
What are adverse events?
“ALLERGIC” response may be RASH, HIVES, or URTICARIA, very rarely BRONCHOSPASM
Severe LIFE THREATENING reactions are very rare
Although RARE we must always be aware of symptoms
[Need for consent]
Per the _____ MANUAL ON CONTRAST MEDIA VERSION 10
“Because of the low incidence of adverse events, intravenous injection of contrast media may be exempted from the need for informed consent, but this decision should be based in state law and institutional policy, and departmental policy.”
[Need for consent]
Per the ACR MANUAL ON CONTRAST MEDIA VERSION 10
“Because of the low incidence of adverse events, intravenous injection of contrast media may be exempted from the need for informed consent, but this decision should be based in state law and institutional policy, and departmental policy.”
[Appropriate Considerations]
Assess patient _____ verses patient _____ if contrast media is injected
Are there imaging _____ that would provide the same or better diagnostic information
Is there a valid _____ reason for contrast media to be injected
[Appropriate Considerations]
Assess patient RISK verses patient BENEFIT if contrast media is injected
Are there imaging ALTERNATIVES that would provide the same or better diagnostic information
Is there a valid CLINICAL reason for contrast media to be injected
[General Aims ] to [Appropriate Considerations]
_____ a contrast reaction or adverse effect from happening
All personnel who will administer contrast agents are trained to _____ any adverse event, monitor it and to _____ appropriate response
Equipment is available to treat reactions
[General Aims] to [Appropriate Considerations]
PREVENT a contrast reaction or adverse effect from happening
All personnel who will administer contrast agents are trained to RECOGNIZE any adverse event, monitor it and to INITIATE appropriate response
Equipment is available to treat reactions
[General Aims] to [Appropriate Considerations]
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
[General Aims] to [Appropriate Considerations]
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
AWARE THAT SEVERE, LIFE THREATENING REACTIONS CAN OCCUR
Classification of adverse events:
- _____
- _____
- _____
Classification of adverse events:
- MILD
- MODERATE
- SEVERE
[Mild Adverse Reactions ]
Allergic like: • Itchy/scratchy throat • Hives (1-3 small diameter) • Nasal congestion • Sneezing
Physiological: • Limited nausea/vomiting • Flushing/warmth • Headache/dizziness • Anxiety • Vasovagal reaction that resolves spontaneously
[Mild Adverse Reactions]
Allergic like: • Itchy/scratchy throat • Hives (1-3 small diameter) • Nasal congestion • Sneezing
Physiological: • Limited nausea/vomiting • Flushing/warmth • Headache/dizziness • Anxiety • Vasovagal reaction that resolves spontaneously
[Moderate Reactions ]
Allergic like: • Diffuse hives • Facial edema without dyspnea • Throat tightness • Wheezing/bronchospasm • Mild or no hypoxia
Physiological: • Protracted nausea/vomiting • Hypertensive urgency • Isolated chest pain • Vasovagal reaction that requires and is responsive to treatment
[Moderate Reactions]
Allergic like: • Diffuse hives • Facial edema without dyspnea • Throat tightness • Wheezing/bronchospasm • Mild or no hypoxia
Physiological: • Protracted nausea/vomiting • Hypertensive urgency • Isolated chest pain • Vasovagal reaction that requires and is responsive to treatment
[Severe - can be life threatening! ]
Allergic like:
• Diffuse edema, or facial edema with dyspnea
• Diffuse erythema with hypotension
• Laryngeal edema with stridor and/or hypoxia
• Anaphylactic shock (hypotension+tachycardia)
Physiological: • Vasovagal reaction resistant to treatment • Arrhythmia • Seizures • Hypertensive emergency
[Severe - can be life threatening!]
Allergic like:
• Diffuse edema, or facial edema with dyspnea
• Diffuse erythema with hypotension
• Laryngeal edema with stridor and/or hypoxia
• Anaphylactic shock (hypotension+tachycardia)
Physiological: • Vasovagal reaction resistant to treatment • Arrhythmia • Seizures • Hypertensive emergency
[Mild reaction treatment]
_____ treatment often needed
Advise pt to increase _____ _____
Monitor _____ signs/preserve IV access during an observation period
_____ may be given for hives if widespread
[Mild reaction treatment]
NO treatment often needed
Advise pt to increase ORAL FLUIDS
Monitor VITAL signs/preserve IV access during an observation period
BENADRYL may be given for hives if widespread
[Diffuse Erythema ]
- _____ IV access
- Monitor _____/pulse _____
- O2 by _____
- IV fluids if _____
- _____ if unresponsive to fluids
[Diffuse Erythema]
- Maintain IV access
- Monitor vitals/pulse oximetry
- O2 by mask
- IV fluids if hypotensive
- Epinephrine if unresponsive to fluids
[Bronchospasm ]
- _____ IV access
- Monitor _____/pulse ____
- O2 by _____
- _____ – Albuterol
- If severe may consider _____ IV or IM
[Bronchospasm]
- Preserve IV access
- Monitor vitals/pulse oximetry
- O2 by mask
- Inhaler – Albuterol
- If severe may consider epinephrine IV or IM
[Laryngeal edema ]
- _____ IV access
- Monitor _____/pulse _____
- O2 by _____
- _____ IV or IM
[Laryngeal edema]
- Maintain IV access
- Monitor vitals/pulse oximetry
- O2 by mask
- Epinephrine IV or IM
[Hypotension ]
- _____ IV access
- Monitor _____/pulse _____
- O2 by _____
- Elevate _____
- Consider _____ _____
[Hypotension]
- Preserve IV access
- Monitor vitals/pulse oximetry
- O2 by mask
- Elevate legs
- Consider IV fluids
[Hypotension with bradycardia ]
- Same as _____
- If mild – _____ treatment
- Severe – IV _____
[Hypotension with bradycardia]
- Same as hypotension
- If mild – no treatment
- Severe – IV atropine
[Hypotension with tachycardia ]
- Same as _____
- _____ IM or IV
[Hypotension with tachycardia]
- Same as hypotension
- Epinephrine IM or IV
[Hypertensive crisis ]
All Forms: • \_\_\_\_\_ IV access • Monitor \_\_\_\_\_/pulse \_\_\_\_\_ • O2 by \_\_\_\_\_ • \_\_\_\_\_ IV
Unresponsive/pulseless:
• Call _____ or _____
[Hypertensive crisis]
All Forms: • Preserve IV access • Monitor vitals/pulse oximetry • O2 by mask • Labetalol IV
Unresponsive/pulseless:
• Call code or 911
[Pulmonary edema ]
- _____ IV access
- Monitor _____/pulse _____
- O2 by _____
- Elevate _____ of bed if possible
- Lasix – diuretic
- Morphine
- Call _____ or _____
[Pulmonary edema]
- Preserve IV access
- Monitor vitals/pulse oximetry
- O2 by mask
- Elevate head of bed if possible
- Lasix – diuretic (Gets fluid out of lungs)
- Morphine
- Call code or 911
[Seizures ]
- _____ and _____ pt
- Turn on _____ to avoid aspiration
- Suction _____ if needed
- _____ IV access
- Monitor _____/ pulse _____
- O2 by _____
- Anti-seizure _____ if unremitting
[Seizures]
- Observe and protect pt
- Turn on side to avoid aspiration
- Suction airway if needed
- Preserve IV access
- Monitor vitals/ pulse oximetry
- O2 by mask
- Anti-seizure med if unremitting
[Contrast Reaction Drug Box ]
Some departments may maintain a drug reaction box which contains the most commonly used medications
Know where this box is in your clinical work area.
[Contrast Reaction Drug Box]
Some departments may maintain a drug reaction box which contains the most commonly used medications
Know where this box is in your clinical work area.
[Premedication ]
If patient has a history of contrast allergy _____ may be ordered
Most common regime is _____ – 50my by mouth at 13 hours, 7 hours, and 1 hour before contrast media plus _____ – 50 mg 1 hour prior to contrast medium
_____ Manual on Contrast Media, Version 10, 2015
[Premedication]
If patient has a history of contrast allergy premedication may be ordered
Most common regime is Prednisone – 50my by mouth at 13 hours, 7 hours, and 1 hour before contrast media plus Benadryl – 50 mg 1 hour prior to contrast medium
ACR Manual on Contrast Media, Version 10, 2015
[Delayed Reaction to Contrast Media ]
Onset __ days to __ days following the injection.
Manifestations are skin _____, may be pustular and often with itching.
Usually self limited and require _____ symptomatic treatment.
May, however progress to severe symptoms and may need an _____ or _____ consult.
[Delayed Reaction to Contrast Media]
Onset 3 days to 7 days following the injection.
Manifestations are skin rashes, may be pustular and often with itching.
Usually self limited and require minimal symptomatic treatment.
May, however progress to severe symptoms and may need an allergy or dermatology consult.
[GI Contrast Media ]
Oral, rectal, and intravenous contrast agents are utilized in a variety of ways for imaging of the GI system
Oral contrast agents are used for fluoro studies such a upper GI series, and small bowel follow-through
Also used for CT studies to highlight the GI tract in studies of the abdomen and pelvis
[GI Contrast Media]
Oral, rectal, and intravenous contrast agents are utilized in a variety of ways for imaging of the GI system
Oral contrast agents are used for fluoro studies such a upper GI series, and small bowel follow-through
Also used for CT studies to highlight the GI tract in studies of the abdomen and pelvis
[GI Contrast Media ]
Rectal contrast media is given for conventional fluoro colon studies
Rectal contrast media may also be administered for CT studies to opacify the colonic lumen during imaging of the abdomen and pelvis
[GI Contrast Media]
Rectal contrast media is given for conventional fluoro colon studies
Rectal contrast media may also be administered for CT studies to opacify the colonic lumen during imaging of the abdomen and pelvis
[GI Contrast Media used in Conventional Fluoroscopic Exams]
Barium Sulfate:
• Preferred for opacification of the _____ tract for fluoro studies
• Also used for patients undergoing studies performed via _____ or _____ tubes terminating in the stomach or small intestine
[GI Contrast Media used in Conventional Fluoroscopic Exams]
Barium Sulfate:
• Preferred for opacification of the GI tract for fluoro studies
• Also used for patients undergoing studies performed via oral or nasoenteric tubes terminating in the stomach or small intestine
[GI Contrast Media used in Conventional Fluoroscopic Exams]
Water soluble:
• Limited to select situations predominantly where there is a suspected _____ _____ or to confirm percutaneous feeding tube position
• Two iodinated HOCM (_____ _____ _____ _____) are Gastrografin and Gastroview – used undiluted
[GI Contrast Media used in Conventional Fluoroscopic Exams]
Water soluble:
• Limited to select situations predominantly where there is a suspected bowel perforation or to confirm percutaneous feeding tube position
• Two iodinated HOCM (high osmolarity contrast media) are Gastrografin and Gastroview – used undiluted
[Contraindications]
Barium Sulfate:
• Any possibility of _____ _____
• Suspected Barium allergy
[Contraindications]
Barium Sulfate:
• Any possibility of bowel perforation
• Suspected Barium allergy
[Contraindications]
HOCM water soluble:
• Pts at risk for _____ as can cause severe _____ _____
- Very _____ or very _____ pts with fluid and electrolyte imbalances
- LOCM are preferable for the above pt populations
[Contraindications]
HOCM water soluble:
• Pts at risk for aspiration as can cause severe pulmonary edema
- Very young or very old pts with fluid and electrolyte imbalances
- LOCM are preferable for the above pt populations
[GI Contrast Media ]
- Iodinated contrast media supplied for _____ use may also be administered safely by _____ or _____.
- This is usually “_____ _____” use
- The taste of LOCM agents are often more palatable.
[GI Contrast Media]
- Iodinated contrast media supplied for intravenous use may also be administered safely by mouth or rectum.
- This is usually “off label” use
- The taste of LOCM agents are often more palatable.
[Complications of GI Contrast Media]
Barium sulfate:
• Almost always mild
- Nausea, vomiting and abdominal cramping during and/or after the exam – are not allergic reactions but physiological responses.
- Allergic responses can include _____, _____ and mild _____
- Anaphylactic reactions are rare
[Complications of GI Contrast Media]
Barium sulfate:
• Almost always mild
- Nausea, vomiting and abdominal cramping during and/or after the exam – are not allergic reactions but physiological responses.
- Allergic responses can include rashes, itching and mild bronchospasm
- Anaphylactic reactions are rare
[Complications of GI Contrast Media]
Water soluble:
• Only __-__% is absorbed and therefore adverse reactions are very rare
- Very rare reports of moderate or severe allergic like reactions
- However, there always is the possibility of an _____ event
- _____ and _____ are possible due to fluid loss from intestine
[Complications of GI Contrast Media]
Water soluble:
• Only 1-2% is absorbed and therefore adverse reactions are very rare
- Very rare reports of moderate or severe allergic like reactions
- However, there always is the possibility of an anaphylactic event
- Hypovolemia and hypotension are possible due to fluid loss from intestine
[GI Contrast Media for CT Scan Studies ]
Used for _____ studies
_____ and _____ are used but in a diluted state
Usually _____ and mixed with favoring
_____ are used very dilute and therefore aspiration and hypovolemia are not a concern
[GI Contrast Media for CT Scan Studies]
Used for abdominopelvic studies
Gastrografin and Gastroview are used but in a diluted state
Usually diluted and mixed with favoring
HOCM are used very dilute and therefore aspiration and hypovolemia are not a concern
[Patient Screening prior to a contrast enhanced study ]
The history obtained should focus on identification of factors that may indicate either a _____ to contrast media use or an _____ likelihood of a reaction
[Patient Screening prior to a contrast enhanced study]
The history obtained should focus on identification of factors that may indicate either a contraindication to contrast media use or an increased likelihood of a reaction
[Patient Questionnaire ]
Review prior to every _____ _____ study
Review responses with patient or with family member if patient is uncertain
- Notify _____ or _____ if any responses are of concern
[Patient Questionnaire]
Review prior to every contrast media study
Review responses with patient or with family member if patient is uncertain
Notify radiologist or nurse if any responses are of concern
[Risk Factors for Adverse Intravenous Contrast Media Reactions ]
- Allergy
- Asthma
- Renal Insufficiency
- Cardiac Status
- Anxiety
- Misc. Risk Factors – Age, multiple myeloma, sickle cell, pheochromocytoma, thyroid disease
[Risk Factors for Adverse Intravenous Contrast Media Reactions]
- Allergy
- Asthma
- Renal Insufficiency
- Cardiac Status
- Anxiety
- Misc. Risk Factors – Age, multiple myeloma, sickle cell, pheochromocytoma, thyroid disease
[Allergies ]
Previous Contrast Reaction – prior allergic like reaction is associated with an up to _____ fold increased likelihood of a subsequent reaction
History of multiple allergies - note _____ allergy is proven to be unreliable as a factor for concern
History of prior _____ reaction to 1 or more drugs
[Allergies]
Previous Contrast Reaction – prior allergic like reaction is associated with an up to five fold increased likelihood of a subsequent reaction
History of multiple allergies - note shellfish allergy is proven to be unreliable as a factor for concern
History of prior anaphylactic reaction to 1 or more drugs
[Asthma]
A history of asthma may indicate an _____ likelihood of a contrast reaction
[Asthma]
A history of asthma may indicate an increased likelihood of a contrast reaction
[Renal Disease ]
Know your departments _____ numbers (usual GFR cutoff is less than 30 ml/min)
Risk Factors – age > __
History of renal disease – dialysis, kidney transplant, single kidney, kidney _____, known kidney cancer
History of _____
Diabetes mellitus
Metformin use
[Renal Disease]
Know your departments guideline numbers (usual GFR cutoff is less than 30 ml/min)
Risk Factors – age > 60
History of renal disease – dialysis, kidney transplant, single kidney, kidney surgery, known kidney cancer
History of hypertension
Diabetes mellitus
Metformin use
[Cardiac Status ]
Patients with significant cardiac disease may be at INCREASED/DECREASED risk for reactions
With these patients attention should be paid to limiting the _____ and _____ of the contrast media
[Cardiac Status]
Patients with significant cardiac disease may be at increased risk for reactions
With these patients attention should be paid to limiting the volume and osmolality of the contrast media
[Special Considerations ]
Multiple Myeloma
Sickle Cell Disease
Pheochromocytoma (tumor of the _____ glands)
Breastfeeding mothers
Pregnancy
[Special Considerations]
Multiple Myeloma
Sickle Cell Disease
Pheochromocytoma (tumor of the adrenal glands)
Breastfeeding mothers
Pregnancy
[Metformin ]
What is Metformin ?
- A significant adverse effect of Metformin therapy is the development of _____ _____
- Any factors that decrease metformin excretion are important risk factors for _____ _____ – this includes renal insufficiency
[Metformin]
Is an oral anti-hyperglycemic agent used to treat patients with non-insulin dependent diabetes mellitus
A significant adverse effect of Metformin therapy is the development of lactic acidosis
Any factors that decrease metformin excretion are important risk factors for lactic acidosis – this includes renal insufficiency
[Management of patients taking Metformin ]
ARE OR ARE NOT at higher risk than other patients for post-contrast acute kidney injury
_____ is a potential concern for FURTHERING renal damage in patients with acute kidney injury of severe chronic kidney disease
There have been no reports of lactic acidosis following contrast administration in properly selected patients
[Management of patients taking Metformin]
ARE NOT at higher risk than other patients for post-contrast acute kidney injury
Contrast is a potential concern for FURTHERING renal damage in patients with acute kidney injury of severe chronic kidney disease
There have been no reports of lactic acidosis following contrast administration in properly selected patients
[Metformin Policy ]
The ACR guidelines - 2015 ACR Manual of Contrast Media Version 10:
Category I
Patients with normal kidney function and no known comorbidities - _____ need to discontinue Metformin prior to intravenously administering iodinated contrast media, nor is there a need to check _____ following the procedure before instructing the patient to resume Metformin after 48 hours.
[Metformin Policy]
The ACR guidelines - 2015 ACR Manual of Contrast Media Version 10:
Category I
Patients with normal kidney function and no known comorbidities - NO need to discontinue Metformin prior to intravenously administering iodinated contrast media, nor is there a need to check CREATININE following the procedure before instructing the patient to resume Metformin after 48 hours.
[Metformin Policy]
The ACR guidelines - 2015 ACR Manual of Contrast Media Version 10:
Category II
Patients known to have acute kidney injury or severe chronic kidney disease SHOULD/SHOULDN’T temporarily discontinue Metformin at the time of, or prior to the procedure and withhold for __ hours following the procedure. Metformin should only be _____ after renal function has been re-evaluated and found to be normal.
[Metformin Policy]
The ACR guidelines - 2015 ACR Manual of Contrast Media Version 10:
Category II
Patients known to have acute kidney injury or severe chronic kidney disease SHOULD temporarily discontinue metformin at the time of, or prior to the procedure and withhold for 48 hours following the procedure. Metformin should only be reinstituted after renal function has been re-evaluated and found to be normal.
[Post contrast Acute Kidney Injury and Contrast-Induced Nephropathy in Adults ]
Post contrast acute kidney injury (PC-AKI) is a general term used to describe a sudden _____ in renal function that occurs within 48hrs following intravenous administration of iodinated _____ medium
Contrast induced nephropathy (CIN) is a term used to describe a sudden deterioration in renal function that is caused by _____ administration of iodinated contrast medium
[Post contrast Acute Kidney Injury and Contrast-Induced Nephropathy in Adults]
Post contrast acute kidney injury (PC-AKI) is a general term used to describe a sudden deterioration in renal function that occurs within 48hrs following intravenous administration of iodinated contrast medium
Contrast induced nephropathy (CIN) is a term used to describe a sudden deterioration in renal function that is caused by intravascular administration of iodinated contrast medium
[Contrast Induced Nephropathy ]
Media position is CIN is a real, but rare, entity.
The exact pathophysiology of CIN is not understood.
- Most important risk factor appears to be _____ severe renal insufficiency
[Contrast Induced Nephropathy]
Media position is CIN is a real, but rare, entity.
The exact pathophysiology of CIN is not understood.
- Most important risk factor appears to be pre-existing severe renal insufficiency
[Contrast Induced Nephropathy ]
If a threshold for CIN risk is used at all, __ mL/min seems to be the one with the greatest level of evidence.
Multiple other risk factors have been proposed – diabetes mellitus, dehydration, cardiovascular disease, diuretic use, advanced age, multiple myeloma, hypertension and multiple contrast injections over a short period of time.
[Contrast Induced Nephropathy]
If a threshold for CIN risk is used at all, 30 mL/min seems to be the one with the greatest level of evidence.
Multiple other risk factors have been proposed – diabetes mellitus, dehydration, cardiovascular disease, diuretic use, advanced age, multiple myeloma, hypertension and multiple contrast injections over a short period of time.
[Injection of Contrast Media ]
*** THE 6 Rs OF DRUG ADMINISTRATION
The 6 R’s of Drug Administration
Right PATIENT - 2 patient identifiers
Right DRUG - check drug name before drawing up, after drawing up and before administering drug. Syringe must be labeled with drug name and dose
Right DOSE
Right ROUTE
Right TIME
Right DOCUMENTATION
